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Dharmayat KI, Vallejo-Vaz AJ, Stevens CA, Brandts JM, Lyons AR, Groselj U, Abifadel M, Aguilar-Salinas CA, Alhabib K, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Ashavaid TF, Banach M, Béliard S, Binder C, Bourbon M, Chlebus K, Corral P, Cruz D, Descamps OS, Drogari E, Durst R, Ezhov MV, Genest J, Harada-Shiba M, Holven KB, Humphries SE, Khovidhunkit W, Lalic K, Laufs U, Liberopoulos E, Roeters van Lennep J, Lima-Martinez MM, Lin J, Maher V, März W, Miserez AR, Mitchenko O, Nawawi H, Panayiotou AG, Paragh G, Postadzhiyan A, Reda A, Reiner Ž, Reyes X, Sadiq F, Sahebkar A, Schunkert H, Shek AB, Stroes E, Su TC, Subramaniam T, Susekov A, Vázquez Cárdenas A, Huong Truong T, Tselepis AD, Vohnout B, Wang L, Yamashita S, Al-Sarraf A, Al-Sayed N, Davletov K, Dwiputra B, Gaita D, Kayikcioglu M, Latkovskis G, Marais AD, Thushara Matthias A, Mirrakhimov E, Nordestgaard BG, Petrulioniene Z, Pojskic B, Sadoh W, Tilney M, Tomlinson B, Tybjærg-Hansen A, Viigimaa M, Catapano AL, Freiberger T, Hovingh GK, Mata P, Soran H, Raal F, Watts GF, Schreier L, Bañares V, Greber-Platzer S, Baumgartner-Kaut M, de Gier C, Dieplinger H, Höllerl F, Innerhofer R, Karall D, Lischka J, Ludvik B, Mäser M, Scholl-Bürgi S, Thajer A, Toplak H, Demeure F, Mertens A, Balligand JL, Stephenne X, Sokal E, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Hegele RA, Gaudet D, Brunham L, Ruel I, McCrindle B, Cuevas A, Perica D, Symeonides P, Trogkanis E, Kostis A, Ioannou A, Mouzarou A, Georgiou A, Stylianou A, Miltiadous G, Iacovides P, Deltas C, Vrablik M, Urbanova Z, Jesina P, Tichy L, Hyanek J, Dvorakova J, Cepova J, Sykora J, Buresova K, Pipek M, Pistkova E, Bartkova I, S|ulakova A, Toukalkova L, Spenerova M, Maly J, Benn M, Bendary A, Elbahry A, Ferrières J, Ferrieres D, Peretti N, Bruckert E, Gallo A, Valero R, Mourre F, Aouchiche K, Reynaud R, Tounian P, Lemale J, Boccara F, Moulin P, Charrières S, Di Filippo M, Cariou B, Paillard F, Dourmap C, Pradignac A, Verges B, Simoneau I, Farnier M, Cottin Y, Yelnik C, Hankard R, Schiele F, Durlach V, Sultan A, Carrié A, Rabès JP, Sanin V, Schmieder R, Ates S, Rizos CV, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Skalidis E, Kolovou G, Kolovou V, Garoufi A, Koutagiar I, Polychronopoulos G, Kiouri E, Antza C, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Adamidis PS, Milionis H, Lambadiari V, Stabouli S, Filippatos T, Mollaki V, Tsaroumi A, Lamari F, Proyias P, Harangi M, Reddy LL, Shah SAV, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Hosseini S, Jamialahmadi T, Alareedh M, Shaghee F, Rhadi SH, Abduljalal M, Alfil S, Kareem H, Cohen H, Leitersdorf E, Schurr D, Shpitzen S, Arca M, Averna M, Bertolini S, Calandra S, Tarugi P, Casula M, Galimberti F, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Giorgino F, Suppressa P, Bossi AC, Borghi C, Muntoni S, Cipollone F, Scicali R, Pujia A, Passaro A, Berteotti M, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Nascimbeni F, Iughetti L, Fortunato G, Cavallaro R, Iannuzzo G, Calabrò P, Cefalù AB, Capra ME, Zambon A, Pirro M, Sbrana F, Trenti C, Minicocci I, Federici M, Del Ben M, Buonuomo PS, Moffa S, Pipolo A, Citroni N, Guardamagna O, Lia S, Benso A, Biolo GB, Maroni L, Lupi A, Bonanni L, Rinaldi E, Zenti MG, Masuda D, Mahfouz L, Jambart S, Ayoub C, Ghaleb Y, Kasim NAM, Nor NSM, Al-Khateeb A, Kadir SHSA, Chua YA, Razman AZ, Nazli SA, Ranai NM, Latif AZA, Torres MTM, Mehta R, Martagon AJ, Ramirez GAG, Antonio-Villa NE, Vargas-Vazquez A, Elias-Lopez D, Retana GG, Encinas BR, Macias JJC, Zazueta AR, Alvarado RM, Portano JDM, Lopez HA, Sauque-Reyna L, Gomez Herrera LG, Simental Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PAC, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AYR, Arriaga Cazares HE, Gonzalez Gonzalez JR, Mendez Valencia CV, Padilla Padilla FG, Prado RM, De los Rios Ibarra MO, Arjona Villica~na RD, Acevedo Rivera KJ, Carrera RA, Alvarez JA, Amezcua Martinez JC, Barrera Bustillo MDLR, Vargas GC, Chacon RC, Figueroa Andrade MH, Ortega AF, Alcala HG, Garcia de Leon LE, Guzman BG, Gardu~no Garcia JJ, Garnica Cuellar JC, Gomez Cruz JR, Garcia AH, Holguin Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Medrano Rodriguez AB, Morales Oyervides JC, Perez Vazquez DI, Reyes Rodriguez EA, Osorio MLR, Saucedo JR, Tamayo MT, Valdez Talavera LA, Vera Arroyo LE, Zepeda Carrillo EA, Galema-Boers A, Weigman A, Bogsrud MP, Malik M, Shah S, Khan SA, Rana MA, Batool H, Starostecka E, Konopka A, Lewek J, Bielecka-Dąbrowa A, Gach A, Jóźwiak J, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Hellmann M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Michalska-Grzonkowska A, Chlebus I, Kleinschmidt M, Wojtecka A, Zdrojewski T, Myśliwiec M, Hennig M, Medeiros AM, Alves AC, Almeida AF, Lopes A, Guerra A, Bilhoto C, Simões F, Silva F, Lobarinhas G, Gama G, Palma I, Salgado JM, Matos LD, Moura MD, Virtuoso MJ, Tavares M, Ferreira P, Pais P, Garcia P, Coelho R, Ribeiro R, Correia S, Sadykova D, Slastnikova E, Alammari D, Mawlawi HA, Alsahari A, Khudary AA, Alrowaily NL, Rajkovic N, Popovic L, Singh S, Rasulic I, Petakov A, Lalic NM, Peng FK, Vasanwala RF, Venkatesh SA, Raslova K, Fabryova L, Nociar J, Šaligova J, Potočňáková L, Kozárová M, Varga T, Kadurova M, Debreova M, Novodvorsky P, Gonova K, Klabnik A, Buganova I, Battelino T, Bizjan BJ, Debeljak M, Kovac J, Mlinaric M, Molk N, Sikonja J, Sustar U, Podkrajsek KT, Muñiz-Grijalvo O, Díaz-Díaz JL, de Andrés R, Fuentes-Jiménez F, Blom D, Miserez EB, Shipton JL, Ganokroj P, Futema M, Ramaswami U, Alieva RB, Fozilov KG, Khoshimov SU, Nizamov UI, Abdullaeva GJ, Kan LE, Abdullaev AA, Zakirova DV, Do DL, Nguyen MNT, Kim NT, Le TT, Le HA, Santos R, Ray KK. Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study. Lancet 2024; 403:55-66. [PMID: 38101429 DOI: 10.1016/s0140-6736(23)01842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. METHODS For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. FINDINGS Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. INTERPRETATION Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Edelson JB, Zak V, Goldberg D, Fleming G, Mackie AS, Patel JK, Files M, Downing T, Richmond M, Acheampong B, Cartoski M, Detterich J, McCrindle B, McHugh K, Hansen JE, Wagner J, Maria MD, Weingarten A, Nowlen T, Yoon JK, Kim GB, Williams R, Whitehill R, Kirkpatrick E, Yin S, Ermis P, Lubert AM, Stylianou M, Freemon D, Hu C, Garuba OD, Frommelt P, Goldstein BH, Paridon S, Garg R. The Effect of Udenafil on Heart Rate and Blood Pressure in Adolescents With the Fontan Circulation. Am J Cardiol 2024; 210:183-187. [PMID: 37918818 PMCID: PMC10872492 DOI: 10.1016/j.amjcard.2023.09.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 11/04/2023]
Abstract
The Fontan Udenafil Exercise Longitudinal (FUEL) trial showed that treatment with udenafil was associated with improved exercise performance at the ventilatory anaerobic threshold in children with Fontan physiology. However, it is not known how the initiation of phosphodiesterase 5 inhibitor therapy affects heart rate and blood pressure in this population. These data may help inform patient selection and monitoring after the initiation of udenafil therapy. The purpose of this study is to evaluate the effects of udenafil on vital signs in the cohort of patients enrolled in the FUEL trial. This international, multicenter, randomized, double-blind, placebo-controlled trial of udenafil included adolescents with single ventricle congenital heart disease who had undergone Fontan palliation. Changes in vital signs (heart rate [HR], systolic [SBP] and diastolic blood pressure [DBP]) were compared both to subject baseline and between the treatment and the placebo groups. Additional exploratory analyses were performed to evaluate changes in vital signs for prespecified subpopulations believed to be most sensitive to udenafil initiation. Baseline characteristics were similar between the treatment and placebo cohorts (n = 200 for each). The groups demonstrated a decrease in HR, SBP, and DBP 2 hours after drug/placebo administration, except SBP in the placebo group. There was an increase in SBP from baseline to after 6-min walk test in the treatment and placebo groups, and the treatment group showed an increase in HR (87.4 ± 15.0 to 93.1 ± 19.4 beats/min, p <0.01) after exercise. When comparing changes from baseline to the 26-week study visit, small decreases in both SBP (-1.9 ± 12.3 mm Hg, p = 0.03) and DBP (-3.0 ± 9.6 mm Hg, p <0.01) were seen in the treatment group. There were no clinically significant differences between treatment and placebo group in change in HR or blood pressure in the youngest age quartile, lightest weight quartile, or those on afterload-reducing agents. In conclusion, initiation of treatment with udenafil in patients with Fontan circulation was not associated with clinically significant changes in vital signs, implying that for patients similar to those enrolled in the FUEL trial, udenafil can be started without the requirement for additional monitoring after initial administration.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania.
