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Piccirillo M, Pucinischi V, Mennini M, Strisciuglio C, Iannicelli E, Giallorenzi MA, Furio S, Ferretti A, Parisi P, Di Nardo G. Gastrointestinal bleeding in children: diagnostic approach. Ital J Pediatr 2024; 50:13. [PMID: 38263189 PMCID: PMC10807079 DOI: 10.1186/s13052-024-01592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024] Open
Abstract
Different conditions may underlie gastrointestinal bleeding (GIB) in children. The estimated prevalence of GIB in children is 6.4%, with spontaneous resolution in approximately 80% of cases. Nonetheless, the initial approach plays a pivotal role in determining the prognosis. The priority is the stabilization of hemodynamic status, followed by a systematic diagnostic approach. GIB can originate from either upper or lower gastrointestinal tract, leading to a broad differential diagnosis in infants and children. This includes benign and self-limiting disorders, alongside serious conditions necessitating immediate treatment. We performed a nonsystematic review of the literature, in order to describe the variety of conditions responsible for GIB in pediatric patients and to outline diagnostic pathways according to patients' age, suspected site of bleeding and type of bleeding which can help pediatricians in clinical practice. Diagnostic modalities may include esophagogastroduodenoscopy and colonoscopy, abdominal ultrasonography or computed tomography and, when necessary, magnetic resonance imaging. In this review, we critically assess these procedures, emphasizing their respective advantages and limitations concerning specific clinical scenarios.
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Affiliation(s)
- Marisa Piccirillo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Valentina Pucinischi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Maurizio Mennini
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elsa Iannicelli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Radiology Unit, Rome, Italy
| | - Maria Agostina Giallorenzi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Radiology Unit, Rome, Italy
| | - Silvia Furio
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Alessandro Ferretti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy.
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Mazumder MW, Benzamin M. Upper gastrointestinal bleeding in Bangladeshi children: Analysis of 100 cases. World J Gastrointest Endosc 2024; 16:44-50. [PMID: 38313460 PMCID: PMC10835477 DOI: 10.4253/wjge.v16.i1.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is defined as bleeding that occurs proximal to the ligament of Treitz and can sometimes lead to potentially serious and life-threatening clinical situations in children. Globally, the cause of UGIB differs significantly depending on the geographic location, patient population and presence of comorbid conditions. AIM To observe endoscopic findings of UGIB in children at a tertiary care center of Bangladesh. METHODS This retrospective study was carried out in the department of Pediatric Gastroenterology and Nutrition of Bangabandhu Shiekh Mujib Medical University, a tertiary care hospital of Bangladesh, between January 2017 and January 2019. Data collected from hospital records of 100 children who were 16 years of age or younger, came with hematemesis, melena or both hematemesis and melena. All patients underwent upper gastrointestinal endoscopy (Olympus CV 1000 upper gastrointestinal video endoscope) after initial stabilization. Necessary investigations to diagnose portal hypertension and chronic liver disease with underlying causes for management purposes were also done. RESULTS A total of 100 patients were studied. UGIB was common in the age group 5-10 years (42%), followed by above 10 years (37%). Hematemesis was the most common presenting symptom (75%) followed by both hematemesis and melena (25%). UGIB from ruptured esophageal varices was the most common cause (65%) on UGI endoscopy followed by gastric erosion (5%) and prolapsed gastropathy (2%). We observed that 23% of children were normal after endoscopic examination. CONCLUSION Ruptured esophageal varices were the most common cause of UGIB in children in Bangladesh. Other causes included gastric erosions and prolapsed gastropathy syndrome.
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Affiliation(s)
- Md Wahiduzzaman Mazumder
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Md Benzamin
- Department of Pediatric Gastroenterology and Nutrition, Sylhet M A G Osmani Medical College Hospital, Sylhet 3100, Bangladesh
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Kocic M, Rasic P, Marusic V, Prokic D, Savic D, Milickovic M, Kitic I, Mijovic T, Sarajlija A. Age-specific causes of upper gastrointestinal bleeding in children. World J Gastroenterol 2023; 29:6095-6110. [PMID: 38186684 PMCID: PMC10768410 DOI: 10.3748/wjg.v29.i47.6095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/05/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
The etiology of upper gastrointestinal bleeding (UGIB) varies by age, from newborns to adolescents, with some of the causes overlapping between age groups. While particular causes such as vitamin K deficiency and cow's milk protein allergy are limited to specific age groups, occurring only in neonates and infants, others such as erosive esophagitis and gastritis may be identified at all ages. Furthermore, the incidence of UGIB is variable throughout the world and in different hospital settings. In North America and Europe, most UGIBs are non-variceal, associated with erosive esophagitis, gastritis, and gastric and duodenal ulcers. In recent years, the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries. However, variceal bleeding still predominates in certain parts of the world, especially in South Asia. The most severe hemorrhage arises from variceal bleeding, peptic ulceration, and disseminated intravascular coagulation. Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients. Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings, the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIB includes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability, followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis in the pediatric population because some of them are unique to children. Endoscopic techniques are of significant diagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally, surgical treatment is reserved for the most severe bleeding.
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Affiliation(s)
- Marija Kocic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Petar Rasic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Vuk Marusic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Dragan Prokic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Djordje Savic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Maja Milickovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Ivana Kitic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Tanja Mijovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Adrijan Sarajlija
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
- Pediatric Day Care Hospital Department, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Eastern Sarajevo, Foča 73300, Bosnia and Herzegovina
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Adeniyi OF, Lesi OA, Odeghe EA, Oyeleke G, Croft N. Gastrointestinal Bleeding in Children: The Role of Endoscopy and the Sheffield Scoring System in a Resource-Limited Setting. JPGN REPORTS 2023; 4:e369. [PMID: 38034436 PMCID: PMC10684120 DOI: 10.1097/pg9.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/15/2023] [Indexed: 12/02/2023]
Abstract
Objective To document the clinical presentation, endoscopic diagnosis, and Sheffield scores of children with gastrointestinal (GI) bleeding who were referred for endoscopy at the Lagos University Teaching Hospital. The participants who needed endoscopy based on clinical criteria and according to the Sheffield scores were also documented. Methods This study analyzed the records of 111 children with GI bleeding retrospectively from January 2013 to January 2021, while 9 children were recruited prospectively from February 2021 to March 2022. Receiver operating curves and area under the curve were generated to test the ability of the Sheffield scores to predict rebleeds, mortality, and the need for endoscopic intervention for upper GI bleeds. Results One hundred and twenty participants were recruited. Ninety-one (75.8%) presented with upper GI bleeding (UGIB), while 29 (24.2%) had lower GI bleeding (LGIB). Only 70 (58.3%) (53 UGIB and 17 LGIB) had endoscopy performed. For UGIB, 5 (9.4%) had no source of the bleeding identified at endoscopy, 12 (22.6%) had variceal bleeding, and 36 (67.9%) had nonvariceal bleeding. Colonoscopy revealed juvenile polyps in 5 (29.4%), indeterminate colitis in 5 (29.4%), ulcerative colitis in 4 (23.5%), Crohn's disease in 1 (5.9%), and hemorrhoids in 2 (11.8%) participants, respectively. The Sheffield score was ≥8 in 42 (46.1%) of the participants who presented only with UGIB (hematemesis and melena). The scores were significantly related to the type of bleeds, rebleeds, and deaths (P = 0.00). Conclusion The clinical and endoscopic findings in this study are similar to those reported previously. The Sheffield scoring was useful in assessing Nigerian children. However, due to limited access and other restraints, endoscopy was not performed on all the study participants even when the scoring system was suggestive. The availability, and therefore, utility of GI endoscopy in this setting are still suboptimal. The need for the provision of adequate equipment and resources and the training of personnel is thus recommended.
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Affiliation(s)
- Oluwafunmilayo Funke Adeniyi
- From the Department of Paediatrics, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufunmilayo Adenike Lesi
- Department of Medicine, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Emuobor Aghoghor Odeghe
- Department of Medicine, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ganiyat Oyeleke
- Department of Medicine, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nicholas Croft
- Barts and the London School of Medicine and Dentistry/Queen Mary University of London, United Kingdom
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Sun W, Wang M, Zhao J, Zhao S, Zhu W, Wu X, Li F, Liu W, Wang Z, Gao M, Zhang Y, Xu J, Zhang M, Wang Q, Wen Z, Shen J, Zhang W, Huang Z. Sulindac selectively induces autophagic apoptosis of GABAergic neurons and alters motor behaviour in zebrafish. Nat Commun 2023; 14:5351. [PMID: 37660128 PMCID: PMC10475106 DOI: 10.1038/s41467-023-41114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 08/22/2023] [Indexed: 09/04/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs compose one of the most widely used classes of medications, but the risks for early development remain controversial, especially in the nervous system. Here, we utilized zebrafish larvae to assess the potentially toxic effects of nonsteroidal anti-inflammatory drugs and found that sulindac can selectively induce apoptosis of GABAergic neurons in the brains of zebrafish larvae brains. Zebrafish larvae exhibit hyperactive behaviour after sulindac exposure. We also found that akt1 is selectively expressed in GABAergic neurons and that SC97 (an Akt1 activator) and exogenous akt1 mRNA can reverse the apoptosis caused by sulindac. Further studies showed that sulindac binds to retinoid X receptor alpha (RXRα) and induces autophagy in GABAergic neurons, leading to activation of the mitochondrial apoptotic pathway. Finally, we verified that sulindac can lead to hyperactivity and selectively induce GABAergic neuron apoptosis in mice. These findings suggest that excessive use of sulindac may lead to early neurodevelopmental toxicity and increase the risk of hyperactivity, which could be associated with damage to GABAergic neurons.
