Kg For Children Research Articles

Daptomycin Dose Optimization in Pediatric Staphylococcus aureus Bacteremia: A Pharmacokinetic/Pharmacodynamic Investigation.

Daptomycin is an antibiotic with Gram-positive activity, including methicillin-resistant Staphylococcus aureus, for which optimal pediatric dosing is unknown. This study aimed to evaluate daptomycin exposures achieved with package label dosing and to identify dosing regimens necessary to enhance efficacy and minimize toxicity in children with S. aureus bacteremia. Monte Carlo simulations were performed to determine probability of target attainment (PTA) for six pediatric age cohorts. Area under the curve to minimum inhibitory concentration ratio (AUC0-24:MIC) ≥666 was used to determine the PTA for efficacy (PTAE). Minimum concentration (Cmin) ≥24.3mg/L determined the PTA for toxicity (PTAT). Acceptable dosing regimens were those which achieved the combined target of ≥90% PTAE and ≤5% PTAT. Package label dosing of daptomycin yielded insufficient efficacy with only 26.3% PTAE in children 13-24 months, 39.5% PTAE in children 2-6 years, 30.1% PTAE in children 7-11 years, and 50.1% PTAE in adolescents ≥12 years. To achieve the combined efficacy and safety target, doses of 18-24mg/kg in children 3-12 months, 20-24mg/kg in children 13-24 months, 19-24mg/kg in children 2-6 years, 17-19mg/kg in children 7-11 years, and 10-14mg/kg in adolescents ≥12 years are necessary. Package label dosing resulted in suboptimal exposure for the majority of pediatric patients in all age groups evaluated. If targeting validated efficacy and safety endpoints, daily daptomycin doses of at least 20mg/kg in children ≤6 years, 17mg/kg in children 7-11 years, and 10mg/kg in adolescents ≥12 years are necessary. Clinical studies evaluating these higher doses are needed.

Unravelling the Risk of Poisoning From Nicotine-Containing Tobacco Products in Children Less Than Five Years of Age.

For decades, young children in the United States have been accidentally poisoned by traditional tobacco products and the yearly incidence has slowly increased. More poisonings have accompanied the introduction of new products such as e-cigarettes and dissolvable tobacco, with renewed public attention. Using toxicological principles of human health risk assessment, published data from prior exposures, and information about the content and characteristics of specific products, I estimated the acute toxicological risk from exposure to various types and quantities of tobacco products for children <5 years old. Approximate reference levels for a non-lethal oral dose of nicotine were derived: A higher level potentially requiring medical care (0.2mg per kg) and a lower level not potentially requiring medical care (0.04mg per kg). A weight-based oral lowest lethal dose (LDLO) of 1-14mg per kg in children <5 years old is estimated from the cited LDLOs in adults. I provide tables relating e-liquid concentration and volume to the oral LDLO in children <5years old by weight and describing the amount of other tobacco products expected to result in lethality. Communications about safe storage practices should focus on the benefits of keeping any nicotine-containing product out of the reach of young children, and adults can be reminded to always reengage child-resistant closures on packages and call a poison center for accidental exposures. Healthcare providers, families, or any member of the public can also make reports about unexpected health or safety concerns related to tobacco products to the FDA using its online Safety Reporting Portal at https://www.fda.gov/TobaccoProducts/PublicHealthScienceResearch/ucm377563.htm. Tobacco products, particularly electronic nicotine delivery system (ENDS) liquids are highly toxic to children <5 years old in small amounts. Given that the concentration of nicotine in ENDS is 3 to 72mg per mL, the lethal dose (LDLO) is expected to be 13-40mL in a bottle containing a solution of 3mg per mL liquid nicotine but may be as low as ½-2mL in a bottle containing a highly concentrated solution of 72mg per mL liquid nicotine. Features such as flow restrictors, child-resistant closures, and communication of safe storage practices to parents can help to lessen the morbidity and mortality from poisoning.

Body composition in early pubescent children with obesity: effects following 1 year of nonintervention.