| | | | - David Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Greg Fleming
- Duke Children's Pediatric and Congenital Heart Center, Durham, North Carolina
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, Alberta, California
| | - Jyoti K Patel
- Division of Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew Files
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Tacy Downing
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia
| | - Marc Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Ben Acheampong
- Children's Hospital and Medical Center, University of Nebraska, Omaha, Nebraska
| | - Mark Cartoski
- Nemours Cardiac Center, Nemours / Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Brian McCrindle
- Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Kimberly McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Jesse E Hansen
- Division of Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Jonathan Wagner
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, Missouri; Division of Clinical Pharmacology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Michael Di Maria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Angela Weingarten
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Nowlen
- Heart Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Ja Kyoung Yoon
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Gi Beom Kim
- Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Richard Williams
- Division of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Robert Whitehill
- Emory University, School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Edward Kirkpatrick
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Suellen Yin
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Peter Ermis
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Adam M Lubert
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mario Stylianou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood, Institute, National Institutes of Health, Bethesda, Maryland
| | - D'Andrea Freemon
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood, Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Olukayode D Garuba
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Peter Frommelt
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Bryan H Goldstein
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ruchira Garg
- Departments of Cardiology and Pediatrics, Cedars-Sinai Guerin Children's and Smidt Heart Institute, Los Angeles, California
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Farrar D, Hepburn CM, Drouin O, El Tal T, Morin MP, Berard R, King M, Thibodeau ML, Baerg K, Beaudoin-Bussières G, Beaufils C, Bennett TL, Benseler S, Chan K, Cyr C, Dahdah N, Donner E, Embree J, Farrell C, Finzi A, Forgie S, Giroux R, Kang K, Lang B, Laxer R, McCrindle B, Orkin J, Papenburg J, Pound C, Price V, Proulx-Gauthier JP, Purewal R, Sadarangani M, Salvadori M, Thibeault R, Top K, Viel-Thériault I, Haddad E, Scuccimarri R, Yeung R, Kakkar F, Morris S. Resource use and disease severity of children hospitalized for COVID-19 versus multisystem inflammatory syndrome in children (MIS-C) in Canada. Can Commun Dis Rep 2023; 49:103-112. [PMID: 38356877 PMCID: PMC10866613 DOI: 10.14745/ccdr.v49i04a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background Direct comparisons of paediatric hospitalizations for acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) can inform health system planning. We describe the absolute and relative hospital burden of acute paediatric COVID-19 and MIS-C in Canada. Methods This national prospective study was conducted via the Canadian Paediatric Surveillance Program from March 2020-May 2021. Children younger than 18 years old and hospitalized for acute COVID-19 or MIS-C were included in the analysis. Outcomes included supplemental oxygen (low-flow oxygen or high-flow nasal cannula), ventilation (non-invasive or conventional mechanical), vasopressors, paediatric intensive care unit (PICU) admission, or death. Adjusted risk differences (aRD) and 95% confidence intervals (CI) were calculated to identify factors associated with each diagnosis. Results Overall, we identified 330 children hospitalized for acute COVID-19 (including five deaths) and 208 hospitalized for MIS-C (including zero deaths); PICU admission was required for 49.5% of MIS-C hospitalizations versus 18.2% of acute COVID-19 hospitalizations (aRD 20.3; 95% CI, 9.9-30.8). Resource use differed by age, with children younger than one year hospitalized more often for acute COVID-19 (aRD 43.4% versus MIS-C; 95% CI, 37.7-49.1) and more children 5-11 years hospitalized for MIS-C (aRD 38.9% vs. acute COVID-19; 95% CI, 31.0-46.9). Conclusion While there were more hospitalizations and deaths from acute paediatric COVID-19, MIS-C cases were more severe, requiring more intensive care and vasopressor support. Our findings suggest that both acute COVID-19 and MIS-C should be considered when assessing the overall burden of severe acute respiratory syndrome coronavirus 2 in hospitalized children.