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Affiliation(s)
- Wenwei Sun
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Meimei Wang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Jun Zhao
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Shuang Zhao
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Wenchao Zhu
- National Engineering Research Center for Tissue Restoration and Reconstruction, Key Laboratory of Biomedical Engineering of Guangdong Province, Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, Innovation Center for Tissue Restoration Reconstruction, South China University of Technology, Guangzhou, 510006, China
| | - Xiaoting Wu
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Feifei Li
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Wei Liu
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Zhuo Wang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Meng Gao
- National Engineering Research Center for Tissue Restoration and Reconstruction, Key Laboratory of Biomedical Engineering of Guangdong Province, Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, Innovation Center for Tissue Restoration Reconstruction, South China University of Technology, Guangzhou, 510006, China
| | - Yiyue Zhang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Jin Xu
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Meijia Zhang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Qiang Wang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Zilong Wen
- Division of Life Science, State Key Laboratory of Molecular Neuroscience and Center of Systems Biology and Human Health, the Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, People's Republic of China
- Greater Bay Biomedical Innocenter, Shenzhen Bay Laboratory, Shenzhen Peking University-Hong Kong University of Science and Technology Medical Center, Shenzhen, 518055, China
| | - Juan Shen
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, 510006, China.
| | - Wenqing Zhang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China.
- Greater Bay Biomedical Innocenter, Shenzhen Bay Laboratory, Shenzhen, 518055, China.
| | - Zhibin Huang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China.
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Sur LM, Armat I, Sur G, Tisa IB, Bordea MA, Lupan I, Samasca G, Lazar C. Practical Aspects of Upper Gastrointestinal Bleeding in Children. J Clin Med 2023; 12:jcm12082921. [PMID: 37109257 PMCID: PMC10145382 DOI: 10.3390/jcm12082921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/01/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Upper gastrointestinal bleeding (UGB) in children is a potentially life-threatening condition that represents a challenge for pediatricians and pediatric surgeons. It is defined as bleeding from any location within the upper esophagus to the ligament of Treitz. UGB can have many causes that vary with age. The impact on the child is often proportional to the amount of blood lost. This can range from mild bleeding that is unlikely to cause hemodynamic instability, to massive bleeding that requires admission to the intensive care unit. Proper and prompt management are very important factors in reducing morbidity and mortality. This article aims to summarize current research regarding the diagnosis and treatment of UGB. Most of the data used in the literature published on this subject is extrapolated from adulthood.
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Affiliation(s)
- Lucia Maria Sur
- Department of Pediatrics I, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ionel Armat
- Department of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Genel Sur
- Department of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana Badiu Tisa
- Department of Pediatrics III, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Madalina Adriana Bordea
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Iulia Lupan
- Department of Molecular Biology, Babes Bolyai University, 400084 Cluj-Napoca, Romania
| | - Gabriel Samasca
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Calin Lazar
- Department of Pediatrics I, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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Ramprasad C, Palma JA, Norcliffe-Kaufmann L, Levy J, Chen LA, Kaufmann H. Gastrointestinal bleeding in children with familial dysautonomia: a case-control study. Clin Auton Res 2023; 33:87-92. [PMID: 36735101 DOI: 10.1007/s10286-023-00925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Familial dysautonomia (FD) is a rare inherited autosomal recessive disorder with abnormal somatosensory, enteric, and afferent autonomic neurons. We aimed to define the incidence of gastrointestinal bleeding and its associated risk factors in patients with FD. METHODS In this retrospective case-control study, we identified all episodes of gastrointestinal bleeding in patients with FD, occurring over four decades (January 1980-December 2017), using the New York University FD registry. RESULTS We identified 104 episodes of gastrointestinal bleeding occurring in 60 patients with FD. The estimated incidence rate of gastrointestinal bleeds in the FD population rate was 4.20 episodes per 1000 person-years. We compared the 60 cases with 94 age-matched controls. Bleeding in the upper gastrointestinal tract from gastric and duodenal ulcers occurred most frequently (64 bleeds, 75.6%). Patients were more likely to have a gastrostomy (G)-tube and a Nissen fundoplication [odds ratio (OR) 3.73, 95% confidence interval (CI) 1.303-13.565] than controls. The mean time from G-tube placement to first gastrointestinal bleed was 7.01 years. The mean time from Nissen fundoplication to bleed was 7.01 years. Cases and controls had similar frequency of intake of nonsteroidal antiinflammatory drugs (NSAID) and selective serotonin reuptake inhibitors (SSRI). CONCLUSION The incidence of gastrointestinal bleeding in the pediatric FD population was estimated to be 4.20 per 1000 person-years, 21 times higher than in the general pediatric population (0.2 per 1000 person-years). Patients with FD with a G-tube and a Nissen fundoplication had a higher risk of a subsequent gastrointestinal bleeding.
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Affiliation(s)
- Chethan Ramprasad
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University Grossman School of Medicine, 530 First Av, Suite 9Q, New York City, NY, 10016, USA
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University Grossman School of Medicine, 530 First Av, Suite 9Q, New York City, NY, 10016, USA
| | - Joseph Levy
- Division of Pediatric Gastroenterology, New York University Grossman School of Medicine, New York City, NY, USA
| | - Lea Ann Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA
- Division of Gastroenterology and Hepatology, Rutgers University, Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University Grossman School of Medicine, 530 First Av, Suite 9Q, New York City, NY, 10016, USA.
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Quitadamo P, Anselmi F, Mantegazza C, Tambucci R, Campanozzi A, Malamisura M, Raucci U, Tipo V, Dolce P, Saccomani MD, Chiaro A, Mancini V, Felici E, Orizio P, Parma B, Salvatore S, Borrelli O. Hematemesis in Infants: The First Evidence-Based Score to Predict the Need for Timely Endoscopy. Pediatr Emerg Care 2022; 38:e1245-e1250. [PMID: 35482500 DOI: 10.1097/pec.0000000000002579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Infantile acute upper gastrointestinal bleeding involves a decision for therapeutic intervention that most pediatricians first coming into contact with the patient are, not unreasonably, unable to objectively provide. Therefore, some objective tools of individual risk assessment would seem to be crucial. The principal aim of the present study was to investigate the anamnestic and clinical parameters of infants with hematemesis, together with laboratory and instrumental findings, to create a scoring system that may help identify those infants requiring an appropriate and timely application of upper gastrointestinal (GI) endoscopy. METHODS Clinical data of infants admitted for hematemesis to the participating centers over the study period were systematically collected. According to the outcome dealing with rebleeding, need for blood transfusion, mortality, finding of GI bleeding lesions, or need for surgical intervention, patients were blindly divided into a group with major clinical severity and a group with minor clinical severity. Univariate and multivariate logistic regressions were conducted to investigate significant prognostic factors for clinical severity. RESULTS According to our findings, we drafted a practical diagnostic algorithm and a clinical score able to predict the need for timely upper GI endoscopy (BLOVO infant score). Our clinical scoring system was created by incorporating anamnestic factors, clinical parameters, and laboratory findings that emerged as predictors of a worst outcome. CONCLUSIONS We provided the first objective tool of individual risk assessment for infants with hematemesis, which could be very useful for pediatricians first coming into contact with the patient in the emergency department.
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Affiliation(s)
- Paolo Quitadamo
- From the Department of Pediatrics, Santobono-Pausilipon Children's Hospital
| | - Federica Anselmi
- Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Naples
| | - Cecilia Mantegazza
- Department of Pediatrics, University of Milan, Buzzi Children's Hospital, Milan
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Angelo Campanozzi
- Department of Medical and Surgical Sciences, University Hospital of Foggia, Foggia
| | - Monica Malamisura
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Vincenzo Tipo
- Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, Naples
| | | | - Andrea Chiaro
- Paediatric Gastroenterology and Digestive Endoscopy Unit, Giannina Gaslini Institute, Genoa
| | - Valentina Mancini
- Department of Pediatrics and Neonatology, San Carlo Borromeo Hospital, Milan
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia
| | - Barbara Parma
- Paediatric Department, ASST-Lariana, Sant'Anna General Hospital, Como
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte," University of Insubria, Varese, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
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Long-term kidney and liver outcome in 50 children with autosomal recessive polycystic kidney disease. Pediatr Nephrol 2021; 36:1165-1173. [PMID: 33165639 DOI: 10.1007/s00467-020-04808-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/10/2020] [Accepted: 10/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Autosomal recessive polycystic kidney disease (ARPKD) is a rare ciliopathy characterized by congenital hepatic fibrosis and cystic kidney disease. Lack of data about long-term follow-up makes it difficult to discuss timing and type of organ transplantation. Our objectives were to evaluate long-term evolution and indications for transplantation, from birth to adulthood. METHODS Neonatal survivors and patients diagnosed in postnatal period with ARPKD between 1985 January and 2017 December from 3 French pediatric centers were retrospectively enrolled in the study. RESULTS Fifty patients with mean follow-up 12.5 ± 1 years were enrolled. ARPKD was diagnosed before birth in 24%, and at mean age 1.8 years in others. Thirty-three patients were < 1 year of age at first symptoms, which were mostly kidney-related. These most often presented high blood pressure during follow-up. Portal hypertension was diagnosed in 29 patients (58%), 4 of them with bleeding from esophageal varices. Eight patients presented cholangitis (> 3 episodes in three children). Liver function was normal in all patients. Nine children received a kidney transplant without liver complications. A 20-year-old patient received a combined liver-kidney transplant (CLKT) for recurrent cholangitis, and a 15-year-old boy an isolated liver transplant for uncontrollable variceal bleeding despite portosystemic shunt. CONCLUSIONS Long-term outcome in patients with ARPKD is heterogeneous, and in this cohort did not depend on age at diagnosis except for blood pressure. Few patients required liver transplantation. Indications for liver or combined liver-kidney transplantation were limited to recurrent cholangitis or uncontrollable portal hypertension. Liver complications after kidney transplantation were not significant.
