- Volume:4 Issue: 2, 2016
- تاریخ انتشار: 1395/06/10
- تعداد عناوین: 9
The Role of Urinary Biomarker Levels in Assessing the Presence and Severity of Ureteropelvic Junction Obstruction in Children: A Systematic Review and Meta-AnalysisPage 1Context: Ureteropelvic junction obstruction (UPJO) is the most common obstructive disease of the urinary tract in infancy and childhood with a prevalence of 15% - 45% in neonates with antenatal hydronephrosis. The diagnosis of UPJO should be confirmed by imaging studies - most of which have a propensity to radiation exposure.ObjectivesThe current study aimed to present a review protocol to assess the role of measuring urinary biomarkers to distinguish severe UPJO from milder forms of the disease.
Data Sources: The database of UPJO studies was searched and studies that compared the levels of urinary biomarkers with the gold standard (i e, dynamic renal scans) for UPJO diagnosis were selected. Severity assessment was done quantitatively.
Study Selection: Three hundred fifty-eight articles were identified across the electronic databases. Twenty-seven articles were selected for the final analyses.
Data Extraction: Data were extracted independently by three reviewers and analyzed using STATA software version 12.ResultsMeta-analysis of studies showed that patients with severe UPJO had significantly higher biomarker levels than those with mild to moderate obstruction, with a pooled standardized mean difference (SMD) of 0.5 (confidence interval (CI) 95%, 0.34 - 0.67; PConclusionsThe assessment of urinary biomarkers is a helpful tool to assess the presence and severity of UPJO, but there is little published data on each of the studied biomarkers. It is suggested to perform future larger multicenter studies.Keywords: Urinary Biomarker, Ureteropelvic Junction Obstruction, Children, Systematic Review, Meta, Analysis
Page 2Context: Recently, new anti-epileptic drugs are marketed to be used as an add-on to the traditional drugs in children with refractory epilepsy. Levetiracetam is a second-generation of new anti-epileptic drugs with unknown precise mechanism of action in brain and synaptic vesicle in children with drug resistant epilepsy. Herein, the efficacy and safety of add-on levetiracetam in children with refractory epilepsy is reviewed.
Evidence Acquisition: A literature review was performed on efficacy and safety of add-on Levetiracetam in children with refractory epilepsy using international databases with the following terms: levetiracetam, refractory epilepsy, drug resistant epilepsy, seizures/epilepsy, children/pediatric. All articles related to add-on levetiracetam in children with refractory epilepsy written in English and published from 2000 to 2015 were included. The title and abstracts of 542 articles were assessed, of which, 488 were excluded. The full texts of the other 54 articles were assessed for relevance.ResultsOf the nine eligible articles, 1036 patients aged ≤ 18 years were identified. Male patients (52%) were more prominent than female ones. Five articles reported that levetiracetam therapy appeared more effective against localization-related than generalized epilepsy. The dosage of levetiracetam ranged from 6 to 70 mg/kg/day, with a mean of 43.2 mg/kg/day based on the mean doses reported by four of nine reviewed articles. The mean duration of follow-up was 39 weeks (ranging from 8 - 144 weeks). Administration of levetiracetam was effective in 42.24% of the patients (responders with >50% decrease in seizure frequency), of whom 11.8% had become seizure free. The mean number of anti-epileptic drugs tried before introducing levetiracetam treatment was 4.4 (ranging 1 - 20). The most frequent side effects were psychological and behavioral changes (11.1%), followed by agitation (9.2%) and sleep disturbances (6.7%).ConclusionsThe current review demonstrated that levetiracetam, as an add-on therapy, is an effective and well-tolerated anti-epileptic drug, associated with reversible and no serious side effects, to control seizure frequency of childhood refractory epilepsy.Keywords: Levetiracetam, Epilepsy, New Antiepileptic Drug, Childhood Refractory Epilepsy
Alterations in Humoral Immunity After Partial Versus Total Tonsillectomy: A Pilot Study and Systematic Review of LiteraturePage 3BackgroundThe palatine tonsils are secondary lymphoid organs, important in sampling antigens directly from the epithelial surfaces. They produce antibodies locally and distally through their migrating B cells.ObjectivesThe aim of this study was to compare the changes in serum and saliva immunoglobulin (Ig) levels after total vs. partial tonsillectomy and also to systematically review the literature regarding the changes in humoral immunity following tonsillar surgery.