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Affiliation(s)
- Daniel Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON
| | - Charlotte Moore Hepburn
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Olivier Drouin
- Division of General Paediatrics, Department of Paediatrics, CHU Sainte-Justine, Montréal, QC
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC
| | - Tala El Tal
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
| | - Marie-Paule Morin
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | - Roberta Berard
- Division of Rheumatology, Department of Paediatrics, Children’s Hospital at London Health Sciences Centre, London, ON
| | - Melanie King
- Canadian Paediatric Surveillance Program, Canadian Paediatric Society, Ottawa, ON
| | | | - Krista Baerg
- Department of Paediatrics, University of Saskatchewan, Saskatoon, SK
- Division of General Paediatrics, Jim Pattison Children’s Hospital, Saskatchewan Health Authority, Saskatoon, SK
| | - Guillaume Beaudoin-Bussières
- Centre de Recherche du CHUM et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC
| | - Camille Beaufils
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | | | - Susanne Benseler
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB
- Division of Rheumatology, Department of Paediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB
| | - Kevin Chan
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Department of Children’s and Women’s Health, Trillium Health Partners, Mississauga, ON
- Institute for Better Health, Trillium Health Partners, Mississauga, ON
| | - Claude Cyr
- Service de Soins Intensifs Pédiatriques, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Nagib Dahdah
- Division of Paediatric Cardiology, CHU Sainte-Justine, Department of Paediatrics, University of Montréal, Montréal, QC
| | - Elizabeth Donner
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Neurology, The Hospital for Sick Children, Toronto, ON
| | - Joanne Embree
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB
| | - Catherine Farrell
- Division of Paediatric Intensive Care, Department of Paediatrics, CHU Sainte-Justine, Montréal, QC
| | - Andrés Finzi
- Centre de Recherche du CHUM et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC
| | - Sarah Forgie
- Division of Infectious Diseases, Department of Paediatrics, University of Alberta, Edmonton, AB
- Stollery Children’s Hospital, Edmonton, AB
| | - Ryan Giroux
- Women’s and Children’s Health Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON
| | - Kristopher Kang
- Department of Paediatrics, University of British Columbia, Vancouver, BC
| | - Bianca Lang
- Division of Rheumatology, Department of Paediatrics, Dalhousie University, Halifax, NS
| | - Ronald Laxer
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Brian McCrindle
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON
| | - Julia Orkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Jesse Papenburg
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Montreal Children’s Hospital, Montréal, QC
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, QC
| | - Catherine Pound
- Division of Consulting Paediatrics, Department of Paediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON
| | - Victoria Price
- Division of Paediatric Hematology/Oncology, Department of Paediatrics, Dalhousie University, Halifax, NS
| | | | - Rupeena Purewal
- Department of Paediatrics, University of Saskatchewan, Saskatoon, SK
- Division of Paediatric Infectious Diseases, Jim Pattison Children’s Hospital, Saskatchewan Health Authority, Saskatoon, SK
| | - Manish Sadarangani
- Department of Paediatrics, University of British Columbia, Vancouver, BC
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC
| | | | - Roseline Thibeault
- Division of Infectious Diseases, Department of Paediatrics, CHU de Québec-Université Laval, Québec City, QC
| | - Karina Top
- Department of Paediatrics, Dalhousie University, Halifax, NS
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Department of Paediatrics, CHU de Québec-Université Laval, Québec City, QC
| | - Elie Haddad
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | - Rosie Scuccimarri
- Division of Paediatric Rheumatology, Montreal Children’s Hospital and McGill University Health Centre, Montréal, QC
| | - Rae Yeung
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
- Cell Biology Program, The Hospital for Sick Children, Toronto, ON
- Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, ON
| | - Fatima Kakkar
- Division of Infectious Diseases, CHU Sainte-Justine, Montréal, QC
| | - Shaun Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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McCrindle B, Zukotynski K, Doyle TE, Noseworthy MD. A Radiology-focused Review of Predictive Uncertainty for AI Interpretability in Computer-assisted Segmentation. Radiol Artif Intell 2021; 3:e210031. [PMID: 34870219 PMCID: PMC8637228 DOI: 10.1148/ryai.2021210031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/09/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022]
Abstract
The recent advances and availability of computer hardware, software tools, and massive digital data archives have enabled the rapid development of artificial intelligence (AI) applications. Concerns over whether AI tools can "communicate" decisions to radiologists and primary care physicians is of particular importance because automated clinical decisions can substantially impact patient outcome. A challenge facing the clinical implementation of AI stems from the potential lack of trust clinicians have in these predictive models. This review will expand on the existing literature on interpretability methods for deep learning and review the state-of-the-art methods for predictive uncertainty estimation for computer-assisted segmentation tasks. Last, we discuss how uncertainty can improve predictive performance and model interpretability and can act as a tool to help foster trust. Keywords: Segmentation, Quantification, Ethics, Bayesian Network (BN) © RSNA, 2021.
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Affiliation(s)
- Brian McCrindle
- From the Department of Electrical and Computer Engineering (B.M., T.E.D., M.D.N.), Department of Radiology, Faculty of Health Sciences (K.Z., M.D.N.), and School of Biomedical Engineering (K.Z., T.E.D., M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Vector Institute for Artificial Intelligence, Toronto, Canada (T.E.D.)
| | - Katherine Zukotynski
- From the Department of Electrical and Computer Engineering (B.M., T.E.D., M.D.N.), Department of Radiology, Faculty of Health Sciences (K.Z., M.D.N.), and School of Biomedical Engineering (K.Z., T.E.D., M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Vector Institute for Artificial Intelligence, Toronto, Canada (T.E.D.)
| | - Thomas E. Doyle
- From the Department of Electrical and Computer Engineering (B.M., T.E.D., M.D.N.), Department of Radiology, Faculty of Health Sciences (K.Z., M.D.N.), and School of Biomedical Engineering (K.Z., T.E.D., M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Vector Institute for Artificial Intelligence, Toronto, Canada (T.E.D.)
| | - Michael D. Noseworthy
- From the Department of Electrical and Computer Engineering (B.M., T.E.D., M.D.N.), Department of Radiology, Faculty of Health Sciences (K.Z., M.D.N.), and School of Biomedical Engineering (K.Z., T.E.D., M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Vector Institute for Artificial Intelligence, Toronto, Canada (T.E.D.)
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5
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Delayun C, McCrindle B, Deliva R, Cifra B. SHORT-TERM OUTCOME EVALUATION OF A NOVEL PEDIATRIC EXERCISE MEDICINE PROGRAM. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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6
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Luk A, Clarke B, Dahdah N, Ducharme A, Krahn A, McCrindle B, Mizzi T, Naus M, Udell JA, Virani S, Zieroth S, McDonald M. Myocarditis and Pericarditis following COVID-19 mRNA Vaccination: Practical Considerations for Care Providers. Can J Cardiol 2021; 37:1629-1634. [PMID: 34375696 PMCID: PMC8349442 DOI: 10.1016/j.cjca.2021.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/01/2021] [Accepted: 08/01/2021] [Indexed: 01/06/2023] Open
Abstract
The mRNA vaccines against COVID-19 infection have been effective in reducing the number of symptomatic cases worldwide. With widespread uptake, case series of vaccine-related myocarditis/pericarditis have been reported, particularly in adolescents and young adults. Men tend to be affected with greater frequency, and symptom onset is usually within 1 week after vaccination. Clinical course appears to be mild in most cases. On the basis of the available evidence, we highlight a clinical framework to guide providers on how to assess, investigate, diagnose, and report suspected and confirmed cases. In any patient with highly suggestive symptoms temporally related to COVID-19 mRNA vaccination, standardized workup includes serum troponin measurement and polymerase chain reaction testing for COVID-19 infection, routine additional lab work, and a 12-lead electrocardiogram. Echocardiography is recommended as the imaging modality of choice for patients with unexplained troponin elevation and/or pathologic electrocardiogram changes. Cardiovascular specialist consultation and hospitalization should be considered on the basis of the results of standard investigations. Treatment is largely supportive, and myocarditis/pericarditis that is diagnosed according to defined clinical criteria should be reported to public health authorities in every jurisdiction. Finally, we recommend COVID-19 vaccination in all individuals in accordance with the Health Canada and National Advisory Committee on Immunization guidelines. In patients with suspected myocarditis/pericarditis after the first dose of an mRNA vaccine, deferral of a second dose is recommended until additional reports become available.
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Affiliation(s)
- Adriana Luk
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Brian Clarke
- Libin Cardiovascular Institute, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Andrew Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian McCrindle
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Trent Mizzi
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Monika Naus
- Communicable Diseases and Immunization Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob A Udell
- Division of Cardiology, Women's College Hospital and Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Sean Virani
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michael McDonald
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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Muthusami P, Luining W, McCrindle B, van der Geest R, Riesenkampff E, Yoo SJ, Seed M, Manlhiot C, Grosse-Wortmann L. Myocardial Perfusion, Fibrosis, and Contractility in Children With Kawasaki Disease. JACC Cardiovasc Imaging 2018; 11:1922-1924. [PMID: 30121268 DOI: 10.1016/j.jcmg.2018.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 05/29/2018] [Accepted: 06/07/2018] [Indexed: 11/24/2022]
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8
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Ruel I, Aljenedil S, Brophy J, Gaudet D, McCrindle B, Frohlich J, Hegele R, Genest J. Update on the Familial Hypercholesterolemia Canada (FH Canada) Registry. ATHEROSCLEROSIS SUPP 2018. [DOI: 10.1016/j.atherosclerosissup.2018.04.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Eny K, Maguire J, Dai D, Lebovic G, Adeli K, Hamilton J, Hanley A, Mamdani M, McCrindle B, Tremblay M, Parkin P, Birken C. ACCELERATED GROWTH IN EARLY CHILDHOOD IS ASSOCIATED WITH INCREASED SYSTOLIC AND DIASTOLIC BLOOD PRESSURE. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Maternal obesity, low birthweight, and accelerated growth have been shown to be associated with elevated blood pressure in children. However, it is unknown which growth periods are associated with blood pressure, and whether birthweight or maternal obesity modify the relationship between growth and blood pressure in early childhood.
OBJECTIVES
We examined the relationship between age- and sex-standardized body mass index (zBMI) growth trajectories with longitudinal measures of systolic (SBP) and diastolic (DBP) blood pressure in early childhood.
DESIGN/METHODS
We collected repeated measures of zBMI and blood pressure in 2502 children participating in the TARGet Kids! cohort. In stage 1 we used linear spline multilevel models to estimate each child’s zBMI at birth and zBMI growth trajectories in early infancy (0–3 m), late infancy (3–18 m) and toddler years (18–36 m). In stage 2 we used generalized estimating equations to examine the relationship between zBMI at birth and zBMI growth with repeated measures of SBP and DBP from 3 to 6 years of age. We tested for effect modification by birthweight and maternal obesity status by inclusion of interaction terms in each growth period.