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10
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Martinelli M, Quaglietta L, Banderali G, Ferrara P, Romano C, Staiano A. Prescribing patterns, indications and adverse events of ibuprofen in children: results from a national survey among Italian pediatricians. Ital J Pediatr 2021; 47:98. [PMID: 33883005 PMCID: PMC8059227 DOI: 10.1186/s13052-021-01047-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Despite ibuprofen widely recognized safety profile, an increase of suspected adverse events has been reported in the last decade in parallel with its growing over-the-counter use. The aims of this study were to assess the therapeutic approach to the feverish child and to evaluate the main indications and the most frequent adverse events related to ibuprofen administration in children. Methods A specific questionnaire-form regarding the management of ibuprofen therapy in children was distributed among a sample of pediatricians all over the Italian territory between September and October 2020. An electronic data collection through a specifically designed web-based platform was performed among the participating pediatricians. Results One-hundred-eighty-one pediatricians completed the survey. In case of fever, 177 (98%) participants prescribe paracetamol, while only 4 (2%) preferred ibuprofen as first choice. One-hundred-twenty-eight pediatricians (71%) administer paracetamol alone, while 53 (29.2%) use the combined/alternating treatment with ibuprofen. Ibuprofen is mostly administered for musculoskeletal pain (30%), upper respiratory tract infection (20%), headache (15%) and post-surgical pain (9%). Sixty-three (35%) out of 181 participating pediatricians reported 191 adverse events during ibuprofen administration. The most common were gastrointestinal (GI), with GI bleeding being reported in 30/191 cases (15.7%), epigastric pain in 29/191 (15.1%), non-specified abdominal pain in 22/191 (11.1%) and nausea/vomiting in 21/191 (11%). Severe adverse events including kidney damage (3.1%), complicated infections (0.5%), pneumonia associated empyema (0.5%), soft tissue infection (0.5%) and disseminated intravascular coagulation (0.5%) were also reported. The adverse events led to a hospitalization in 12% of children. In 53/191 cases (28%) the adverse events were related to a wrong dosage or prolonged therapy or errors in frequency of administration. Conclusions This survey demonstrate a sufficient awareness of Italian pediatricians regarding ibuprofen-prescribing patterns with the only possible concern related to the relatively high percentage of pediatricians performing a combining/alternating use of paracetamol and ibuprofen. The reported adverse events were mild in most of the cases and often related to errors in dosage, frequency and treatment duration, emphasizing the need for a major caution of both practitioners and patients in their use. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-01047-y.
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Affiliation(s)
- Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | | | - Giuseppe Banderali
- Clinical Department of Pediatrics and Neonatology, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Pietro Ferrara
- Institute of Pediatrics, Catholic University Medical School, Rome, Italy.,Service of Pediatrics, Campus Bio-Medico University, Rome, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
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11
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Quaglietta L, Martinelli M, Staiano A. Serious infectious events and ibuprofen administration in pediatrics: a narrative review in the era of COVID-19 pandemic. Ital J Pediatr 2021; 47:20. [PMID: 33514404 PMCID: PMC7844800 DOI: 10.1186/s13052-021-00974-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose of review Despite its recognized efficacy and tolerability profile, during the last decade a rise of adverse events following ibuprofen administration in children has been reported, including a possible role in worsening the clinical course of infections. Our aim was to critically evaluate the safety of ibuprofen during the course of pediatric infectious disease in order to promote its appropriate use in children. Recent findings Ibuprofen is associated with severe necrotizing soft tissue infections (NSTI) during chickenpox course. Pre-hospital use of ibuprofen seems to increase the risk of complicated pneumonia in children. Conflicting data have been published in septic children, while ibuprofen in the setting of Cystic Fibrosis (CF) exacerbations is safe and efficacious. No data is yet available for ibuprofen use during COVID-19 course. Summary Ibuprofen should not be recommended for chickenpox management. Due to possible higher risks of complicated pneumonia, we suggest caution on its use in children with respiratory symptoms. While it remains unclear whether ibuprofen may have harmful effects during systemic bacterial infection, its administration is recommended in CF course. Despite the lack of data, it is seems cautious to prefer the use of paracetamol during COVID-19 acute respiratory distress syndrome in children.
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Affiliation(s)
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
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12
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Ravindra VM, Bollo RJ, Dewan MC, Riva-Cambrin JK, Tonetti D, Awad AW, Akbari SH, Gannon S, Shannon C, Birkas Y, Limbrick D, Jea A, Naftel RP, Kestle JR, Grandhi R. Comparison of anticoagulation and antiplatelet therapy for treatment of blunt cerebrovascular injury in children <10 years of age: a multicenter retrospective cohort study. Childs Nerv Syst 2021; 37:47-54. [PMID: 32468243 DOI: 10.1007/s00381-020-04672-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Blunt cerebrovascular injury (BCVI) is uncommon in the pediatric population. Among the management options is medical management consisting of antithrombotic therapy with either antiplatelets or anticoagulation. There is no consensus on whether administration of antiplatelets or anticoagulation is more appropriate for BCVI in children < 10 years of age. Our goal was to compare radiographic and clinical outcomes based on medical treatment modality for BCVI in children < 10 years. METHODS Clinical and radiographic data were collected retrospectively for children screened for BCVI with computed tomography angiography at 5 academic pediatric trauma centers. RESULTS Among 651 patients evaluated with computed tomography angiography to screen for BCVI, 17 patients aged less than 10 years were diagnosed with BCVI (7 grade I, 5 grade II, 1 grade III, 4 grade IV) and received anticoagulation or antiplatelet therapy for 18 total injuries: 11 intracranial carotid artery, 4 extracranial carotid artery, and 3 extracranial vertebral artery injuries. Eleven patients were treated with antiplatelets (10 aspirin, 1 clopidogrel) and 6 with anticoagulation (4 unfractionated heparin, 2 low-molecular-weight heparin, 1 transitioned from the former to the latter). There were no complications secondary to treatment. One patient who received anticoagulation died as a result of the traumatic injuries. In aggregate, children treated with antiplatelet therapy demonstrated healing on 52% of follow-up imaging studies versus 25% in the anticoagulation cohort. CONCLUSION There were no observed differences in the rate of hemorrhagic complications between anticoagulation and antiplatelet therapy for BCVI in children < 10 years, with a nonsignificantly better rate of healing on follow-up imaging in children who underwent antiplatelet therapy; however, the study cohort was small despite including patients from 5 hospitals.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Robert J Bollo
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Michael C Dewan
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jay K Riva-Cambrin
- Department of Clinical Neurosciences, Division of Pediatric Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Tonetti
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Al-Wala Awad
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - S Hassan Akbari
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA.,Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Stephen Gannon
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Chevis Shannon
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Yekaterina Birkas
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - David Limbrick
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA.,Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Andrew Jea
- Department of Neurosurgery, Indiana University, Bloomington, IN, USA.,Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, IN, USA
| | - Robert P Naftel
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John R Kestle
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA. .,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA.
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13
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Yabe K, Kouchi K, Takenouchi A, Matsuoka A, Kudou W, Nakata C. Current status and future challenges in the endoscopic management of non-variceal upper gastrointestinal bleeding in children. Pediatr Surg Int 2020; 36:1451-1458. [PMID: 33034717 DOI: 10.1007/s00383-020-04755-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to elucidate the characteristics of non-variceal upper gastrointestinal bleeding (NVUGIB) in children and the outcomes of endoscopic hemostasis (EH) performed by pediatric surgeons. METHODS We retrospectively reviewed the medical records of pediatric patients with NVUGIB who had undergone esophagogastroduodenoscopy (EGD) at our hospital, between December 2006 and March 2020. RESULTS Thirty-six patients were included. The most common endoscopic diagnosis was gastritis (28%), followed by gastric ulcer (25%) and duodenal ulcer (25%). Thirty patients (83%) had underlying diseases, including a recent viral infection (39%), followed by Helicobacter pylori infection (14%). Fourteen patients (39%) underwent EH, exhibiting a high initial rate of hemostasis (100%). This was achieved in 12/14 patients by clipping. One patient was treated using a combination of a hypersaline and epinephrine (HSE) injection and coagulation therapy, as the ulcer exceeded the width of the hemoclips. Rebleeding occurred in one patient (7.1%) initially treated with pure ethanol injections. The partial view of the pediatric duodenum prevented the placement of hemoclips; hence, the patient was treated using a combination of HSE and coagulation therapy. CONCLUSION Clipping, injection, and/or coagulation therapy can lead to high success rates for hemostasis, considering the anatomical characteristics in a pediatric population.