Little is known about whether body composition changes differently between children with and without obesity following 1 year of nonintervention. Therefore, we investigated body composition in early pubescent children (8-12 yr) with and without obesity before and after a period of 1 year of nonintervention. Early pubescent children (8-12 yr; Tanner stage ≤ 3) with (body mass index, BMI ≥ 95th percentile) and without obesity (15th < BMI < 85th percentile) were recruited. At baseline, 88 children (n = 25 without obesity) completed dual-energy X-ray absorptiometry imaging (DXA) for body composition measurements [%body fat, fat mass, fat-free mass (FFM)]. One year later, 47 participants (n = 15 without obesity) returned for repeat testing. The children without obesity were older (11.0 ± 1.0 vs. 10.0 ± 1.2 yr; means ± SD) (P = 0.013). There was no group difference in height, and both groups increased in height similarly after 1 year (147.7 ± 8.9 to 154.5 ± 9.2 cm without vs. 145.6 ± 5.8 to 152.5 ± 5.9 cm with obesity) (P < 0.001). Weight was greater (P < 0.001) in children with obesity at baseline as was the increase in weight after 1 yr (9.25 vs. 5.82 kg) (interaction, P = 0.005). Fat mass increased by 4.4 kg in children with obesity and by 1.1 kg in children without obesity (interaction, P < 0.001). However, there was no difference in fat-free mass between those with and without obesity at baseline (29.9 ± 5.9 vs. 31.6 ± 4.8 kg) (P = 0.206) with both groups increasing similarly over 1 year (gain of 4.87 vs. 4.85 kg with and without obesity, respectively). Without intervention, the increase in fat mass is four times greater in children with obesity after 1 year as compared with children without obesity.NEW & NOTEWORTHY Little is known about changes in body composition in children with and without obesity following 1 year of nonintervention. We report that without intervention, fat mass gain is significantly greater in children with obesity after 1 year compared with those without obesity. Body mass index (BMI) and %body fat measurements after 1 year yielded no significant increase suggesting that BMI and %fat alone are not suitable measures for tracking changes in adiposity among children.

Substitution of sugar-sweetened beverages with non-caloric alternatives and weight change: A systematic review of randomized trials and meta-analysis.

Intake of sugar-sweetened beverages has been associated with weight gain. It is uncertain if replacing an existing use of sugar-sweetened beverages with non-caloric beverages results in long-term reduction in body weight. The objective of this study is to explore if a long-term reduction in body weight can be achieved by replacing an existing intake of sugar-sweetened beverages with non-caloric beverages. Systematic review and meta-analysis of randomized clinical trials in accordance with PRISMA guidelines. PubMed and EMBASE were searched for literature. Studies with a "substitution" design were included, that is, studies where subjects substituted an existing intake of sugar-sweetened beverages with either artificially sweetened beverages or unsweetened beverages/water. Studies with 6 months or longer follow-up of weight change were included. Six trials with a total of 1729 participants were included in the meta-analysis. Replacing an existing intake of sugar-sweetened beverages with a non-caloric beverage resulted in a long-term BMI reduction of 0.31 kg/m2 compared with the sugar-sweetened beverage-group (95% CI; 0.17-0.44). One study with 1 year's intervention and 2 years follow-up showed a regression towards baseline BMI after the intervention had ended. Replacing an existing use of sugar-sweetened beverages with artificially sweetened beverages or unsweetened beverages resulted in a long-term 0.31 kg/m2 reduction in BMI equivalent to 0.5-1 kg in children and adults, respectively, as long as the interventions lasted.

Potential risks of heavy metals in green mussels (Perna viridis) harvested from Cilincing and Kamal Muara, Jakarta Bay, Indonesia to human health

This study investigates Pb, Cd, and Cr in the suspended particulate matter (SPM), sediments, and green mussels from Cilincing and Kamal Muara, Jakarta Bay and estimates their potential human health risks. The results showed that the metal levels in SPM from Cilincing ranged from 0.81 to 1.69 mg/kg for Pb and 2.14 to 5.31 mg/kg for Cr, while in Kamal Muara ranged from 0.70 to 3.82 mg/kg for Pb and 1.88 to 4.78 mg/kg dry weight for Cr. The levels of Pb, Cd, and Cr in sediments from Cilincing ranged from 16.53 to 32.51 mg/kg, 0.91 to 2.52 mg/kg; and 0.62 to 1.0 mg/kg whereas in Kamal Muara ranged from 8.74 to 8.81 mg/kg; 0.51 to 1.79 mg/kg, and 0.27 to 0.31 mg/kg dry weight, respectively. The levels of Cd and Cr of green mussels in Cilincing ranged from 0.014 to 0.75 mg/kg and 0.003 to 0.11 mg/kg; while in Kamal Muara ranged from 0.015 to 0.073 mg/kg and 0.01 to 0.04 mg/kg wet weight, respectively. Pb was not detected in all samples of green mussels. The Pb, Cd, and Cr levels in the green mussels were still below the permissible limits set by international standards. However, the Target Hazard Quotient (THQ) for adult and children in several samples were higher than one indicating potential noncarcinogenic effects to consumers due to Cd accumulation. To reduce the detrimental effects of metals, we suggest maximum mussel consumption of 0.65 kg for adults and 0.19 kg for children in a week based on the highest level of metals.