RESULTS
After adjusting for confounders and prior growth, a 1 standard deviation unit increase in zBMI growth per month in early infancy (β=0.59; 95% CI 0.32,0.87) and late infancy (β=0.73; 95% CI 0.44,1.01), were associated with higher SBP. Growth in the toddler years was not significantly associated with SBP (p=0.08). Similar but smaller associations were observed for zBMI growth and DBP in early (β=0.29; 95% CI 0.04, 0.53) and late infancy (β=0.42; 95% CI 0.18, 0.66). Birthweight status modified (p=0.004) the relationship between zBMI growth and SBP during late infancy, with the strongest positive association observed in the low birthweight group. During toddler years, birthweight status modified the relationship between zBMI growth with SBP (p=0.03) and DBP (p=0.04), with the strongest positive association observed in the low birthweight group, followed by the high birthweight group. Maternal obesity status modified (p= 0.03) the relationship between zBMI growth with DBP in late infancy, with a stronger association observed among children of mothers with obesity.
CONCLUSION
Accelerated growth in early and late infancy are associated with increased blood pressure in early childhood. Growth during late infancy and toddler years may impact blood pressure differently in children born with high and low birthweights and high maternal BMI, suggesting prospective windows and risk groups to target interventions.
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10
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Torok RD, Li JS, Kannankeril PJ, Atz AM, Bishai R, Bolotin E, Breitenstein S, Chen C, Diacovo T, Feltes T, Furlong P, Hanna M, Graham EM, Hsu D, Ivy DD, Murphy D, Kammerman LA, Kearns G, Lawrence J, Lebeaut B, Li D, Male C, McCrindle B, Mugnier P, Newburger JW, Pearson GD, Peiris V, Percival L, Pina M, Portman R, Shaddy R, Stockbridge NL, Temple R, Hill KD. Recommendations to Enhance Pediatric Cardiovascular Drug Development: Report of a Multi-Stakeholder Think Tank. J Am Heart Assoc 2018; 7:JAHA.117.007283. [PMID: 29440007 PMCID: PMC5850184 DOI: 10.1161/jaha.117.007283] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rachel D Torok
- Duke University and the Duke Clinical Research Institute, Durham, NC
| | - Jennifer S Li
- Duke University and the Duke Clinical Research Institute, Durham, NC
| | | | - Andrew M Atz
- Medical University of South Carolina, Charleston, SC
| | | | | | | | | | | | | | | | | | - Eric M Graham
- Medical University of South Carolina, Charleston, SC
| | - Daphne Hsu
- Albert Einstein College of Medicine, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | - Gail D Pearson
- US National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Vasum Peiris
- US Food and Drug Administration , Silver Spring, MD
| | | | | | | | | | | | | | - Kevin D Hill
- Duke University and the Duke Clinical Research Institute, Durham, NC
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11
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Meza JM, Hickey E, McCrindle B, Blackstone E, Anderson B, Overman D, Kirklin JK, Karamlou T, Caldarone C, Kim R, DeCampli W, Jacobs M, Guleserian K, Jacobs JP, Jaquiss R. The Optimal Timing of Stage-2-Palliation After the Norwood Operation. Ann Thorac Surg 2017; 105:193-199. [PMID: 28847537 DOI: 10.1016/j.athoracsur.2017.05.041] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The effect of the timing of stage-2-palliation (S2P) on survival through single ventricle palliation remains unknown. This study investigated the optimal timing of S2P that minimizes pre-S2P attrition and maximizes post-S2P survival. METHODS The Congenital Heart Surgeons' Society's critical left ventricular outflow tract obstruction cohort was used. Survival analysis was performed using multiphase parametric hazard analysis. Separate risk factors for death after the Norwood and after S2P were identified. Based on the multivariable models, infants were stratified as low, intermediate, or high risk. Cumulative 2-year, post-Norwood survival was predicted. Optimal timing was determined using conditional survival analysis and plotted as 2-year, post-Norwood survival versus age at S2P. RESULTS A Norwood operation was performed in 534 neonates from 21 institutions. The S2P was performed in 71%, at a median age of 5.1 months (IQR: 4.3 to 6.0), and 22% died after Norwood. By 5 years after S2P, 10% of infants had died. For low- and intermediate-risk infants, performing S2P after age 3 months was associated with 89% ± 3% and 82% ± 3% 2-year survival, respectively. Undergoing an interval cardiac reoperation or moderate-severe right ventricular dysfunction before S2P were high-risk features. Among high-risk infants, 2-year survival was 63% ± 5%, and even lower when S2P was performed before age 6 months. CONCLUSIONS Performing S2P after age 3 months may optimize survival of low- and intermediate-risk infants. High-risk infants are unlikely to complete three-stage palliation, and early S2P may increase their risk of mortality. We infer that early referral for cardiac transplantation may increase their chance of survival.
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Affiliation(s)
- James M Meza
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario
| | - Edward Hickey
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario
| | - Brian McCrindle
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario
| | - Eugene Blackstone
- Division of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Brett Anderson
- Division of Cardiology, Morgan-Stanley Children's Hospital/New York Presbyterian Hospital, New York, New York
| | - David Overman
- Division of Pediatric Cardiovascular Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tara Karamlou
- Division of Thoracic and Cardiovascular Surgery, Phoenix Children's Hospital, Phoenix, Arizona
| | - Christopher Caldarone
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario
| | - Richard Kim
- Division of Cardiothoracic Surgery, Los Angeles Children's Hospital, Los Angeles, California
| | - William DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Florida
| | - Marshall Jacobs
- Division of Cardiac Surgery, Johns Hopkins Heart and Vascular Institute, Baltimore, Maryland
| | - Kristine Guleserian
- Division of Cardiovascular Surgery, Niklaus Children's Hospital, Miami, Florida
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Robert Jaquiss
- Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, Texas.
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12
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Plumptre L, Anderson LN, Chen Y, Carsley S, Narang I, Hamilton J, McCrindle B, Parkin PC, Maguire JL, Birken CS, on behalf of the TARGet Kids! Colla. Longitudinal Analysis of Sleep Duration and Cardiometabolic Risk in Young Children. Child Obes 2017; 13:291-299. [PMID: 30433827 DOI: 10.1089/chi.2016.0279] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study is to determine if sleep duration in early childhood is associated with cardiometabolic risk (CMR) in later childhood as assessed by a CMR cluster score [sum of age- and sex-standardized z-scores of waist circumference (WC), systolic blood pressure, triglycerides, glucose, and (inverse) high-density lipoprotein (HDL)]. Secondary objectives included examining sleep duration and the individual CMR factors and BMI z-score. PATIENTS AND METHODS A prospective cohort study was conducted using data from the TARGet Kids! practice-based research network in Toronto, Canada. Children (n = 597) with parent-reported 24-hour sleep duration in early childhood (12-36 months) and a follow-up visit (36-96 months) with all five CMR factors were included in the analysis. Multivariable linear regression was used to assess the relationship between early childhood sleep duration and later childhood CMR, adjusting for relevant covariates. RESULTS Average 24-hour sleep duration in early childhood [mean age: 28.1 (6.6) months] was 11.8 (1.4) hours, with 87% meeting or exceeding total sleep recommendations for their age. Sleep duration in early childhood was not associated with the CMR cluster score in later childhood. Shorter sleep duration was associated with higher HDL concentrations [adjusted β = -0.028 (95% confidence interval: -0.049 to -0.007), p = 0.009]. CONCLUSIONS Further research is needed to determine if early childhood sleep duration is associated with HDL in later childhood. Future studies, which investigate sleep quality in addition to sleep duration, may be helpful.