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Affiliation(s)
- Kiyoaki Yabe
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan.
| | - Katsunori Kouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
| | - Aki Matsuoka
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
| | - Wataru Kudou
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
| | - Chikako Nakata
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
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14
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von Philipsborn P, Biallas R, Burns J, Drees S, Geffert K, Movsisyan A, Pfadenhauer LM, Sell K, Strahwald B, Stratil JM, Rehfuess E. Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review. BMJ Open 2020; 10:e040990. [PMID: 33444207 PMCID: PMC7678345 DOI: 10.1136/bmjopen-2020-040990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. DESIGN Rapid systematic review. PARTICIPANTS Humans with viral respiratory infections, exposed to systemic NSAIDs. PRIMARY OUTCOMES Acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. RESULTS We screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution. CONCLUSIONS It is unclear whether the use of NSAIDs increases the risk of severe adverse outcomes in patients with viral respiratory infections. This absence of evidence should not be interpreted as evidence for the absence of such risk. This is a rapid review with a number of limitations. PROSPERO REGISTRATION NUMBER CRD42020176056.
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Affiliation(s)
- Peter von Philipsborn
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke Biallas
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Simon Drees
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karin Geffert
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lisa Maria Pfadenhauer
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kerstin Sell
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
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15
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Faisantieu N, Kowalski V, Soulié B. [Benefits and risks of ibuprofen in children with fever: Overview of the literature with a view to producing a written information tool for parents]. Therapie 2020; 75:553-567. [PMID: 32571587 DOI: 10.1016/j.therap.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/02/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
Drug information, as it appears in package leaflet, lacks relevant encrypted data for the patient. The aim of our research was to propose a written model of drug information inspired from the concept of the "Drug Facts Box", about ibuprofen in children with fever. To this end, we carried out a systematic review of systematic literature reviews ("overview") to look for data on the benefits and risks of ibuprofen compared to placebo, paracetamol or a treatment alternating or combining paracetamol and ibuprofen in children with fever aged 0-18 years. 9 systematic reviews were included from the Pubmed/Medline, Embase and Cochrane databases. 1 clinical practice guideline and 2 documents published by the French Haute Autorité de santé (HAS) and the French Agence nationale de sécurité du médicament et des produits de santé (ANSM) were also included. Paracetamol and ibuprofen have a comparable efficacy and safety profile in children with fever. A low increased risk of adverse reactions to ibuprofen is to be feared in specifics clinical situations (chicken pox, pneumonia, angina). Treatments alternating or combining paracetamol and ibuprofen can further lower the temperature compared to paracetamol or ibuprofen alone, but there is no evidence of improved child comfort. The limited data available on the adverse effects of these treatment regimens suggests that they should not be routinely recommended. There is little evidence of the comfort of the febrile child even though it is the primary objective of antipyretic treatment.
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Affiliation(s)
| | | | - Benoît Soulié
- Cabinet de médecine générale, 8, rue des Cerisiers, 14210 Evrecy, France.
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16
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Tobaiqy M, MacLure K, Radwi M, Almalki AM, Alhasan AH, Tannoury M, Attieh Z. Parental Experience of Potential Adverse Drug Reactions Related to Their Oral Administration of Antipyretic Analgesic Medicines in Children in Saudi Arabia. CURRENT THERAPEUTIC RESEARCH 2020; 92:100592. [PMID: 32714474 PMCID: PMC7378853 DOI: 10.1016/j.curtheres.2020.100592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/13/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Oral antipyretic analgesic medicines are commonly used in children and have the potential for adverse drug reactions (ADRs). OBJECTIVE The aim of this study was to explore parental experiences of potential ADRs related to their oral administration of antipyretic analgesics in children in the Kingdom of Saudi Arabia. METHODS For this cross-sectional survey, a paper-based questionnaire, consent form and information sheet were handed out to 1000 parents who had administered an oral antipyretic analgesic medicine to their children during the previous 3 months. Data were entered and analyzed using SPSS version 21.0 (IBM-SPSS Inc, Armonk, NY). Simple descriptive and inferential statistics were used. Management and ethical approvals were attained. RESULTS During March to April 2017, 661 parents agreed to participate, giving a response rate of 66.1%. Of the surveyed sample, 208 parents had observed 1 or more potential ADRs (31.5%, n = 208 out of 661). Parents' (n = 208) most commonly reported potential ADRs (n = 523) were loss of appetite (23%, n = 120 out of 523), stomachache (20.3%, n = 106 out of 523), abdominal colic (13%, n = 68 out of 523), and diarrhea (10.3%, n = 54 out of 523). Parents described severity of the ADRs as slight (71.8%, n = 342 out of 476), annoying to the child (7.9%, n = 85 to of 476), significant and affecting daily tasks (3.6%, n = 17 out of 476) and significant and led to the hospital (6.7%, n = 32 out of 476). Fever was the top-ranked reason for using antipyretic analgesic medicines (41.0%, n = 271 out of 661), followed by toothache (25.0%, n = 165 out of 661) and tonsillitis/laryngitis (24.7%, n = 163 out of 661). Among parents, 34.7% (n = 165 out of 476) did not seek medical attention when a potential ADR occurred, whereas 26.3% (n = 125 out of 476) of parents took their children to hospital clinics. CONCLUSIONS Although the majority of parentally reported (but not proven) ADRs were mild, a number of significant ADRs were reported. Future research should consider whether there is a role for physicians and pharmacists in educating parents in Saudi Arabia, and perhaps more widely, about the optimal use of oral antipyretic and analgesic medicines in children. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX)© 2020 Elsevier HS Journals, Inc.
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Affiliation(s)
- Mansour Tobaiqy
- Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah, P.O. Box 45311 Jeddah 21512, Makkah, Saudi Arabia
| | - Katie MacLure
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, United Kingdom
| | - Mansoor Radwi
- Department of Hematology, College of Medicine, University of Jeddah, Jeddah, Makkah, Saudi Arabia
| | - Ashwaq M. Almalki
- Department of Ophthalmology, King Abdulaziz Medical City, Jeddah, Makkah, Saudi Arabia
| | - Ahmed H. Alhasan
- Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah, P.O. Box 45311 Jeddah 21512, Makkah, Saudi Arabia
| | - Maya Tannoury
- Faculty of Health Sciences, American University of Science and Technology, Beirut, Lebanon
| | - Zouhair Attieh
- Faculty of Health Sciences, American University of Science and Technology, Beirut, Lebanon
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Marseglia GL, Alessio M, Da Dalt L, Giuliano M, Ravelli A, Marchisio P. Acute pain management in children: a survey of Italian pediatricians. Ital J Pediatr 2019; 45:156. [PMID: 31796092 PMCID: PMC6892238 DOI: 10.1186/s13052-019-0754-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current guidelines recommend assessing and relieving pain in all children and in all instances; yet, in clinical practice, management is frequently suboptimal. We investigated the attitude of Italian family pediatricians towards the evaluation and treatment of different types of acute pain in children aged 7-12 years. METHODS This is a cross-sectional study based on a 17-question survey accessible online from October 2017 to October 2018. Responders had to describe cases of children suffering from any type of acute pain among headache, sore throat, musculoskeletal/post-traumatic pain, and earache. Children's characteristics, pain assessment modalities and therapeutic approaches were queried. The following tests were used: Z-proportion to evaluate the distribution of categorical data; chi-squared and Kruskall-Wallis to explore data heterogeneity across groups; Mann-Whitney for head-to-head comparisons. RESULTS Overall, 929 pediatricians presented 6335 cases uniformly distributed across the types examined. Pain was more frequently of moderate intensity (42.2%, P < 0.001) and short duration (within some days: 98.4%, P < 0.001). Only 50.1% of responders used an algometric scale to measure pain and 60.5% always prescribed a treatment. In children with mild-moderate pain (N = 4438), the most commonly used first-line non-opioids were ibuprofen (53.3%) and acetaminophen (44.4%). Importantly, a non-recommended dosage was prescribed in only 5.3% of acetaminophen-treated cases (overdosing). Among the misconceptions emerged, there were the following: i) ibuprofen and acetaminophen have different efficacy and safety profiles (when choosing the non-opioid, effectiveness weighted more for ibuprofen [79.7% vs 74.3%, P < 0.001] and tolerability for acetaminophen [74.0% vs 55.4%, P < 0.001]); ii) ibuprofen must be taken after meals to prevent gastric toxicities (52.5%); ibuprofen and acetaminophen can be used combined/alternated for persisting mild-moderate pain (16.1%). In case of moderate-severe pain not completely controlled by opioids, ibuprofen and acetaminophen were the most used add-on medications, with ibuprofen being much more prescribed than acetaminophen (65.2% vs 23.7%, respectively) overall and in all pain types. CONCLUSIONS Several gaps exist between the current practice of pain assessment and treatment and recommendations. Further efforts are needed to raise awareness and improve education on the possible exposure of the child to short- and long-term consequences in case of suboptimal pain management.
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Affiliation(s)
- Gian Luigi Marseglia
- Pediatrics Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Maria Alessio
- Pediatrics Clinic, Pediatrics Department, Federico II University, Via Sergio Pansini 5, Naples, Italy
| | - Liviana Da Dalt
- Department of Woman and Child Health, University of Padua, Via Giustiniani 2, Padua, Italy
| | | | - Angelo Ravelli
- Università degli Studi di Genova and IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, Genoa, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, University of Milan, via Francesco Sforza, 28, Milan, Italy.