Patients andMethodsChildren with obstructive tonsils were recruited in a pilot study and randomized to undergo total or partial tonsillectomy. Blood and saliva samples were obtained immediately preoperatively and within 3 months postoperatively, to measure serum Ig (G, M and A) and saliva secretory IgA concentrations. Patients clinical history was reviewed at one year postoperatively. Systematic literature review regarding the effects of tonsillar surgery on humoral immunity was performed, using Medline, Embase and Cochrane.ResultsNineteen patients completed the study (11 partial, 8 total). No statistically significant changes noted in the serum Igs level in both groups, except for IgM which increased (P = 0.018) after partial tonsillectomy, mainly in males (P = 0.04), and in those aged 5 years and older (P = 0.02). There was noticeable decrease in susceptibility to infections. Four out of 30 studies (406 out of 1796 patients) showed decrease in some elements of the humoral immunity or suspected a negative impact of tonsillectomy on the immune system.ConclusionsPartial tonsillectomy does not seem to offer an immunological advantage over total tonsillectomy. The literature does not imply a significant negative impact of tonsillectomy on the humoral immune system.Keywords: Humoral Immunity, Partial Vs, Total Tonsillectomy, Serum, Saliva Immunoglobulin
Pediatric Endoscopic Third Ventriculostomy: A Narrative Review of Current Indications, Techniques and ComplicationsPage 4Hydrocephalus is a disorder in which excess cerebrospinal fluid (CSF) collects in the brain. Possible managements for hydrocephalus contain CSF deviation through ventriculoperitoneal shunt assignment and endoscopic third ventriculostomy. An endoscopic third ventriculostomy has been in trend for the past two decades, as a tool in the field of the neurosurgery, for the management of hydrocephalus. Its utility has been confirmed consistently in congenital and acquired aqueductal stenosis, although the outcomes in communicating hydrocephalus and hydrocephalus secondary to other etiologies have not been impressive. It is a relatively harmless technique with the appropriate selection of patients with a low rate of enduring morbidity. Further studies in child should focus on the predictive factors that are specific to the older population. A combination of clinical, radiological, and intraoperative findings may be necessary to plan a clinical prediction rule suitable to this group of patients. The purpose of this review is to describe the current indications, management outcomes, techniques and complications of this method.Keywords: Pediatric, Endoscopic Third Ventriculostomy, Hydrocephalus
Page 5Context: Necrotizing enterocolitis (NEC) remains one of the most common causes of morbidity and mortality for premature infants in the neonatal intensive care unit (NICU). Many theories concerning its pathophysiology and inciting factors have been suggested but progression in preventing the onset of NEC has been minimal. While this article highlights the pathophysiology, management, and outcomes of NEC, it mainly serves as a narrative review to discuss the emerging methods of treatment and prevention.
Evidence Acquisition: A literature search was done using Medline/Pub Med, Cochrane Database of Systematic Reviews via Ovid, and CINAHL Complete with focus on articles published between 2000 and 2016. Searched terms included the following: necrotizing enterocolitis, pathogenesis, prevention, management, breast milk, formula, probiotics, prebiotics, and treatment.ResultsIntestinal barrier dysfunction, hypoxic ischemic injury, receipt of packed red blood cells, immature intestinal immunity and alterations of the gut microbiome of the premature infant were reviewed factors that have been studied related to the pathophysiology of NEC. The presentation, staging and management remain relatively unchanged in the last few decades, though there have been a few studies evaluating different surgical options, various antibacterial regimen, and recently use of moderate hypothermia and amniotic fluid stem cells to treat NEC. Use of breast milk, use of pre-, pro- and postbiotics show promise in the prevention of NEC.ConclusionsNEC is a likely multifactorial illness of the gastrointestinal tract affecting mostly premature infants. Recent studies have focused on preventative strategies, with promise in pre-, pro- and postbiotics; however continued research is imperative.Keywords: Necrotizing Enterocolitis, Prevention, Treatment, Narrative Review
Page 6Nowadays, acute pancreatitis is not a rare disease in children and adolescences and the incidence of the disease has increased in pediatric patients over the past two decades. Acute pancreatitis in children can be triggered by a wide array of factors such as drugs, infections, trauma, anatomic anomalies and metabolic disorders. The signs and symptoms of acute pancreatitis are non-specific with an age- related pattern. The most common symptoms are upper abdominal pain and vomiting. Other less common signs and symptoms include abdominal discomfort, tachycardia, fever, and hypotension, jaundice and back pain. Since the signs and symptoms of acute pancreatitis are non-specific, it should be considered during the differential diagnosis of abdominal pain in children and needs prompt treatment because it may become a life-threatening disorder. Diagnosis of acute pancreatitis is principally achieved by meeting two of the following criteria: compatible clinical symptoms including abdominal pain, nausea, vomiting, or back pain; > 3 fold increase in serum amylase and/or lipase; presence of radiographic evidence including pancreatic edema on ultrasound or computed tomography. To provide a framework to review the diagnosis in pediatrics and identify evidence-based guidelines to manage acute pancreatitis in children, the current concepts on the diagnosis and treatment of pediatric acute pancreatitis are summarized.Keywords: Acute Pediatric Pancreatitis, Diagnosis, Treatment
Page 7Context: Folates are B-vitamins that cannot be generated de novo and are therefore obtained from the diet. In the brain, these vitamins are involved in nucleotide synthesis, DNA repair, lipid metabolism, methylation and neurotransmitter synthesis. It is well established that adequate levels of maternal folates are required for closure of the neural tube within the first month of pregnancy, however, it is not clear whether maternal folates are needed throughout pregnancy for brain development and whether they influence offspring neurological function after birth. The aim of this review is to outline current literature from epidemiological and animal model studies that shows maternal supplementation of folates throughout pregnancy does indeed affect offspring neurological function after birth.