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Affiliation(s)
- Lesley Plumptre
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Laura N Anderson
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,2 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Ontario, Canada
| | - Yang Chen
- 3 The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto, Ontario, Canada
| | - Sarah Carsley
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,4 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada
| | - Indra Narang
- 5 Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children , Toronto, Ontario, Canada .,6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Jill Hamilton
- 6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,7 Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children , Toronto, Ontario, Canada
| | - Brian McCrindle
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,8 Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto , Toronto, Ontario, Canada
| | - Patricia C Parkin
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,4 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada .,6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,9 Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Jonathon L Maguire
- 3 The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto, Ontario, Canada .,4 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada .,6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,10 Department of Pediatrics, St. Michael's Hospital , Toronto, Ontario, Canada
| | - Catherine S Birken
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,4 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada .,6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,9 Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children , Toronto, Ontario, Canada
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13
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Mah D, Sleeper L, Crosson J, Czosek R, Gamboa D, Love B, McCrindle B, Mosquero LM, Olson A, Shah M, Wechsler S, Young L, Lacro R. RHYTHM ABNORMALITIES IN CHILDREN AND YOUNG ADULTS WITH MARFAN SYNDROME. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Charles S, Rempel G, Rogers L, Rankin K, Williams E, Schuh M, Dragieva D, Mustafa S, Anthony S, Jelen A, Kaufman M, Kovacs A, McCrindle B, Nicholas D, Oechslin E, Sananes R, Mackie A. TEENS WITH CONGENITAL HEART DISEASE IN TRANSITION FROM PEDIATRIC TO ADULT CARE: QUALITATIVE EVALUATION OF NURSE-LED INTERVENTION TO SUPPORT TRANSITION READINESS. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Pondorfer P, Yun TJ, Cheung M, Ashburn D, McCrindle B, Mertens L, Grosse-Wortmann L, Manlhiot C, Al'Radi O, Vanderlaan R, Chetan D, Redington A, Van Arsdell G. Tetralogy of Fallot Repair — Long Term Follow-up: Preservation Strategy Improves Late Outcomes. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Sun L, Macgowan CK, Sled JG, Yoo SJ, Manlhiot C, Porayette P, Grosse-Wortmann L, Jaeggi E, McCrindle B, Kingdom J, Hickey E, Miller S, Seed M. Response to Letter Regarding Article, "Reduced Fetal Cerebral Oxygen Consumption Is Associated With Smaller Brain Size in Fetuses With Congenital Heart Disease". Circulation 2016; 133:e8. [PMID: 26719396 DOI: 10.1161/circulationaha.115.018748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Liqun Sun
- Department of Ultrasound, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDivision of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Christopher K Macgowan
- Department of Physiology and Experimental Medicine, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - John G Sled
- Department of Physiology and Experimental Medicine, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Shi-Joon Yoo
- Department of Pediatrics, Department of Diagnostic Imaging, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Cedric Manlhiot
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Prashob Porayette
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Pediatrics, Department of Diagnostic Imaging, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Edgar Jaeggi
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Brian McCrindle
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - John Kingdom
- Department of Obstetrics and Gynecology, University of Toronto and Mount Sinai Hospital, Toronto, ON, Canada
| | - Edward Hickey
- Department of Cardiovascular Surgery, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Steven Miller
- Department of Pediatric Neurology, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Mike Seed
- Department of Pediatrics, Department of Diagnostic Imaging, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
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17
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Palma A, Viegas J, Manlhiot C, McCrindle B, Benson L. Use of local anesthetic (0.25% bupivacaine) for pain control after pediatric cardiac catheterization: A randomized controlled trial. Catheter Cardiovasc Interv 2015; 87:318-23. [PMID: 26525313 DOI: 10.1002/ccd.26284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/07/2015] [Accepted: 10/03/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the effects of local infiltration of 0.25% bupivacaine on post-operative pain and analgesic use in children undergoing cardiac catheterization procedures. BACKGROUND In pediatric catheterization procedures performed under general anesthesia, a local anesthetic is often used prior to femoral sheath removal. There are no published reports of the impact of local anesthetic infiltration on pain after pediatric procedures, and mixed reports on its effectiveness in adults. METHODS A randomized controlled trial was undertaken of 140 children, aged 7-18 years undergoing cardiac catheterization under general anesthesia via the femoral vein or artery. Participants received a subcutaneous infiltration of 0.25% bupivacaine at the access site prior to sheath removal, or usual care without bupivacaine. Outcomes included patient reported pain scores and analgesic use up to 6 hr after the procedure. RESULTS Pain scores were similar between groups through the 6-hr post-procedure period. The proportion of children reporting a maximal pain score of ≤2/10 was higher in the bupivacaine group (64% vs. 44%, P = 0.03). A significantly higher proportion of children in the control group required IV morphine (18.8% vs. 4.5%, P = 0.02). CONCLUSIONS Morphine use can be reduced with the use of 0.25% bupivacaine given prior to femoral sheath removal and should be considered for post-procedural pain control for pediatric patients undergoing cardiac catheterization. This study is the first to contribute evidence to the effectiveness of 0.25% bupivacaine after pediatric cardiac catheterization.
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Affiliation(s)
- Amy Palma
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Jacqueline Viegas
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Brian McCrindle
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Lee Benson
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada
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Gidding SS, Champagne MA, de Ferranti SD, Defesche J, Ito MK, Knowles JW, McCrindle B, Raal F, Rader D, Santos RD, Lopes-Virella M, Watts GF, Wierzbicki AS. The Agenda for Familial Hypercholesterolemia: A Scientific Statement From the American Heart Association. Circulation 2015; 132:2167-92. [PMID: 26510694 DOI: 10.1161/cir.0000000000000297] [Citation(s) in RCA: 458] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Chungsomprasong P, Hamilton R, Fatah M, Seed M, Manlhiot C, Yoo S, McCrindle B, Grosse-Wortmann L. PRESENTATION AND DISEASE PROGRESSION OF CHILDREN AND ADOLESCENTS EVALUATED FOR ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Dionne A, Bakloul M, Manlhiot C, McCrindle B, Hosking M, Houde C, Pepelassis D, Dahdah N. CORONARY INTERVENTION AFTER KAWASAKI DISEASE: THE CANADIAN EXPERIENCE. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Banks L, Rosenthal S, Longmuir P, Manlhiot C, McKillop A, McCrindle B. 182: Associations Between Physical Activity, Exercise Capacity, and Gross Motor Skill Development are Independent of the Type of Congenital Heart Disease. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Khoury M, Manlhiot C, Gibson D, Stearne K, Chahal N, Dobbin S, McCrindle B. 134: Patterns and Associated Factors with E-Cigarette Use Among Canadian Adolescents. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e82b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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McKillop A, Narang I, Manlhiot C, McCrindle B. Physical Activity and Sleepiness among Obese Youth. Can J Diabetes 2015. [DOI: 10.1016/j.jcjd.2015.01.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Atz AM, Zak V, Mahony L, Burns K, Goldberg D, Williams R, Breitbart R, Korsin R, Colan S, Marino BS, Margossian R, Daniels K, Uzark K, Henderson H, McCrindle B. LONGITUDINAL ASSESSMENT OF SINGLE VENTRICLE PATIENTS IN THE PEDIATRIC HEART NETWORK FONTAN COHORT. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wilder TJ, Hickey EJ, McCrindle B, Ziemer G, Blackstone E, Karamlou T, Kirshbom P, Gruber P. 108 * INITIAL MANAGEMENT OF PULMONARY BLOOD FLOW IS ASSOCIATED WITH LATE OUTCOMES IN TRICUSPID ATRESIA. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Carsley S, Borkhoff CM, Maguire JL, Birken CS, Khovratovich M, McCrindle B, Macarthur C, Parkin PC. Cohort Profile: The Applied Research Group for Kids (TARGet Kids!). Int J Epidemiol 2014; 44:776-88. [PMID: 24982016 DOI: 10.1093/ije/dyu123] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Applied Research Group for Kids (TARGet Kids!) is an ongoing open longitudinal cohort study enrolling healthy children (from birth to 5 years of age) and following them into adolescence. The aim of the TARGet Kids! cohort is to link early life exposures to health problems including obesity, micronutrient deficiencies and developmental problems. The overarching goal is to improve the health of Canadians by optimizing growth and developmental trajectories through preventive interventions in early childhood. TARGet Kids!, the only child health research network embedded in primary care practices in Canada, leverages the unique relationship between children and families and their trusted primary care practitioners, with whom they have at least seven health supervision visits in the first 5 years of life. Children are enrolled during regularly scheduled well-child visits. To date, we have enrolled 5062 children. In addition to demographic information, we collect physical measurements (e.g. height, weight), lifestyle factors (nutrition, screen time and physical activity), child behaviour and developmental screening and a blood sample (providing measures of cardiometabolic, iron and vitamin D status, and trace metals). All data are collected at each well-child visit: twice a year until age 2 and every year until age 10. Information can be found at: http://www.targetkids.ca/contact-us/.