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Zheng W, Jiang L, Jia X, Long G, Shu X, Jiang M. Analysis of risk factors and development of scoring system to predict severity of upper gastrointestinal bleeding in children. J Gastroenterol Hepatol 2019; 34:1035-1041. [PMID: 30462839 DOI: 10.1111/jgh.14548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/29/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Upper gastrointestinal bleeding is a rare and potentially life-threatening condition in children. Herein, clinical features and risk factors in children with upper gastrointestinal bleeding were analyzed, and a clinical scoring system was constructed to assess severity. METHODS This retrospective cohort study involved 224 children hospitalized with upper gastrointestinal bleeding between January 2012 and April 2018. Demographic data, clinical information, and laboratory test results on admission were statistically examined. RESULTS Out of 224 upper gastrointestinal bleeding cases, 76 were diagnosed as severe and 148 as mild cases according to the rate of blood loss and severity. Severe group was significantly different from mild group in 23 items including age, number of patients aged more than 7 years, and so forth (P < 0.01 or P < 0.05). Positive detection rate of bleeding etiology was gradually decreased (P < 0.01) in relation to delay in timing of endoscopy. Analysis of logistic regression evinced five independent risk factors for severe cases to be associated with poor consciousness, hemoglobin < 80 g/L, hemoglobin drop of > 20 g/L, hematochezia, and anemic appearance (P < 0.01 or P < 0.05). Using these five parameters, a number of scoring models were tested. The most predictive resulted in a scoring system constructed with a total of 16 and a cutoff for intervention of 8. CONCLUSIONS Amalgamation of risk factors with the scoring system plays an important role in assessing upper gastrointestinal bleeding severity in children.
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Affiliation(s)
- Wei Zheng
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Linmei Jiang
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinyi Jia
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Gao Long
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoli Shu
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mizu Jiang
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Boucher AA, Taylor JM, Luchtman-Jones L. Aspirin in childhood acute ischemic stroke: The evidence for treatment and efficacy testing. Pediatr Blood Cancer 2019; 66:e27665. [PMID: 30762284 DOI: 10.1002/pbc.27665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/17/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
Aspirin is the most commonly prescribed antiplatelet agent worldwide, but evidence supporting its use varies by age and disease process. Despite its frequent use in childhood acute ischemic stroke prevention and management, major knowledge gaps exist about optimal pediatric aspirin use, particularly in this setting, where high-quality clinical trials are urgently needed. This review focuses upon the evidence for aspirin use in childhood acute ischemic stroke, includes a summary of aspirin pharmacology to highlight misconceptions and common clinical situations which may limit its efficacy, and discusses the techniques and potential role of laboratory monitoring of aspirin efficacy in children.
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Affiliation(s)
- Alexander A Boucher
- Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - J Michael Taylor
- University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Neurology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Lori Luchtman-Jones
- Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
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Barbagallo M, Sacerdote P. Ibuprofen in the treatment of children's inflammatory pain: a clinical and pharmacological overview. Minerva Pediatr 2019; 71:82-99. [PMID: 30574736 DOI: 10.23736/s0026-4946.18.05453-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Unlike fever, which is often over-treated especially in children, pain is underestimated and under-treated in pediatric age. The pharmacological agents approved for treating pain in these patients are few, also considering the recent limitation for codeine in children younger than 12 years. Paracetamol and the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen are the most used at this purpose. The aim of this overview was to analyze the therapeutic appropriateness of ibuprofen in children based on its pharmacological properties. This work is a critical review of the pediatric literature over the last 20 years on efficacy and adverse events associated with the use of ibuprofen as analgesic in the pediatric population. Ibuprofen resulted effective in several pain conditions in children such as musculoskeletal pain, ear pain and acute otitis media, toothache and the inflammatory disease of the oral cavity and pharynx. The drug is a reasonable and efficacious alternative in postoperative pain, including tonsillectomy and adenoidectomy. It remains the treatment of choice for pain in chronic inflammatory diseases such as arthritis. Side effects and adverse events associated with ibuprofen are mild. It has the lowest gastrointestinal (GI) toxicity among NSAIDs, although some cases of GI toxicity may occur. Its renal effects are minimal, but dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with vomiting and diarrhea. Ibuprofen showed a good safety profile and provided evidence of effectiveness for mild-moderate pain of different origin in children. In case of fever or pain, the choice about the drug to be used should fall on ibuprofen in a clinical context where there is an inflammatory pathogenesis.
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Affiliation(s)
- Massimo Barbagallo
- Department of Pediatrics, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione "Garibaldi", Catania, Italy -
| | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
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Rodieux F, Piguet V, Desmeules J, Samer CF. Safety Issues of Pharmacological Acute Pain Treatment in Children. Clin Pharmacol Ther 2019; 105:1130-1138. [DOI: 10.1002/cpt.1358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/16/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Frédérique Rodieux
- Division of Clinical Pharmacology and Toxicology; Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine; Geneva University Hospitals; Geneva Switzerland
- Multidisciplinary Pain Center; Geneva University Hospitals; Geneva Switzerland
| | - Valérie Piguet
- Division of Clinical Pharmacology and Toxicology; Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine; Geneva University Hospitals; Geneva Switzerland
- Multidisciplinary Pain Center; Geneva University Hospitals; Geneva Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology; Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine; Geneva University Hospitals; Geneva Switzerland
- Multidisciplinary Pain Center; Geneva University Hospitals; Geneva Switzerland
- Faculty of Medicine; University of Geneva; Geneva Switzerland
- Faculty of Sciences; School of Pharmacy; University of Geneva and Lausanne; Lausanne Switzerland
| | - Caroline F. Samer
- Division of Clinical Pharmacology and Toxicology; Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine; Geneva University Hospitals; Geneva Switzerland
- Multidisciplinary Pain Center; Geneva University Hospitals; Geneva Switzerland
- Faculty of Medicine; University of Geneva; Geneva Switzerland
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Abstract
BACKGROUND There is a lack of clarity about the approach to and management of upper gastrointestinal (UGI) bleeding in children. AIM To examine the recent literature on UGI bleeding in children in order to outline the diagnostic approach and management. METHODS The English language literature was searched for articles on UGI bleeding in children. Special attention was paid to its prevalence, risk factors, clinical approach and management. RESULTS Although UGI bleeding is a common complication (10%) in paediatric intensive care units (PICU), clinically significant UGI bleeding (haemodynamic instability, fall in haemoglobin by 2 g/dL and/or a requirement for blood transfusion) is less common (1.6%). In low- and middle-income countries, clinically significant UGI bleeding is commonly owing to variceal bleeding whereas non-variceal aetiologies (e.g. peptic ulcer disease) are common in high-income countries. The fundamental clinical principles of managing UGI bleeding are immediate assessment of severity, detecting possible causes and stabilising the haemodynamic status. In suspected cases of variceal bleeding, intravenous octreotide and, in non-variceal bleeding, administration of a proton pump inhibitor (PPI) should be commenced immediately. UGI endoscopy plays a vital role in diagnosis and management. Over-transfusion should be avoided (target haemoglobin 7-9 g/dL). Stress ulcer prophylaxis is recommended in a select group of patients in PICUs (e.g. respiratory failure, coagulopathy and paediatric risk of mortality score ≥10). CONCLUSIONS In clinically significant UGI bleeding, the primary goal is to restore the haemodynamic status, followed by early endoscopy. Intravenous octreotide in suspected variceal and PPI in non-variceal bleeding should be administered early. Stress ulcer prophylaxis should be restricted to high-risk children only.
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Affiliation(s)
- Ujjal Poddar
- a Department of Pediatric Gastroenterology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
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Abstract
Ibuprofen is the most widely used non-steroidal anti-inflammatory drug (NSAID) for the treatment of inflammation, mild-to-moderate pain and fever in children, and is the only NSAID approved for use in children aged ≥3 months. Its efficacy and safety profile have led to its increasing use in paediatric care, even without medical prescription. However, an increase of suspected adverse reactions to ibuprofen has been noted in concomitance with the raised, often medically unsupervised, consumption of the drug. The purpose of this work was a critical review of the paediatric literature over the last 15 years on side effects and adverse events associated with ibuprofen, in order to highlight circumstances associated with higher risks and to promote safe and appropriate use of this drug. The literature from 2000 to date demonstrates that gastrointestinal events are rare, but (when they occur) include both upper and lower digestive tract lesions. Dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with diarrhoea and vomiting, with or without fever. Likewise, ibuprofen should never be administered to patients who are sensitive to it or to other NSAIDs. It is contraindicated in neonates and in children with wheezing and persistent asthma and/or during varicella. Most of the analysed studies reported adverse events when ibuprofen was being used for fever symptoms or flu-like syndrome. Ibuprofen should not be used as an antipyretic, except in rare cases. Ibuprofen remains the drug of first choice in the treatment of inflammatory pain in children.