Comparison of Intubating Conditions of Two Doses of Rocuronium Bromide with Succinylcholine in Children undergoing Elective Surgeries under General Anaesthesia- A Randomised Control Trial

Introduction: Succinylcholine is a muscle relaxant of choice for paediatric intubation due to its fast onset and ultrashort duration of action but it is associated with unwanted sideeffects. Rocuronium bromide can be used alternatively to avoid those unwanted side-effects because of its fast onset and intermediate duration of action. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations, and complications to get a better alternative dose of rocuronium bromide in children undergoing elective surgeries. Materials and Methods: The present randomised, doubleblinded clinical trial study was conducted in the Department of Anaesthesiology, Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India from January 2021 to October 2022. Ninety American Society of Anaesthesiology (ASA) Grade-I-II children of both sexes of 1-10 years age, undergoing elective surgery were equally divided into three groups. GroupR9 (n=30) and Group-R12 (n=30) received rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively while Group-S (n=30) received succinylcholine 1.5 mg/kg. Comparative evaluation of intubating conditions was done around 60 seconds in all three groups and duration of action, haemodynamic variations, and complications were noted. All data were entered in a microsoft excel sheet and results were expressed as percentages, mean Standard Deviation (SD), chi-square test, and Analysis of Variance (ANOVA) test where the difference was considered statistically significant if the p-value &lt;0.05 by using the software Statistical Package for the Social Sciences version 11.0 (SPSS version 11.0). Results: Rocuronium bromide 1.2 mg/kg and succinylcholine 1.5 mg/kg provided excellent intubating conditions in 96.7% children and good intubating conditions in 3.3% children in both groups while rocuronium bromide 0.9 mg/kg provided excellent intubation conditions in 83.3% of children and good intubating conditions in 16.7% of children There was a significant difference present in intubation scores between three groups (p=0.01). The duration of action was longer with rocuronium bromide 1.2 mg/kg (38.93±4.323 min) as compared to rocuronium bromide 0.9 mg/kg (26.07±2.791 min) while it was shortest with succinylcholine 1.5 mg/kg (6.00±1.74 min). Adverse effects like fasciculations were only found in children (n=30) receiving succinylcholine (p=0.01) but not in rocuronium bromide groups. Conclusion: Rocuronium bromide 1.2 mg/kg gives the same intubating conditions as succinylcholine 1.5 mg/kg with good haemodynamic stability and no side-effects but the duration of action was longer with rocuronium bromide 1.2 mg/kg as compared to rocuronium bromide 0.9 mg/kg. So, to avoid unwanted sideeffects of succinylcholine in children, rocuronium bromide 1.2 mg/kg can be used as an alternative to succinylcholine 1.5 mg/ kg in children undergoing elective surgeries where early return of spontaneous recovery is not needed.

Potential toxic elements (PTEs) concentration in wheat and flour products in Iran: A probabilistic risk assessment

The aim of This study was to assess the concentration of potential toxic elements (PTEs) in wheat, flour of Sangak, and Lavash bread samples and the possible effect of the milling process due to a depreciation of the device. Levels of PTEs in tested samples (n = 270) from 10 factories in Iran were determined by ICP-OES (inductively coupled plasma atomic emission spectrometry). In addition, the associated human health risk due to consumption of wheat, Sangak and Lavash bread flours in adults and children was estimated. In this approach, percentile 95% hazard quotient (HQ), Hazard index (HI), and Total Hazard Index (THI) was used as a symptom for endangering the consumer people health. A significant difference was detected in Ni concentration between wheat and two brands of flours i.e., Sangak and Lavash samples. The PTEs concentration order in the wheat and flour samples was Fe > Zn > Cu > Ni > Cr > Pb > As > Cd, respectively. Consistent with findings, the concentration of PTEs in all samples was less than the permitted limit set by the European Commission and JECFA committee. The non-carcinogenic and carcinogenic human health risk assessment (HRA) was calculated. Bread consumption per capita is 0.45 kg for adults and 0.27 kg for children per day. The results showed that both adults and children groups are not at remarkable health risk for PTEs at mean HQ, HI, THI <1 and ELCR <10E-4, but for HRA at the percentile 95% showed there is HRA of non-carcinogenic and carcinogenic disease for children group (HQ, HI, THI >1 and ELCR >10E-4).