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Affiliation(s)
- Sarah Carsley
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Jonathon L Maguire
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada, Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada and
| | - Catherine S Birken
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada and
| | - Marina Khovratovich
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Brian McCrindle
- Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Colin Macarthur
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada and
| | - Patricia C Parkin
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada and
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Cohen M, Syme C, Deforest M, Wells G, Detzler G, Cheng HL, McCrindle B, Hanley A, Hamilton J. Ectopic fat in youth: the contribution of hepatic and pancreatic fat to metabolic disturbances. Obesity (Silver Spring) 2014; 22:1280-6. [PMID: 24402863 DOI: 10.1002/oby.20674] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/15/2013] [Accepted: 11/30/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study the relationships between parameters of glucose and insulin metabolism and visceral and abdominal ectopic fat in youth. METHODS A cross sectional study of 50 children (24 females), 8-18 years old. Anthropometrics, body composition, blood-work and visceral and ectopic fat by magnetic resonance imaging were assessed. Insulin secretion, insulin sensitivity and beta cell function were calculated from an oral glucose tolerance test. RESULTS BMI z-scores ranged between -1.3 and 4.5. The hepatic fat fraction (HFF) ranged between 0 and 36% and pancreatic fat fraction (PFF) between 0 and 14%. Visceral fat, HFF and PFF were associated with clinical and biochemical metabolic abnormalities, and correlated with markers of insulin sensitivity (r = -0.60, P < 0.01; r = -0.64, P < 0.01; r = -0.48, P < 0.01, respectively) insulin secretion (r = 0.55, P < 0.01; r = 0.57, P < 0.01; r = 0.41, P < 0.01, respectively), and beta cell function (r = -0.49, P < 0.01; r = -0.59, P < 0.01; r = -0.39, P < 0.01, respectively). CONCLUSIONS Accumulations of pancreatic and hepatic fat have complementary clinical consequences in youth. While visceral and hepatic fat demonstrated a dominant effect, even relatively small degrees of pancreatic fat deposition may contribute to metabolic alterations.
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Affiliation(s)
- Michal Cohen
- Division of Endocrinology, the Hospital for Sick Children, and the University of Toronto, ON, Canada
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Atz AM, Zak V, Mahony L, Uzark K, Shrader P, Gallagher D, Paridon S, Williams R, Breitbart R, Colan S, Kaltman J, Margossian R, Pasquali S, Allen K, Lai W, Korsin R, Marino B, Mirarchi N, McCrindle B. THE PEDIATRIC HEART NETWORK FONTAN FOLLOW-UP STUDY: SURVIVAL DATA AND PREDICTORS OF FUNCTIONAL OUTCOME 7 YEARS LATER. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vanderlaan R, Manlhiot C, Edwards L, McCrindle B, Dipchand A. Risk Factor Analysis for Individual Causes of Death Following Pediatric Heart Transplant: An Analysis of the ISHLT Registry. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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30
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Langslet G, Braamskamp MJAM, McCrindle B, Cassiman D, Francis G, Gagné C, Gaudet D, Morrison KM, Wiegman A, Turner T, Miller E, Raichlen J, Martin PG, Stein E, Kastelein J. EFFECT OF ROSUVASTATIN THERAPY ON ARTERIAL WALL CHANGES IN CHILDREN AND ADOLESCENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA: RESULTS FROM THE CHARON STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61379-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Poynter JA, Williams WG, McIntyre S, Brothers JA, Jacobs ML, Overman D, Bondarenko I, Forbess J, Jacobs ML, Lorber R, Chen J, Lodge A, Jaquiss R, Mavroudis C, Herlong R, Poynter J, Weinstein S, Pasquali SK, Pizarro C, McCulloch M, Gruber P, Welke K, Eghtesady P, Mainwaring R, Heinle J, Mery C, Gaynor JW, Paridon S, Brothers J, Jacobs JP, Dadlani G, Caldarone C, Williams WG, Jegatheeswaran A, DeCampli W, George J, Jaggers J, Blackstone E, Wilder T, McCrindle B, Frommelt PC, Srivastava S, Walters HL. Anomalous Aortic Origin of a Coronary Artery. World J Pediatr Congenit Heart Surg 2014; 5:22-30. [DOI: 10.1177/2150135113516984] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Anomalous aortic origin of a coronary artery (AAOCA) is a common congenital heart lesion that may be rarely associated with myocardial ischemia and sudden death in the young. Evidence-based criteria for managing young patients with AAOCA are lacking. The Congenital Heart Surgeons Society (CHSS) established a multicenter registry of patients with AAOCA aged ≤30 years to develop these criteria. Methods: All institutional members of the CHSS are eligible to enroll patients. Patients were enrolled retrospectively if diagnosis of AAOCA occurred between January 1, 1998, and January 20, 2009, and prospectively from January 20, 2009 forward. The first phase of analysis explored possible associations between demographics, symptoms, coronary anatomy, and management using correlation analysis and logistic regression. Results: As of June 2012, 198 patients were enrolled from CHSS member institutions (median age at diagnosis = 10.2 years; 64% male). Data were extracted from clinical records. Fifty-four percent were symptomatic at presentation (most commonly chest pain, N = 78). The AAOCA was diagnosed at autopsy in two patients who presented with sudden death (one with anomalous aortic origin of the left coronary artery [AAOLCA]; one with a single ostium above a commissure giving rise to both left and right coronary arteries). Imaging reports documented anomalous aortic origin of the right coronary artery (AAORCA) in 144 patients, AAOLCA in 51 patients, and AAOLCA/AAORCA in 1 patient. Surgery or autopsy without surgery was performed in 106 patients (71 AAORCA [67%]; 31 AAOLCA [29%]; and 4 AAORCA/AAOLCA [4%]) at a median age of 12.6 years. Overall, 52% of patients with AAORCA versus 67% with AAOLCA had surgery. Most surgical operative reports described an intramural segment of the coronary artery with anomalous origin. Surgery correlated with symptoms, older age, and presence of an intramural segment in the setting of AAOLCA. Conclusions: Management decisions, including surgical referral, are associated with patient symptoms and coronary morphology. Information derived from annual follow-up of surgically and nonsurgically managed patients enrolled in the registry will eventually form the basis for development of evidence-based protocols to address the spectrum of risk and inform clinical decision making in this heterogeneous population of young patients.
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Affiliation(s)
| | | | - Susan McIntyre
- Congenital Heart Surgeons Society Data Center, Toronto, Ontario, Canada
| | - Julie A. Brothers
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Marshall L. Jacobs
- Department of Surgery, John Hopkins School of Medicine, Baltimore, MD, USA
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Jean-St-Michel E, Thompson S, Manlhiot C, Caterini J, McCrindle B, Redington A, Wells G. Remote Ischemic Preconditioning Does Not Affect Cellular Energy Metabolism Measured by 31-Phosphorus Mr Spectroscopy: a Randomized Crossover Trial. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Gagné C, Kusters M, Caceres M, Coll M, Cuffie C, Jacobson M, Kwiterovich P, Lee R, Lowe R, Massaad R, McCrindle B, Musliner T, Triscari J, Kastelein J. Efficacy and Safety of Ezetimibe Monotherapy in 6-10 Year Old Children with Heterozygous Familial or Non-familial Hypercholesterolemia. J Clin Lipidol 2013. [DOI: 10.1016/j.jacl.2013.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Conway J, Manlhiot C, Dipchand A, McCrindle B, Humpl T. Thrombosis and Bleeding Complications in Pediatric Patients with Ventricular Assist Devices. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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35
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Khoury M, Manlhiot C, Gibson D, Chahal N, Stearne K, Dobbin S, McCrindle B. Universal Screening of Obesity and Cardiovascular Risk Factors in Adolescents: Does it Identify High Risk Families? Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.03.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khoury M, Manlhiot C, McCrindle B. Lipid Abnormalities Associated With Childhood Obesity: Are Individual Surrogate Indicators or Combined Dyslipidemia More Strongly Associated With Adiposity? Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.03.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Kastelein JJ, Kusters M, Caceres M, Coll M, Cuffie C, Gagné C, Jacobson M, Kwiterovich P, Lee R, Lowe R, Massaad R, McCrindle B, Musliner T, Triscari J. EFFICACY AND SAFETY OF EZETIMIBE MONOTHERAPY IN CHILDREN SIX TO TEN YEARS OF AGE WITH HETEROZYGOUS FAMILIAL OR NON-FAMILIAL HYPERCHOLESTEROLEMIA. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Grosse-Wortmann L, Etoom Y, Govindapillai S, McCrindle B, Manlhiot C, Yoo SJ. MRI in childhood Arrhythmogenic Right Ventricular Cardiomyopathy and proposed modification of the Task Force Criteria for children. J Cardiovasc Magn Reson 2012. [PMCID: PMC3304869 DOI: 10.1186/1532-429x-14-s1-o1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ho J, Panagiotopoulos C, McCrindle B, Grisaru S, Pringsheim T. Les recommandations de prise en charge des complications métaboliques associées aux antipsychotiques de deuxième génération chez les enfants et les adolescents. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_b.5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Josephine Ho
- Département de pédiatrie, université de Calgary, Calgary (Alberta)
| | | | - Brian McCrindle
- département de pédiatrie, université de Toronto, Toronto (Ontario)
| | - Silviu Grisaru
- Département de pédiatrie, université de Calgary, Calgary (Alberta)
| | - Tamara Pringsheim
- département de neurosciences cliniques et de pédiatrie, université de Calgary (Alberta)
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Ho J, Panagiotopoulos C, McCrindle B, Grisaru S, Pringsheim T. [Not Available]. Paediatr Child Health 2012; 17:5B-11B. [PMID: 24082815 PMCID: PMC3486686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2011] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Second-generation antipsychotics are commonly associated with metabolic complications. These medications are being used more frequently for the treatment of mental health disorders in children, which has stimulated the need for creating formal guidelines on monitoring their safety and effectiveness. Previous guidelines have been developed for monitoring metabolic and neurological complications. To assist practitioners who perform these monitoring procedures, a complementary set of treatment recommendations have been created for situations in which abnormal measurements or results are encountered. OBJECTIVE To create evidence-based recommendations to assist in managing metabolic complications in children being treated with second-generation antipsychotics. METHODS A systematic review of the literature on metabolic complications of second-generation antipsychotic medications in children was conducted. Members of the consensus group evaluated the information gathered from the systematic review of the literature and used a nominal group process to reach a consensus on treatment recommendations. Wherever possible, references were made to existing guidelines on the evaluation and treatment of metabolic abnormalities in children. RESULTS Evidence-based recommendations are presented to assist in managing metabolic complications including weight gain; increased waist circumference; elevation in prolactin, cholesterol, triglyceride and glucose levels; abnormal liver function tests; and abnormal thyroid studies. CONCLUSION The use of second-generation antipsychotics requires proper monitoring procedures. The present treatment guideline provides guidance to clinicians on the clinical management of metabolic complications if they occur.
