Anna Children Research Articles

Clemens von Pirquet

Clemens Peter Freiherr von Pirquet, a great physician-scientist who described serum sickness and opened the field of allergy, was born in Hirschstetten near Vienna on 12 May 1874 into a...

A Web-Based Mobile App (INTERACCT App) for Adolescents Undergoing Cancer and Hematopoietic Stem Cell Transplantation Aftercare to Improve the Quality of Medical Information for Clinicians: Observational Study.

BackgroundA growing number of cancer and hematopoietic stem cell transplant (HSCT) survivors require long-term follow-up with optimal communication schemes, and patients' compliance is crucial. Adolescents have various unmet needs. Regarding self-report of symptoms and health status, users of mobile apps showed enhanced compliance. Currently, HSCT aftercare at the HSCT outpatient clinic of the St. Anna Children’s Hospital in Vienna, Austria, is based on handwritten diaries, carrying various disadvantages. Recently, we developed the prototype of a web-based, self-monitoring gamified mobile app tailored for adolescents: the INTERACCT (Integrating Entertainment and Reaction Assessment into Child Cancer Therapy) app.ObjectiveThis observational, prospective study evaluated the usability of the INTERACCT app for tracking real-time self-reported symptoms and health status data in adolescent HSCT patients and a healthy matched control group. The primary outcome of the study was the quality of the self-reported medical information. We hypothesized that the mobile app would provide superior medical information for the clinicians than would the handwritten diaries.MethodsHealth data were reported via paper diary and mobile app for 5 consecutive days each. The quality of medical information was rated on a 5-point scale independently and blinded by two HSCT clinicians, and the duration of use was evaluated. A total of 52 participant questionnaires were assessed for gaming patterns and device preferences, self-efficacy, users’ satisfaction, acceptability, and suggestions for improvement of the mobile app. Interrater reliability was calculated with the intraclass correlation coefficient, based on a two-way mixed model; one-way repeated-measures analysis of variance and t tests were conducted post hoc. Descriptive methods were used for correlation with participants’ demographics. For users’ satisfaction and acceptability of the mobile app, the median and the IQR were calculated.ResultsData from 42 participants—15 patients and 27 healthy students—with comparable demographics were evaluated. The results of our study indicated a superiority of the quality of self-reported medical data in the INTERACCT app over traditional paper-and-pencil assessment (mobile app: 4.14 points, vs paper-based diary: 3.77 points, P=.02). The mobile app outperformed paper-and-pencil assessments mainly among the patients, in particular among patients with treatment-associated complications (mobile app: 4.43 points, vs paper-based diary: 3.73 points, P=.01). The mobile app was used significantly longer by adolescents (≥14 years: 4.57 days, vs ≤13 years: 3.14 days, P=.03) and females (4.76 days for females vs 2.95 days for males, P=.004). This corresponds with a longer duration of use among impaired patients with comorbidities. User satisfaction and acceptability ratings for the mobile app were high across all groups, but adherence to entering a large amount of data decreased over time. Based on our results, we developed a case vignette of the target group.ConclusionsOur study was the first to show that the quality of patient-reported medical information submitted via the INTERACCT app embedded in a serious game is superior to that submitted via a handwritten diary. In light of these results, a refinement of the mobile app supported by a machine learning approach is planned within an international research project.

Human papillomavirus in female adolescents and young adults after allogeneic hematopoietic stem cell transplantation-Not a problem prior to coitarche.

To evaluate the prevalence of HPV colonization in female adolescents and young adults after allogenic hematopoietic stem cell transplantation. In this prospective pilot study, we enrolled 18 girls and young women aged 12-22years cared for at the SCT (stem cell transplantation) Outpatient Clinic of the St. Anna children's hospital. Vaginal, buccal, and rectal HPV swabs were collected twice at intervals of 2-6months at the Outpatient Clinic for children's and adolescents' gynecology of the University Clinic for Gynecology Vienna. Overall, 3 (16.7%; 95% CL [≥0.0%; 33.9%]) of the 18 patients were vaginally HPV-positive at least at one timepoint. Among these three, two patients belonged to the smaller sub-group (3 patients) of patients after coitarche and one patient belonged to the larger one (15 patients) of patients prior to coitarche. In one of the three vaginally HPV-positive patients, we also found HPV DNA rectally. Orally, HPV DNA could not be detected at all. According to the data of this study, vaginal, buccal, and rectal HPV colonization seems to be of little relevance in girls and young women after HSCT prior to coitarche. As expected, a higher risk for vaginal HPV colonization could be shown by trend for patients after coitarche, but also for those having been treated with total body irradiation as a conditioning regimen and for those showing signs of vaginal hypoestrogenization-which has not been published so far.