Optimization of Initial Dose Regimen for Sirolimus in Pediatric Patients With Lymphangioma.

Sirolimus is an effective oral treatment for pediatric patients with lymphangioma. The present clinical study in 15 children (0.12–16.39 years of age) examines the effects of underlying factors on sirolimus concentrations through application of a population pharmacokinetic model. Using Monte Carlo simulation, an initial dose regimen for sirolimus in pediatric patients with lymphangioma is presented. It is found that the lower the body weight, the higher the clearance rate and sirolimus clearances are 0.31–0.17 L/h/kg in pediatric patients with lymphangioma whose weights are 5–60 kg, respectively. The doses of sirolimus, 0.07, 0.06, 0.05 mg/kg/day are recommended for weights of 5–10, 10–24.5 and 24.5–60 kg in children with lymphangioma. This study is the first to establish a population pharmacokinetic model for sirolimus and to recommend initial doses in pediatric patients with lymphangioma. Large scale, prospective studies are needed in the future.

Body weight impact of the sugar-sweetened beverages tax in Mexican children: A modeling study.

In Mexico, a 10% tax to sugar-sweetened beverages was implemented in 2014. Projections of the potential health effect of this tax in children are not available. To estimate the 1-year effect of the tax on the body weight of children 5 to 17 years old, and estimated alternative scenarios with higher tax rates (20%, 30%, and 40%). We used a dynamical mathematical model, recalibrated to the Mexican population. Input data were obtained from the Mexican National Health and Nutrition Survey 2006 and 2012. We estimated the expected average weight reduction, stratified by category of sugar-sweetened beverages consumption. With a 10% tax, we estimated an overall weight reduction of 0.26 kg for children and 0.61 kg for adolescents; in high consumers, the reduction could reach 0.50 and 0.87 kg, respectively. Higher tax rates would produce larger weight decreases; in high consumers a 40% tax would result in a reduction of 1.99 kg for children and 3.50 kg for adolescents. The tax represents an effective component of any child or adolescent weight control program, and must be considered as part of any integrated population-level program for children and adolescent obesity prevention.

Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials.

Multiple environmental factors have been implicated in obesity, and multiple interventions, besides drugs and surgery, have been assessed in obese patients. Results are scattered across many studies and meta-analyses, and they often mix obese and overweight individuals. PubMed and Cochrane Database of Systematic Reviews were searched through 21 January 2017 for meta-analyses of cohort studies assessing environmental risk factors for obesity, and randomized controlled trials investigating nonpharmacological and nonsurgical therapeutic interventions for obesity. We excluded data on overweight participants. Evidence from observational studies was graded according to criteria that included the statistical significance of the random-effects summary estimate and of the largest study in a meta-analysis, the number of obesity cases, heterogeneity between studies, 95% prediction intervals, small-study effects and excess significance. The evidence of intervention studies for obesity was assessed with the GRADE framework. Fifty-four articles met eligibility criteria, including 26 meta-analyses of environmental risk factors (166 studies) and 46 meta-analyses of nondrug, nonsurgical interventions (206 trials). In adults, the only risk factor with convincing evidence was depression, and childhood obesity, adolescent obesity, childhood abuse and short sleep duration had highly suggestive evidence. Infancy weight gain during the first year of life, depression and low maternal education had convincing evidence for association with paediatric obesity. All interventions had low or very-low-quality evidence with one exception of moderate-quality evidence for one comparison (no differences in efficacy between brief lifestyle primary care interventions and other interventions for paediatric obesity). Summary effect sizes were mostly small across compared interventions (maximum 5.1kg in adults and 1.78kg in children) and even these estimates may be inflated. Depression, obesity in earlier age groups, short sleep duration, childhood abuse and low maternal education have the strongest support among proposed risk factors for obesity. Furthermore, there is no high-quality evidence to recommend treating obesity with a specific nonpharmacological and nonsurgical intervention among many available, and whatever benefits in terms of magnitude of weight loss appear small.