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Affiliation(s)
- Josephine Ho
- Département de pédiatrie, université de Calgary, Calgary (Alberta)
| | | | - Brian McCrindle
- département de pédiatrie, université de Toronto, Toronto (Ontario)
| | - Silviu Grisaru
- Département de pédiatrie, université de Calgary, Calgary (Alberta)
| | - Tamara Pringsheim
- département de neurosciences cliniques et de pédiatrie, université de Calgary (Alberta)
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Conway J, Edwards L, Kirk R, McCrindle B, Manlhiot C, Dipchand A. 21 Risk Factors for and Risk of Graft Loss after Pediatric Heart Retransplantation: Analysis of the ISHLT Registry. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Taylor K, Manlhiot C, McCrindle B, Grosse-Wortmann L, Holtby H. Poor accuracy of noninvasive cardiac output monitoring using bioimpedance cardiography [PhysioFlow(R)] compared to magnetic resonance imaging in pediatric patients. Anesth Analg 2012; 114:771-5. [PMID: 22314693 DOI: 10.1213/ane.0b013e318246c32c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Identification of low cardiac output (CO) states in anesthesia is important because preoperative hemodynamic optimization may improve outcome in surgery. Accurate real-time CO measurement would be useful in optimizing "goal-directed" therapy. We sought to evaluate the reliability and accuracy of CO measurement using bioimpedance cardiography (PhysioFlow®, NeuMeDx, Bristol, PA) in pediatric patients with and without cardiac disease undergoing anesthesia for magnetic resonance imaging (MRI). METHODS All consenting patients undergoing anesthesia for cardiac MRI were enrolled. After equilibration of anesthesia for ≥10 minutes, 6 PhysioFlow electrodes were applied to the patient's chest for continuous real-time monitoring for 10 minutes. Data were stored in 15-second epochs and later averaged offline to obtain CO. Phase contrast MRI measurements of flow volumes in the superior vena cava and ascending and descending aorta were made from a single imaging plane through all 3 vessels at the level of the right pulmonary artery. Both CO measurements were indexed to body surface area. The anesthetic technique was the same for both measurements. Agreement was assessed using Bland-Altman analysis. RESULTS Thirty-one patients were enrolled and 23 were analyzed. The median age at study was 2.8 years (range, 0.02-8.02 years) and median body surface area was 0.54 m(2) (range, 0.21-1.00 m(2)). Eleven of the 23 patients (48%) were males. Patients were grouped into those with univentricular physiology, 6 of 23 (26%); biventricular physiology with shunt, 3 of 23 (13%); biventricular without shunt, 10 of 23 (43%); and no structural heart disease, 4 of 23 (17%). The mean bias was -0.34 ± 1.50 L/min/m(2) (P = 0.29). The 95% limits of agreement were -3.21 to +2.69 L/min/m(2). Only 8 of 23 measurements (35%) were within 20% and 14 of 23 measurements (61%) were within 30% of each other. CONCLUSION PhysioFlow performance was not sufficiently accurate in this population. Modifications of the algorithm and further testing are required before this device can be recommended for routine clinical use in pediatric patients.
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Affiliation(s)
- Katherine Taylor
- Department of Anesthesia, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada.
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Prakash A, Lacro RV, Sleeper LA, Minich LL, Colan SD, McCrindle B, Covitz W, Golding F, Hlavacek AM, Levine JC, Cohen MS. Challenges in echocardiographic assessment of mitral regurgitation in children after repair of atrioventricular septal defect. Pediatr Cardiol 2012; 33:205-14. [PMID: 21909774 PMCID: PMC3265615 DOI: 10.1007/s00246-011-0107-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/19/2011] [Indexed: 01/17/2023]
Abstract
The validity and reproducibility of echocardiographic methods used to quantify mitral regurgitation (MR) in children with congenital heart disease are unknown. We evaluated the usefulness of methods used to quantify MR in children enrolled in a multicenter trial of enalapril 6 months after surgical repair of an atrioventricular septal defect (AVSD). MR severity in this trial was assessed using body surface area (BSA)-adjusted vena contracta lateral (i-VCW(lat)) and anterior-posterior (i-VCW(ap)) dimensions and cross-sectional area (i-VCA), regurgitant volume/BSA, regurgitant fraction, and qualitative MR grade. For each method, association with left ventricular end-diastolic volume (LVEDVz) and end-diastolic dimension (LVEDDz) z-scores and interobserver agreement were assessed. In 149 children (median age 1 year), i-VCW(lat), i-VCW(ap), and i-VCA were best associated with LVEDVz (r (2) = 0.54, r (2) = 0.24, and r (2) = 0.46, respectively; p < 0.001 for all) and showed the highest interobserver agreement (intraclass correlation coefficient = 0.62, 0.73, and 0.68, respectively). Qualitative MR grade was also associated with LVEDVz (r (2) = 0.31, p < 0.001) and showed modest interobserver agreement (kappa 0.56). Regurgitant volume/BSA and regurgitant fraction were associated with LVEDVz (r (2) = 0.45 and r (2) = 0.45, p < 0.001 for both) but showed poor interobserver agreement [ICC = 0.28 (n = 91) and ICC = 0.17 (n = 76), respectively], and their values were negative in 75% of subjects. In conclusion, echocardiographic assessment of MR severity after AVSD remains challenging. Among the quantitative methods used in this trial, i-VCW and i-VCA performed the best but offered little advantage compared with qualitative MR grade. The utility of regurgitant volume and fraction was severely limited by poor interobserver agreement and frequently negative values.