Antibiotic prophylaxis with teicoplanin on alternate days reduces rate of viridans sepsis and febrile neutropenia in pediatric patients with acute myeloid leukemia

Intensive chemotherapy directed against acute myeloid leukemia of childhood is followed by profound neutropenia and high risk for bacterial and fungal infections, including viridans group streptococci as a common cause for gram-positive septicemia. Few retrospective studies have shown the efficacy of various antibiotic prophylactic regimens in children. We retrospectively studied 50 pediatric patients treated on the AML-BFM 2004 protocol between 2005 and 2015 at St. Anna Children’s Hospital and assessed the effect of antibiotic prophylaxis on the frequency of febrile neutropenia and bacterial sepsis. Fifty pediatric patients underwent 199 evaluable chemotherapy cycles. Viridans sepsis occurred after none of 98 cycles with prophylactic administration of teicoplanin/vancomycin in comparison to 12 cases of viridans sepsis among 79 cycles without systemic antibacterial prophylaxis (0 vs. 15 %, p < 0.0001). In addition, there were significantly fewer episodes of febrile neutropenia in the teicoplanin/vancomycin group (44 % vs. no prophylaxis 82 %, p < 0.0001). Severity of infection seemed to be worse when no antibiotic prophylaxis had been administered with a higher rate of intensive care unit treatment (0/98, 0 %, vs. 4/79, 5 %, p = 0.038). So far, no increase of vancomycin-resistant enterococcus isolates in surveillance cultures was noticed. Antibiotic prophylaxis with teicoplanin (or vancomycin) appears safe and feasible and resulted in eradication of viridans sepsis and decreased incidence of febrile neutropenia in pediatric AML patients. The possibility to administer teicoplanin on alternate days on an outpatient basis or at home could contribute to patient’s quality of life and decrease health care costs.

Isolated cutaneous Langerhans cell histiocytosis in a premature baby: What is the optimal approach?

Manuscript ID: PBC-12-0453.R1 Wiley - Manuscript type: Letter to the Editor Date Submitted by the Author: 15-Aug-2012 Complete List of Authors: Herbruggen, Heidrun; St. Anna Children´s Hospital, Lakatos, Karoly; St. Anna Children's Hospital, Radiology Gadner, Helmut; St. Anna Children´s Hospital, Hematology/Oncology Minkov, Milen; St. Anna Children´s Hospital, Hematology/Oncology Keywords: histiocytosis X, cutaneous, premature, newborn, thymus

Asparagine and aspartic acid concentrations in bone marrow versus peripheral blood during Berlin–Frankfurt–Münster-based induction therapy for childhood acute lymphoblastic leukemia

A recent study suggested that mesenchymal cells in bone marrow (BM) may counteract l-asparaginase (L-Asp)-containing acute lymphoblastic leukemia (ALL) therapy by secreting asparagine. Herein, we compared asparagine and aspartic acid concentrations in the BM and peripheral blood (PB), in order to determine whether this in vitro observation could be translated into in vivo differences of amino acid levels between both compartments. Asparagine and aspartic acid concentrations in BM (days 15 and 33) and PB (days 12, 15 and 33) were measured during L-Asp-containing Berlin–Frankfurt–Münster (BFM)-based 5-week multi-agent remission induction therapy in 11 children diagnosed with ALL at the St. Anna Children's Hospital in Vienna, Austria. The level of asparagine depletion did not differ significantly between both compartments at any time point measured, but aspartic acid concentrations were significantly higher in BM than PB at days 15 and 33 (p < 0.05). In the context of the reported mesenchymal asparagine production in BM, an increased asparagine production may indeed take place in BM. However, it may be overcome by continuous action of L-Asp, which is mirrored by increased aspartic acid levels but unchanged low asparagine levels in BM, suggesting a higher BM turnover of asparagine generated by L-Asp during induction therapy.

Theodor Escherich: The First Pediatric Infectious Diseases Physician?

The career of Theodor Escherich (1857-1911) qualifies him as the first pediatric infectious diseases physician. His landmark bacteriologic studies identified the common colon bacillus (now known as Escherichia coli), and he was very committed to pediatrics, serving as chairman of several prominent departments of pediatrics, including the Department of Pediatrics at the University of Vienna and St. Anna's Children's Hospital in Vienna, Austria, arguably Europe's most prestigious pediatric position.

Detection of the episomal, linear, and integrated Epstein-Barr virus genome in human infected cells: [formula omitted], Helmut Gadner, Peter F. Ambros; CCRI, St. Anna Children's Hospital, Kinderspitalgasse 6, A-1090 Vienna

Detection of the episomal, linear, and integrated Epstein-Barr virus genome in human infected cells: [formula omitted], Helmut Gadner, Peter F. Ambros; CCRI, St. Anna Children's Hospital, Kinderspitalgasse 6, A-1090 Vienna