Indicated Prevention of Adult Obesity

To investigate the notion of indicated prevention-helping overweight or obese youth attain non-overweight status to prevent adult obesity-by examining weight-for-height changes needed to normalize weight status in youth who are growing. We determined the amount of weight-for-height change necessary for overweight or obese youth to achieve non-overweight status using linear mixed modeling of longitudinal growth patterns and using Centers for Disease Control and Prevention weight thresholds corresponding to the age- and sex-adjusted body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) below the 85th percentile. Mean weight changes among children who achieved nonoverweight status at 1 and 2 years after treatment were calculated. Weight control programs at 3 research institutions. A total of 669 overweight or obese children aged 8 to 13 years. Family-based behavioral weight control treatment. Weight. Relatively small weight changes (range, -7.55 to +3.90 kg) were necessary for children to achieve nonoverweight status after 1 year; this was most pronounced among younger children (range, -2.90 to +3.36 kg for children aged 8-10 years) and children closer to the 85th BMI percentile (range, +2.44 to +3.90 kg for children at the 90th BMI percentile). Observed weight changes of children who achieved nonoverweight status following treatment were similar to estimates based on Centers for Disease Control and Prevention normative data. Attaining nonoverweight status in childhood is possible with modest weight loss or, in some circumstances, by slowing weight gain, and may help prevent adult obesity. Future research should investigate how much intervention is needed to shift the growth trajectory to nonoverweight status and how much weight-for-height change is needed to improve other health outcomes in adulthood.

468 PEDIATRIC LAPAROSCOPIC PYELOPLASTY AND ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY A COMPARATIVE SINGLE-INSTITUTION STUDY

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Kidney & Ureter1 Apr 2012468 PEDIATRIC LAPAROSCOPIC PYELOPLASTY AND ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY A COMPARATIVE SINGLE-INSTITUTION STUDY Edward Riachy, W. Robert Defoor, Pramod P. Reddy, Eugene A. Minevich, Shumyle Alam, and Paul H. Noh Edward RiachyEdward Riachy Cincinnati, OH More articles by this author , W. Robert DefoorW. Robert Defoor Cincinnati, OH More articles by this author , Pramod P. ReddyPramod P. Reddy Cincinnati, OH More articles by this author , Eugene A. MinevichEugene A. Minevich Cincinnati, OH More articles by this author , Shumyle AlamShumyle Alam Cincinnati, OH More articles by this author , and Paul H. NohPaul H. Noh Cincinnati, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.536AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic pyeloplasty (LP) and robotic-assisted laparoscopic pyeloplasty (RALP) to treat uretero-pelvic junction obstruction (UPJO) in children have been performed as an alternative to open pyeloplasty. The purpose of this study to is report our experience and compare the outcomes between these minimally invasive procedures. METHODS A retrospective cohort study was performed of all patients who underwent LP and RALP for UPJO at a pediatric institution from October 2007 to March 2011. Patient demographics, radiographic imaging, intra-operative details, and surgical outcomes were abstracted from the medical record. Indications for surgery were symptomatic obstruction, increasing grade of hydronephrosis in consecutive renal ultrasounds, or abnormal diuretic renal scan. A successful outcome was defined as absence of clinical symptoms, improvement of the drainage curve on diuretic renal scan, improvement of hydronephrosis on ultrasound, or stable ultrasound with resolution of symptoms. RESULTS We identified 51 patients who underwent 52 dismembered pyeloplasties (32 male, 19 female). RALP was performed on 33 patients (18 left, 15 right). LP was performed on 19 patients (9 left, 10 right). None had conversion to open surgery. Median age was 10 years for children with RALP (range, 19 months - 22 years), and 7 years for those with LP (range, 3 months - 18 years), p=0.09. Median weight was 40.7 Kg for children with RALP (range, 11 - 90), and 30.3 Kg for those with LP (range, 6-71), p=0.06. The median operative time was 227 minutes in RALP (range, 114 - 540) and 274 minutes in LP (range, 145 - 387), p=0.02. The median length of hospital stay was 2 days in RALP (range, 1 - 6) and 1.63 days in LP (range, 1 - 4), p=0.15. The median follow-up period was 17 months (range, 5 - 29) for patients with RALP, and 33 months (range, 5 - 46) for those with LP (p<0.01). Renal ultrasound showed a post-operative improvement of the hydronephrosis in 27 patient with RALP (82%) and 15 with LP (79%), and remained stable in 6 with RALP (18%) and 4 with LP (21%); p=0.53. Post-operative diuretic renal scans were performed on only 2 patients with RALP (6%), and 8 with LP (42%) and all demonstrated an improved drainage curve. The overall success rate was 100% for patients with RALP and 95% for those with LP (consisted of one patient with residual pain); p=0.36. The complication rate was 3% (n=1) in the RALP and 10% (n=2) in the LP group (p=0.54). CONCLUSIONS RALP and LP are both effective techniques to correct UPJO. RALP has a shorter operative time, but its success and complication rates are comparable to LP. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e191-e192 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edward Riachy Cincinnati, OH More articles by this author W. Robert Defoor Cincinnati, OH More articles by this author Pramod P. Reddy Cincinnati, OH More articles by this author Eugene A. Minevich Cincinnati, OH More articles by this author Shumyle Alam Cincinnati, OH More articles by this author Paul H. Noh Cincinnati, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Variations in Infant Feeding Practice Are Associated with Body Composition in Childhood: A Prospective Cohort Study