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Affiliation(s)
- Ashwin Prakash
- Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
| | - Ronald V. Lacro
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | | | | | - Steven D. Colan
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA. New England Research Institutes, Watertown, MA, USA
| | | | - Wesley Covitz
- Wake Forest University Health Sciences, Winston Salem, NC, USA
| | | | | | - Jami C. Levine
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Meryl S. Cohen
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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44
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Ho J, Panagiotopoulos C, McCrindle B, Grisaru S, Pringsheim T. Management recommendations for metabolic complications associated with second-generation antipsychotic use in children and youth. Paediatr Child Health 2011; 16:575-80. [PMID: 23115501 PMCID: PMC3223901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2011] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Second-generation antipsychotics are commonly associated with metabolic complications. These medications are being used more frequently for the treatment of mental health disorders in children, which has stimulated the need for creating formal guidelines on monitoring their safety and effectiveness. Previous guidelines have been developed for monitoring metabolic and neurological complications. To assist practitioners who perform these monitoring procedures, a complementary set of treatment recommendations have been created for situations in which abnormal measurements or results are encountered. OBJECTIVE To create evidence-based recommendations to assist in managing metabolic complications in children being treated with second-generation antipsychotics. METHODS A systematic review of the literature on metabolic complications of second-generation antipsychotic medications in children was conducted. Members of the consensus group evaluated the information gathered from the systematic review of the literature and used a nominal group process to reach a consensus on treatment recommendations. Wherever possible, references were made to existing guidelines on the evaluation and treatment of metabolic abnormalities in children. RESULTS Evidence-based recommendations are presented to assist in managing metabolic complications including weight gain; increased waist circumference; elevation in prolactin, cholesterol, triglyceride and glucose levels; abnormal liver function tests and abnormal thyroid studies. CONCLUSION The use of second-generation antipsychotics requires proper monitoring procedures. The present treatment guideline provides guidance to clinicians on the clinical management of metabolic complications if they occur.
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Affiliation(s)
- Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, Alberta
| | | | - Brian McCrindle
- Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Silviu Grisaru
- Department of Pediatrics, University of Calgary, Calgary, Alberta
| | - Tamara Pringsheim
- Department of Clinical Neurosciences and Pediatrics, University of Calgary, Calgary, Alberta
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Chahal N, McCrindle B, Manlhiot C, Wong H. N005 A 4-week randomized clinical trial of flaxseed supplementation in children with hypercholesterolemia. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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46
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Banks L, McCrindle B, Russell J, Longmuir P. 050 Normal Physiological Response to Sub-Maximal Exercise in Children After the Fontan Procedure. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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47
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Ho J, Panagiotopoulos C, McCrindle B, Grisaru S, Pringsheim T. Management recommendations for metabolic complications associated with second generation antipsychotic use in children and youth. J Can Acad Child Adolesc Psychiatry 2011; 20:234-41. [PMID: 21804854 PMCID: PMC3143701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Second generation antipsychotics (SGAs) are commonly associated with metabolic complications. These medications are being used more frequently for the treatment of mental health disorders in children, which has stimulated the need for creating formal guidelines on monitoring their safety and effectiveness. Previous guidelines have been developed for monitoring for metabolic and neurological complications. In order to assist practitioners who perform these monitoring procedures, we have created a complementary set of treatment recommendations if abnormal measurements or results are encountered. OBJECTIVE To create evidence-based recommendations to assist in managing metabolic complications in children being treated with second generation antipsychotics. METHODS A systematic review of the literature on metabolic complications of second generation antipsychotic medications in children was conducted. Members of the consensus group evaluated the information gathered from the systematic review of the literature and used a nominal group process to come to consensus on treatment recommendations. Wherever possible, references were made to existing guidelines on the evaluation and treatment of metabolic abnormalities in children. RESULTS Evidence-based recommendations are presented to assist in managing metabolic complications, including weight gain, increased waist circumference, elevation in cholesterol, triglycerides and glucose, liver function tests, abnormal thyroid studies, and elevation in prolactin. CONCLUSION The use of SGAs requires proper monitoring procedures. This treatment guideline provides guidance to clinicians on clinical management of metabolic complications if they occur.
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48
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Walpole B, Dettmer E, Morrongiello B, McCrindle B, Hamilton J. Motivational interviewing as an intervention to increase adolescent self-efficacy and promote weight loss: methodology and design. BMC Public Health 2011; 11:459. [PMID: 21663597 PMCID: PMC3144459 DOI: 10.1186/1471-2458-11-459] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 06/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood obesity is associated with serious physiological and psychological consequences including type 2 diabetes, higher rates of depression and low self-esteem. With the population of overweight and obese youth increasing, appropriate interventions are needed that speak to the issue of readiness to change and motivation to maintain adherence to healthy behavior changes. Motivational Interviewing (MI) is a method of therapy found to resolve ambivalence, enhance intrinsic motivation and promote confidence in a person's ability to make behavior changes. While MI has shown promise in the adult obesity literature as effecting positive lifestyle change, little is known about the effectiveness of MI with overweight and obese youth. This study aims to: 1) demonstrate that MI is an effective intervention for increasing a person's self-efficacy; 2) demonstrate that exposure to MI will facilitate healthy behavior changes; 3) explore psychological changes related to participation in MI and 4) compare physiological and anthropometric outcomes before and after intervention. METHODS/DESIGN The current investigation is a prospective study conducted with ongoing participants who regularly attend an outpatient pediatric care center for weight-loss. Overweight youth (BMI > 85th %ile) between the ages of 10 and 18 who meet eligibility criteria will be recruited. Participants will be randomly assigned to a control group (social skills training) or a treatment group (MI). Participants will meet with the therapist for approximately 30 minutes prior to seeing the dietician, over the course of 6 months. Participants will also undergo a full day assessment at the beginning and end of psychology intervention to evaluate body fat, and metabolic risk (screening for diabetes, high cholesterol, high blood pressure and fitness level). The paper and pencil portions of the assessments as well as the clinical testing will occur at baseline and at the conclusion of the intervention (6 months) with a repeat assessment 6 months following the completion of the intervention. DISCUSSION Results from this study are expected to enhance our understanding of the efficacy of MI with children and adolescents who are overweight or obese.
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Affiliation(s)
- Beverly Walpole
- Division of Endocrinology, Hospital for Sick Children, Toronto, Canada
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49
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Sehgal A, Mak W, Dunn M, Kelly E, Whyte H, McCrindle B, McNamara PJ. Haemodynamic changes after delivery room surfactant administration to very low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2010; 95:F345-51. [PMID: 20538711 DOI: 10.1136/adc.2009.173724] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Surfactant replacement therapy (SRT) reduces respiratory morbidity and mortality in premature infants. The goal of this study was to characterise the effects of delivery room SRT on the ductus arteriosus and early neonatal haemodynamics. METHODS A prospective observational study was conducted in preterm infants of less than 32 weeks' gestation who received SRT within 30 min of birth. Serial echocardiography was performed before and after SRT. Characteristics of the ductus arteriosus, myocardial performance, right ventricular output (RVO) and left ventricular output (LVO) and the ratio of RVO:LVO were measured. RESULTS Sixteen babies, born at 28.3+/-1.3 weeks' gestation and weighing 1289+/-224 g, were studied. SRT was associated with an improvement in the arterial oxygen tension:fractional inspired oxygen ratio (p<0.001), increased systolic and decreased diastolic arterial pressure (p<0.05). The ductus arteriosus was patent in all and transductal flow was unrestrictive and exclusively left-to-right after SRT. An increase in transductal diameter (p<0.001), left atrium:aortic ratio (p=0.006) but a decrease in left ventricular end-diastolic dimension (p=0.02) was identified. CONCLUSION SRT administration was followed by increased RVO but decreased LVO, resulting in an increased RVO:LVO ratio and an increase in ductal size. Delivery room administration of SRT is associated with major haemodynamic changes. The impact of these changes needs prospective evaluation.
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Affiliation(s)
- Arvind Sehgal
- Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
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50
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Urbina EM, Williams RV, Alpert BS, Collins RT, Daniels SR, Hayman L, Jacobson M, Mahoney L, Mietus-Snyder M, Rocchini A, Steinberger J, McCrindle B. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension 2009; 54:919-50. [PMID: 19729599 DOI: 10.1161/hypertensionaha.109.192639] [Citation(s) in RCA: 467] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Deterioration in endothelial function and arterial stiffness are early events in the development of cardiovascular diseases. In adults, noninvasive measures of atherosclerosis have become established as valid and reliable tools for refining cardiovascular risk to target individuals who need early intervention. With limited pediatric data, the use of these techniques in children and adolescents largely has been reserved for research purposes. Therefore, this scientific statement was written to (1) review the current literature on the noninvasive assessment of atherosclerosis in children and adolescents, (2) make recommendations for the standardization of these tools for research, and (3) stimulate further research with a goal of developing valid and reliable techniques with normative data for noninvasive clinical evaluation of atherosclerosis in pediatric patients. Precise and reliable noninvasive tests for atherosclerosis in youth will improve our ability to estimate future risk for heart attack and stroke. Currently, large longitudinal studies of cardiovascular risk factors in youth, such as the Bogalusa and Muscatine studies, lack sufficient adult subjects experiencing hard outcomes, such as heart attack and stroke, to produce meaningful risk scores like those developed from Framingham data.
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