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Bouquet É, Star K, Jonville-Béra AP, Durrieu G. Pharmacovigilance in pediatrics. Therapie 2018; 73:171-180. [DOI: 10.1016/j.therap.2017.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022]
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Gultekingil A, Teksam O, Gulsen HH, Ates BB, Saltık-Temizel İN, Demir H. Risk factors associated with clinically significant gastrointestinal bleeding in pediatric ED. Am J Emerg Med 2018; 36:665-668. [PMID: 29305021 DOI: 10.1016/j.ajem.2017.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Gastrointestinal bleeding is a common problem in pediatric emergency department (PED). Some of these patients can lose significant amount of blood which may lead to shock. The aim of this study is to determine the risk factors predicting clinically significant gastrointestinal (GIS) bleeding in patients presenting to PED. METHODS This study was performed prospectively from January 1st 2013 to December 31th 2013 in patients with upper or lower GIS bleeding. Clinically significant GIS bleeding was defined as >2g/dL hemoglobin decrease at any time during observation in PED, need for erythrocyte transfusion or need for rapid endoscopic evaluation. RESULTS 105 patients were enrolled, 81 of which were eligible for the study. Twenty two patients (26,8%) had clinically significant GIS bleeding. These patients have significantly more commonly have upper GI bleeding and symptoms of melena, pallor and tachycardia. Initial laboratory findings revealed lower hemoglobin, RBC and albumin levels with higher WBC and BUN levels. They need significantly more nasogastric tube placement and PPI and H2 blocker treatment. Final diagnosis included more gastritis and peptic ulcers. These patients have less hematochezia, less lower gastrointestinal bleeding and less commonly diagnosed as acute gastroenteritis or Mallory Weiss tear as a final diagnosis. CONCLUSIONS Pediatric emergency physicians should be aware of clinical and laboratory parameters of patients with clinically significant GIS bleeding to predict which patients are under risk of life threatening blood loss. Patients who have melena, pallor, tachycardia, anemia and uremia at presentation are more prone to have significant GIS bleeding.
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Affiliation(s)
- Ayse Gultekingil
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Ankara, Turkey.
| | - Ozlem Teksam
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Ankara, Turkey
| | - Hayriye Hızarcıoğlu Gulsen
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, Ankara, Turkey
| | - Burcu Berberoğlu Ates
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, Ankara, Turkey
| | - Hülya Demir
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, Ankara, Turkey
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Nasher O, Devadason D, Stewart RJ. Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children's Hospital Experience. CHILDREN-BASEL 2017; 4:children4110095. [PMID: 29099778 PMCID: PMC5704129 DOI: 10.3390/children4110095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/30/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Abstract
The aim of this study was to review the aetiology, presentation and management of these patients with upper gastrointestinal bleeding (UGIB) at a tertiary children’s unit in the United Kingdom. This was a retrospective single-institution study on children (<16 years) who presented with acute UGIB over a period of 5 years using known International Classification of Diseases (ICD) codes. A total of 32 children (17 males, 15 females) were identified with a total median age at presentation of 5.5 years. The majority (24/32) of patients presented as an emergency. A total of 19/32 presented with isolated haematemesis, 8/32 with isolated melaena and 5/32 with a combination of melaena and haematemesis. On admission, the mean haemoglobin of patients who presented with isolated haematemesis was 11 g/dL, those with isolated melaena 9.3 g/dL and those with a combination 7.8 g/dL. Blood transfusion was required in 3/19 with haematemesis and 3/5 with haematemesis and melaena. A total of 19/32 underwent upper gastrointestinal endoscopy. Endoscopic findings were oesophageal varices (5/19) of which 4 required banding; bleeding gastric ulcer (1/19) requiring clips, haemospray and adrenaline; gastric vascular malformation (1/19) treated with Argon plasma coagulation therapy; duodenal ulcer (3/19) which required surgery in two cases; oesophagitis (5/19); and gastritis +/− duodenitis (3/19). A total of 13/32 patients did not undergo endoscopy and the presumed aetiology was a Mallory–Weiss tear (4/13); ingestion of foreign body (2/13); gastritis (3/13); viral illness (1/13); unknown (2/13). While UGIB is uncommon in children, the morbidity associated with it is very significant. Melaena, dropping haemoglobin, and requirement for a blood transfusion appear to be significant markers of an underlying cause of UGIB that requires therapeutic intervention. A multi-disciplinary team comprising gastroenterologists and surgeons is essential.
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Affiliation(s)
- Omar Nasher
- Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK.
| | - David Devadason
- Department of Paediatric Gastroenterology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK.
| | - Richard J Stewart
- Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK.
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Minakari M, Badihian S, Jalalpour P, Sebghatollahi V. Etiology and outcome in patients with upper gastrointestinal bleeding: Study on 4747 patients in the central region of Iran. J Gastroenterol Hepatol 2017; 32:789-796. [PMID: 27749981 DOI: 10.1111/jgh.13617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Upper gastrointestinal bleeding (UGIB) is a threatening condition leading to urgent hospitalization. This study aims to investigate etiology and outcome in UGIB patients in Iran. METHODS Medical records of GIB patients admitted to Alzahra referral hospital (in Isfahan) during 2010-2015 were retrospectively reviewed for demographic data, comorbidities, history of smoking and taking non-steroidal anti-inflammatory drugs (NSAIDs), presenting symptoms, endoscopic findings, therapeutic endoscopy, blood products' infusion, surgical intervention, rebleeding, and mortality. RESULTS A total of 4747 patients were enrolled in the study (69.2% men, mean age = 55.46 ± 21.98 years). Hematemesis was the most frequent presenting symptom (63.5%). Peptic ulcer (duodenal ulcer in most cases) was seen as the main reason for UGIB (42.4%). Rebleeding (present in 16.5% of patients) was found to be more frequent in patients with older age, presenting sign of hematochezia and hypotension, history of taking NSAIDs and smoking, presence of comorbidities, history of bleeding because of UGI tract neoplasm and esophageal varices, history of needing blood products' infusion, and history of therapeutic endoscopy or surgical intervention (P < 0.005). We found that mortality (5.5% in total) was also higher in the same group of patients that were seen to have a higher tendency for rebleeding (P < 0.005). CONCLUSION Peptic ulcers are the most common cause of UGIB. Comorbidities, hemodynamic instability, high-risk endoscopic stigmata, history of smoking and taking NSAIDs, gastric and esophageal malignancies, may be important predisposing factors for rebleeding and mortality in patients with UGIB.
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Affiliation(s)
- Mohammad Minakari
- Department of Gastroenterology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shervin Badihian
- Students' Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pooyan Jalalpour
- Students' Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Sebghatollahi
- Department of Gastroenterology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kanabar DJ. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology 2017; 25:1-9. [PMID: 28063133 PMCID: PMC5306275 DOI: 10.1007/s10787-016-0302-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/29/2016] [Indexed: 11/25/2022]
Abstract
The antipyretic analgesics, paracetamol, and non-steroidal anti-inflammatory agents NSAIDs are one of the most widely used classes of medications in children. The aim of this review is to determine if there are any clinically relevant differences in safety between ibuprofen and paracetamol that may recommend one agent over the other in the management of fever and discomfort in children older than 3 months of age.
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Belsha D, Bremner R, Thomson M. Indications for gastrointestinal endoscopy in childhood. Arch Dis Child 2016; 101:1153-1160. [PMID: 27246069 DOI: 10.1136/archdischild-2014-306043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 12/11/2022]
Abstract
Endoscopic examination of the gastrointestinal tract (GIT) for diagnostics and therapy in children has evolved markedly over the last 20 or so years and is now usually undertaken by paediatric endoscopists. Updated diagnostic and management guidelines for common disorders including coeliac disease, gastro-oesophageal reflux disease, eosinophilic oesophagitis and inflammatory bowel disease highlight the central role of endoscopy. Therapeutic endoscopic approaches are also now widely available and further broaden the referral spectrum to include treatment of GIT bleeding, gastrostomy insertion, dilation of strictures and polypectomy. Lastly, the advent of newer technologies allows the examination of hitherto inaccessible areas of the GIT such as the mid-small bowel by wireless capsule video-endoscopy and enteroscopy. We summarise recent current practice and clinical guidelines, focussing on the key indications for referrals that are likely to require endoscopic assessment.
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Affiliation(s)
- D Belsha
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - R Bremner
- Centre for Paediatric Gastroenterology, Birmingham Children's Hospital, Birmingham, UK
| | - M Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
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Gastrointestinal endoscopic practice in infants: Indications and outcome. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Bertille N, Pons G, Fournier-Charrière E, Khoshnood B, Chalumeau M. National cross-sectional study of nonsteroidal anti-inflammatory drugs use highlights differences between parents and professionals and prompts safety concerns. Acta Paediatr 2016; 105:e543-e548. [PMID: 27582177 DOI: 10.1111/apa.13566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 06/01/2016] [Accepted: 08/30/2016] [Indexed: 01/23/2023]
Abstract
AIM Controversy surrounding the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) provides an opportunity to study parents' and healthcare professionals' differential use of over-the-counter drugs. METHODS In this national cross-sectional study, general practitioners, paediatricians and pharmacists were asked to include up to five consecutive febrile paediatric patients aged 1 month to 12 years. Parents and healthcare professionals completed questionnaires about the current fever episode. We studied the differential use of NSAIDs by parents and healthcare professionals notably in three clinical conditions with various estimated risk of NSAIDs complications: varicella, gastroenteritis and pharyngitis. RESULTS The 1534 healthcare professionals prescribed 15% of the 6596 children with an NSAID, but 32% of the parents gave their child an NSAID. Generally, NSAID use was associated with older children, higher temperatures, pain due to otitis and the absence of a rash or gastroenteritis. The differential use of NSAIDs by parents and professionals was greater in conditions with high than low estimated risks of NSAID complications, with odds ratios ranging from to 9.0 to 2.9, respectively. CONCLUSION The differential use of NSAIDs by healthcare professionals and parents for clinical conditions with potential risks should prompt discussions about the safety of their over-the-counter status.