Evidence Acquisition: A Medline search was performed using the following mesh terms, maternal-fetal exchange, folic acid, offspring neurologic manifestations, methylenetetrahydrofolate reductase (MTHFR), embryology, and behavior.ResultsThe studies described in the present review have reported that maternal deficiencies in folates during pregnancy result in changes in behavior as well as in blood and brain tissue in offspring, including altered methylation, including reduced levels of the global methyl donor S-adenosylmethionine (SAM), and increased levels of oxidative stress.ConclusionsThe data summarized here outlines the importance of adequate levels of folates throughout pregnancy to facilitate appropriate neurological development of offspring after birth.Keywords: Behaviour, Embryology, Folic Acid, Maternal Fetal Exchange, Methylenetetrahydrofolate Reductase (MTHFR), Narrative Review, Neuologic Manifestations, Offspring Neurological Model
Page 8Drug-induced hypersensitivity syndrome (DHS), also named drug rash with Eosinophilia and systemic symptoms (DRESS) is a potentially dangerous side effect of some drugs, especially antiepileptic drugs (AEDs) such as phenobarbital, phenytoin, carbamazepine, lamotrigine, primidone, etc. It can also be caused by other drugs, such as sulfonamides and captopril. Diagnosis of DHS may be difficult because of the variety of clinical and laboratory abnormalities and manifestations and because the syndrome may mimic infectious or collagen vascular disorders. Management includes immediate withdrawal of the culprit drug, supportive care and systemic steroids or Immunoglobulins (IVIG). Here, we briefly reviewed the literature, followed by a case report that had all of the criteria of DRESS without eosinophilia.Keywords: Phenobarbital, Drug Hypersensitivity Syndrome, Child, Case Report
Student Perceptions of the Educational Environment at the University of Nebraska Medical Center Department of PediatricsPage 9BackgroundDuring clinic training in medical school, the learning environment plays a pivotal role in molding medical students behavior. A systematic assessment of patient care learning environments needs to be conducted. With two medical schools utilizing limited pediatric patient base, student evaluations indicated dissatisfaction with inpatient and general clinic experiences.ObjectivesThe objective of this study was to generate a profile of clinic and inpatient strengths and weaknesses. This study received exempt approval.
Patients andMethodsThe Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to students over the course of 3 academic years after inpatient and clinic assignments (2-week deployments each) in the 8-week clerkship. DREEM identifies student academic self-perceptions, perceptions of teachers, and perceptions of the educational atmosphere. Fifty questions are rated from 4 = strongly agree to 0 = strongly disagree for a total of 200. Anonymous responses were grouped by assignment and analyzed using Kruskal-Wallis test. Participants were asked for up to 3 suggestions to improve the rotation. An immersion/crystallization framework was used to identify themes. Two authors independently coded suggestions, and then discussed the themes to reach a consensus.ResultsOverall results from DREEM indicated students perceptions were positive for different learning environments. No statistical differences were noted between subscales. Thematic analysis identified concerns with scheduling, lack of teaching, and non-specific feedback.ConclusionsDREEM did not identify measurable deficiencies in the learning environment. However, thematic analysis uncovered specific issues that are currently being addressed.Keywords: Learning Environment, Pediatrics, Qualitative Analysis, DREEM