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Affiliation(s)
- Nathalie Bertille
- Inserm U1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS); Paris Descartes University; Paris France
- Sorbonne Universités; UPMC Univ Paris 06, IFD; Paris France
- Department of General Paediatrics; Hôpital Necker-Enfants malades; Assistance Publique-Hôpitaux de Paris (AP-HP); Paris France
| | - Gérard Pons
- Clinical Pharmacology; Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP; Paris Descartes University; Paris France
- Inserm U663 Paediatric Epilepsies and Brain Plasticity; Paris France
| | | | - Babak Khoshnood
- Inserm U1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS); Paris Descartes University; Paris France
| | - Martin Chalumeau
- Inserm U1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS); Paris Descartes University; Paris France
- Department of General Paediatrics; Hôpital Necker-Enfants malades; Assistance Publique-Hôpitaux de Paris (AP-HP); Paris France
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Yu Y, Wang B, Yuan L, Yang H, Wang X, Xiao Y, Mei H, Xu C. Upper Gastrointestinal Bleeding in Chinese Children: A Multicenter 10-Year Retrospective Study. Clin Pediatr (Phila) 2016; 55:838-43. [PMID: 26467562 DOI: 10.1177/0009922815611642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective This study aims to analyze the clinical and endoscopic presentations of upper gastrointestinal bleeding (UGIB) in the Chinese children. Methods A 10-year retrospective study was made on children with UGIB and undertaken esophagogastroduodenoscopy (EGD) from 4 tertiary referral centers in China. Results Of the 1218 children studied, the bleeding source was found in 76.4%. Erosive gastritis was the most common endoscopic finding (33.5%), followed by duodenal ulcer (23.2%). The proportion of erosive gastritis decreased with age (correlation coefficient = -0.787), and duodenal ulcer increased with age (correlation coefficient = 0.958). The bleeding source was more likely to be determined in children having EGDs within 48 hours (80.6% vs 67.9%). Conclusions In Chinese children with UGIB, erosive gastritis and duodenal ulcer were the leading causes, and their proportions varied with age. EGDs performed within 48 hours may improve the possibility of finding the source of bleeding.
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Affiliation(s)
- Yi Yu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baoxiang Wang
- Wuhan Women and Children Health Care Center, Shanghai, China
| | - Lan Yuan
- Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Hui Yang
- Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Xinqiong Wang
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Xiao
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Mei
- Wuhan Women and Children Health Care Center, Shanghai, China
| | - Chundi Xu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most widely used classes of medications in children. Despite a reported positive safety profile, NSAIDs have been associated with toxicities in both overdose and routine use. Most children with NSAID overdoses are asymptomatic and should be managed conservatively, whereas a small number may present with severe symptoms. We review NSAID exposures in children and strategies for their clinical evaluation and management.
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Cardile S, Martinelli M, Barabino A, Gandullia P, Oliva S, Di Nardo G, Dall'Oglio L, Rea F, de' Angelis GL, Bizzarri B, Guariso G, Masci E, Staiano A, Miele E, Romano C. Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal bleeding in children. World J Gastroenterol 2016; 22:1877-1883. [PMID: 26855547 PMCID: PMC4724619 DOI: 10.3748/wjg.v22.i5.1877] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/13/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate gastrointestinal complications associated with non-steroidal anti-inflammatory drug (NSAIDs) use in children.
METHODS: A retrospective, multicenter study was conducted between January 2005 and January 2013, with the participation of 8 Italian pediatric gastroenterology centers. We collected all the cases of patients who refer to emergency room for suspected gastrointestinal bleeding following NSAIDs consumption, and underwent endoscopic evaluation. Previous medical history, associated risk factors, symptoms and signs at presentation, diagnostic procedures, severity of bleeding and management of gastrointestinal bleeding were collected. In addition, data regarding type of drug used, indication, dose, duration of treatment and prescriber (physician or self-medication) were examined.
RESULTS: Fifty-one patients, including 34 males, were enrolled (median age: 7.8 years). Ibuprofen was the most used NSAID [35/51 patients (68.6%)]. Pain was the most frequent indication for NSAIDs use [29/51 patients (56.9%)]. Seven patients had positive family history of Helicobacter pylori (H. pylori) infection or peptic ulcer, and 12 had associated comorbidities. Twenty-four (47%) out of 51 patients used medication inappropriately. Hematemesis was the most frequent symptom (33.3%). Upper gastrointestinal endoscopy revealed gastric lesions in 32/51 (62%) patients, duodenal lesions in 17 (33%) and esophageal lesions in 8 (15%). In 10/51 (19.6%) patients, a diagnosis of H. pylori gastritis was made. Forty-eight (94%) patients underwent medical therapy, with spontaneous bleeding resolution, while in 3/51 (6%) patients, an endoscopic hemostasis was needed.
CONCLUSION: The data collected in this study confirms that adverse events with the involvement of the gastrointestinal tract secondary to NSAID use are also common in children
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Bertille N, Pons G, Khoshnood B, Fournier-Charrière E, Chalumeau M. Symptomatic Management of Fever in Children: A National Survey of Healthcare Professionals' Practices in France. PLoS One 2015; 10:e0143230. [PMID: 26599740 PMCID: PMC4658127 DOI: 10.1371/journal.pone.0143230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 11/02/2015] [Indexed: 12/02/2022] Open
Abstract
Despite the production and dissemination of recommendations related to managing fever in children, this symptom saturates the practices of primary healthcare professionals (HPs). Data on parent practices related to fever are available, but data on HPs’ practices are limited. We studied HPs’ practices, determinants of practices and concordance with recommendations in France. We conducted a national cross-sectional observational study between 2007 and 2008 among French general practitioners, primary care pediatricians and pharmacists. HPs were asked to include 5 consecutive patients aged 1 month to 12 years with acute fever. HPs completed a questionnaire about their practices for the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables associated with this behavior. In all, 1,534 HPs (participation rate 13%) included 6,596 children (mean age 3.7 ± 2.7 years). Physicians measured the temperature of 40% of children. Primary HPs recommended drug treatment for 84% of children (including monotherapy for 92%) and physical treatment for 62% (including all recommended physical treatments for 7%). HPs gave written advice or a pamphlet for 13% of children. Significant practice variations were associated with characteristics of the child (age, fever level and diagnosis) and HP (profession and experience). In France, despite the production and dissemination of national recommendations for managing fever in children, primary HPs’ observed practices differed greatly from current recommendations, which suggests potential targets for continuing medical education.
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Affiliation(s)
- Nathalie Bertille
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, Paris, France
- Department of General Pediatrics, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- * E-mail:
| | - Gerard Pons
- Clinical Pharmacology, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP Paris-Descartes University, Paris, France
- Inserm U663 Pediatric epilepsies and brain plasticity, Paris, France
| | - Babak Khoshnood
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | | | - Martin Chalumeau
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
- Department of General Pediatrics, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
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Withdrawn: Risk factors associated with clinically significant gastrointestinal bleeding in pediatric emergency department. Am J Emerg Med 2015. [DOI: 10.1016/j.ajem.2015.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Fever is a common symptom of childhood infections that in itself does not require treatment. The UK’s National Institute for Health and Care Excellence (NICE) advises home-based antipyretic treatment for low-risk feverish children only if the child appears distressed. The recommended antipyretics are ibuprofen or paracetamol (acetaminophen). They are equally recommended for the distressed, feverish child; therefore, healthcare professionals, parents and caregivers need to decide which of these agents to administer if the child is distressed. This narrative literature review examines recent data on ibuprofen and paracetamol in feverish children to determine any clinically relevant differences between these agents. The data suggest that these agents have similar safety profiles in this setting and in the absence of underlying health issues, ibuprofen seems to be more effective than paracetamol at reducing NICE’s treatment criterion, ‘distress’ (as assessed by discomfort levels, symptom relief, and general behavior).
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Affiliation(s)
- Dipak Kanabar
- Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK,
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Ryan PB, Schuemie MJ, Welebob E, Duke J, Valentine S, Hartzema AG. Defining a reference set to support methodological research in drug safety. Drug Saf 2014; 36 Suppl 1:S33-47. [PMID: 24166222 DOI: 10.1007/s40264-013-0097-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Methodological research to evaluate the performance of methods requires a benchmark to serve as a referent comparison. In drug safety, the performance of analyses of spontaneous adverse event reporting databases and observational healthcare data, such as administrative claims and electronic health records, has been limited by the lack of such standards. OBJECTIVES To establish a reference set of test cases that contain both positive and negative controls, which can serve the basis for methodological research in evaluating methods performance in identifying drug safety issues. RESEARCH DESIGN Systematic literature review and natural language processing of structured product labeling was performed to identify evidence to support the classification of drugs as either positive controls or negative controls for four outcomes: acute liver injury, acute kidney injury, acute myocardial infarction, and upper gastrointestinal bleeding. RESULTS Three-hundred and ninety-nine test cases comprised of 165 positive controls and 234 negative controls were identified across the four outcomes. The majority of positive controls for acute kidney injury and upper gastrointestinal bleeding were supported by randomized clinical trial evidence, while the majority of positive controls for acute liver injury and acute myocardial infarction were only supported based on published case reports. Literature estimates for the positive controls shows substantial variability that limits the ability to establish a reference set with known effect sizes. CONCLUSIONS A reference set of test cases can be established to facilitate methodological research in drug safety. Creating a sufficient sample of drug-outcome pairs with binary classification of having no effect (negative controls) or having an increased effect (positive controls) is possible and can enable estimation of predictive accuracy through discrimination. Since the magnitude of the positive effects cannot be reliably obtained and the quality of evidence may vary across outcomes, assumptions are required to use the test cases in real data for purposes of measuring bias, mean squared error, or coverage probability.
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Affiliation(s)
- Patrick B Ryan
- Janssen Research and Development LLC, 1125 Trenton-Harbourton Road, Room K30205, PO Box 200, Titusville, NJ, 08560, USA,
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Suppressing childhood fever with antipyretics: inducing a false sense of security. J Pediatr 2013; 163:1796. [PMID: 24112866 DOI: 10.1016/j.jpeds.2013.08.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 08/29/2013] [Indexed: 11/22/2022]
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Consiglio GP, Burden AM, Maclure M, McCarthy L, Cadarette SM. Case-crossover study design in pharmacoepidemiology: systematic review and recommendations. Pharmacoepidemiol Drug Saf 2013; 22:1146-53. [DOI: 10.1002/pds.3508] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/20/2013] [Accepted: 07/29/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Giulia P. Consiglio
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
| | - Andrea M. Burden
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics; University of British Columbia; Vancouver British Columbia Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
- Women's College Research Institute; Toronto Ontario Canada
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Rafeey M, Shoaran M, Majidy H. Diagnostic endoscopy and clinical characteristics of gastrointestinal bleeding in children: a 10-year retrospective study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:794-7. [PMID: 24616788 PMCID: PMC3929813 DOI: 10.5812/ircmj.7075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 06/14/2013] [Accepted: 06/29/2013] [Indexed: 11/16/2022]
Abstract
Background Upper gastrointestinal (UGI) endoscopy is a tool used frequently in the evaluation of patients presented with hematemesis. Objectives The purpose of this study was to evaluate clinical presentations and features of UGI bleeding (UGIB) in children. Methods/Patients and Materials A descriptive retrospective analysis was carried out on the medical records of the patients. Children and adolescents aging 0 – 18 years who were presented with UGIB were recruited in the survey over a period of 10 years (2000 to 2010) in Children's Hospital, Tabriz, Iran. Results There were 447 patients included in this study and they were all evaluated by upper endoscopy. Clinical manifestations included hematemesis (120 cases, 26.85%), melena (60 cases, 13.42%), and hematochezia (11 cases, 2.46%). Age-related analysis showed that erosive esophagities was a more common cause of hematemesis in the younger age group (under 1 year of age) with a prevalence of 37% when compared with elder children and adolescents (40%). Peptic ulcer disease was seen in only 7.4% of infants under the age of one. Overall, Esophagitis and erosive esophagitis was the most common endoscopic finding (179, 40%) . Conclusions There were 80 (17.90%) patients receiving endoscopic hemostatic therapy. In children with UGIB, upper endoscopy is a diagnostic procedure for the categorization of underlying causes of upper gastrointestinal bleeding in children and various endoscopic lesions may be found in a patient with the impression of UGIB.
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Affiliation(s)
- Mandana Rafeey
- Department of Pediatrics Gastroenterology, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding author: Mandana Rafeey, Department of Pediatrics Gastroenterology, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel.: +98-4115262280, Fax: +98-4115262280, E-mail:
| | - Maryam Shoaran
- Department of Pediatrics, Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hamideh Majidy
- Department of Nursing, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Consider the risks and benefits of treatment when using over-the-counter pain medications in children. DRUGS & THERAPY PERSPECTIVES 2013. [DOI: 10.1007/s40267-013-0032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bianciotto M, Chiappini E, Raffaldi I, Gabiano C, Tovo PA, Sollai S, de Martino M, Mannelli F, Tipo V, Da Cas R, Traversa G, Menniti-Ippolito F. Drug use and upper gastrointestinal complications in children: a case-control study. Arch Dis Child 2013; 98:218-21. [PMID: 23264432 PMCID: PMC3582087 DOI: 10.1136/archdischild-2012-302100] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the risk of upper gastrointestinal complications (UGIC) associated with drug use in the paediatric population. METHODS This study is part of a large Italian prospective multicentre study. The study population included children hospitalised for acute conditions through the emergency departments of eight clinical centres. Patients admitted for UGIC (defined as endoscopically confirmed gastroduodenal lesions or clinically defined haematemesis or melena) comprised the case series; children hospitalised for neurological disorders formed the control group. Information on drug and vaccine exposure was collected through parental interview during the children's hospitalisation. Logistic regression was used to estimate ORs for the occurrence of UGIC associated with drug use adjusted for age, clinical centre and concomitant use of any drug. RESULTS 486 children hospitalised for UGIC and 1930 for neurological disorders were enrolled between November 1999 and November 2010. Drug use was higher in cases than in controls (73% vs 54%; p<0.001). UGICs were associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) (adjusted OR 2.9, 95% CI 2.1 to 4.0), oral steroids (adjusted OR 2.9, 95% CI 1.7 to 4.8) and antibiotics (adjusted OR 2.3, 95% CI 1.8 to 3.1). The duration of use of these drug categories was short (range 1-8 days). Paracetamol showed a lower risk (adjusted OR 2.0, 95% CI 1.5 to 2.6) compared to ibuprofen (adjusted OR 3.7, 95% CI 2.3 to 5.9), although with partially overlapping CIs. CONCLUSIONS NSAIDs, oral steroids and antibiotics, even when administered for a short period, were associated with an increased risk of UGIC.
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Affiliation(s)
| | | | | | | | | | - Sara Sollai
- Anna Meyer Children's University Hospital, Florence, Italy
| | | | | | | | - Roberto Da Cas
- National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Giuseppe Traversa
- National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
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Rheumatologische und immunologische Krankheitsbilder. PÄDIATRISCHE GASTROENTEROLOGIE, HEPATOLOGIE UND ERNÄHRUNG 2013. [PMCID: PMC7498816 DOI: 10.1007/978-3-642-24710-1_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Eine Beeinträchtigung der gastrointestinalen Motilität findet sich im Rahmen rheumatologischer Erkrankungen insbesondere bei den chronisch-entzündlichen Bindegewebeerkrankungen und den systemischen Vaskulitiden. Je nach Krankheitsbild und verwandter Untersuchungsmethode variiert der Anteil der Patienten, bei denen eine gastrointestinale Symptomatik dokumentiert wird. Pädiatrische Daten sind bei diesen insgesamt seltenen Erkrankungen rar und umfassen in der Regel nur kleinere Fallserien. Eine gastrointestinale Beteiligung findet sich etwa bei 80–100 % der Patienten mit systemischer Sklerodermie, bei 60 % der Patienten mit einer „Mixed connective tissue disease“ oder einem CREST-Syndrom, etwa bei 50 % der Patienten mit einem Raynaud-Syndrom oder einer lokalen Sklerodermie und ungefähr bei 30 % der Patienten mit systemischem Lupus erythematodes oder juveniler Dermatomyositis.
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46
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Balancing the Risks and Benefits of the Use of Over-the-Counter Pain Medications in Children. Drug Saf 2012; 35:1119-25. [DOI: 10.1007/bf03261998] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Bárzaga Arencibia Z, Choonara I. Balancing the Risks and Benefits of the Use of Over-the-Counter Pain Medications in Children. Drug Saf 2012. [DOI: 10.2165/11633620-000000000-00000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Predictors of clinically significant upper gastrointestinal hemorrhage among children with hematemesis. J Pediatr Gastroenterol Nutr 2012; 54:737-43. [PMID: 22108337 DOI: 10.1097/mpg.0b013e3182417a47] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was to determine the proportion of children with hematemesis who experience a clinically significant upper gastrointestinal hemorrhage (UGIH) and to identify variables predicting their occurrence. METHODS A retrospective cohort study was conducted. All of the emergency department visits by children ages 0 to 18 years who presented with hematemesis between 2000 and 2007 were reviewed. The primary aim of the study was to determine the proportion of children who developed a clinically significant UGIH; the secondary aim was to identify risk factors predictive of a clinically significant UGIH. A significant UGIH was defined by any of the following: hemoglobin drop >20 g/L, blood transfusion, or emergent endoscopy or surgical procedure. RESULTS Twenty-seven of 613 eligible children (4%; 95% confidence interval 3%-6%) had a clinically significant UGIH. Clinically significant hemorrhages were associated with older age (9.7 vs 2.9 years; P<0.001), vomiting moderate to large amounts of fresh blood (58% vs 20%; P<0.001), melena (37% vs 5%; P<0.001), significant medical history (63% vs 24%; P<0.001), unwell appearance (44% vs 6%; P<0.001), and tachycardia (41% vs 10%; P<0.001). The frequency of laboratory investigations increased with age (P<0.001). The hemoglobin level was the only laboratory investigation whose results differed between those with and without significant bleeds. The presence of any one of the following characteristics identified all of the children with a clinically significant hemorrhage: melena, hematochezia, unwell appearance, or a moderate to large volume of fresh blood in the vomitus, sensitivity 100% (95% confidence interval 85%-100%). CONCLUSIONS The occurrence of a clinically significant UGIH was uncommon among children with hematemesis, especially in well-appearing children without melena, hematochezia, or who had not vomited a moderate to large amount of fresh blood.
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Giugliano RP, Braunwald E. The year in non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol 2011; 56:2126-38. [PMID: 21144974 DOI: 10.1016/j.jacc.2010.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 08/30/2010] [Accepted: 09/02/2010] [Indexed: 12/30/2022]
Affiliation(s)
- Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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