Most studies of infant diet and later body composition focus on milk feeding; few consider the influence of variations in the weaning diet. Our objective was to examine how variations in milk feeding and the weaning diet relate to body composition at 4 yr. A total of 536 children participating in a prospective birth cohort study. Diet was assessed at 6 and 12 months of age. Compliance with weaning guidance was defined by the infant's score for a principal component analysis-defined dietary pattern (infant guidelines) at 12 months. Infants with high infant guidelines scores had diets characterized by high consumption of fruit, vegetables, and home-prepared foods. Body composition was assessed at 4 yr by dual x-ray absorptiometry. Longer duration of breastfeeding was associated with lower fat mass at 4 yr [4.5 kg, 95% confidence interval (CI) of 4.3-4.7 kg, in children breastfed for 12 months or more, compared with 5.0 (95% CI 4.7-5.3) kg in children never breastfed (P = 0.002)] but was not related to body mass index. Children with high infant guidelines scores had a higher lean mass [12.6 (95% CI 12.3-12.9) kg in children in the top quarter of the distribution, compared with 12.0 (95% CI 11.7-12.4) kg in children in the bottom quarter (P = 0.001)]. These associations were independent and were little changed by adjustment for confounding factors. These data suggest that variations in both milk feeding and in the weaning diet are linked to differences in growth and development, and they have independent influences on body composition in early childhood.

Population pharmacokinetics of pranlukast hydrate dry syrup in children with bronchial asthma

This is the first report about the pharmacokinetics (PK) of pranlukast in children. The aim of the present study was to assess the PK parameters of pranlukast in children and to compare them with those in adults. Six healthy adult male volunteers and 22 children with bronchial asthma at 3–14 years of age were enrolled in the study. Both 225 and 112.5 mg pranlukast hydrate dry syrup was administered orally to adults, whereas 3.5 mg/kg pranlukast hydrate dry syrup was given to children. Blood samples were obtained at approximately 20 time points per adult (n = 121) and at two or three time points per child (n = 54). Population PK analysis was performed using NONMEM (Globomax, Hanover, MD, USA). The concentration-time-course of pranlukast was described by using a one-compartment model with first-order absorption. The robustness of the final model was evaluated using 200 bootstrap samples. Apparent clearance (CL/F) was 1.81 and 1.14 L/h per kg in children and adults, respectively. According to subgrouping of children, no significant difference was observed in CL/F between infants (3–6 years of age) and schoolchildren (7–14 years of age). The interindividual variability of CL/F accounted for 48.7%. The additive and proportional residual variability was 7.33 ng/mL and 73.8%, respectively. All fixed effect parameters fell within 10% of the bootstrapped mean. Compared with adults, children showed a higher CL/F and more rapid elimination after ingestion of pranlukast hydrate dry syrup. However, no significant variation was seen in CL/F between infants and schoolchildren.

Efficacy and safety of rectal thiopental, intramuscular cocktail and rectal midazolam for sedation in children undergoing neuroimaging.

This study was designed to investigate the overall usefulness of rectal thiopental, rectal midazolam and i.m. modified cocktail (meperidine-chlorpromazine hydrochloride-feniramin maleat) in 70 children undergoing computed tomography (CT) and magnetic resonance imaging (MRI). The dosage of thiopental was 50 mg per kg for infants under 6 months of age, 35 mg per kg between six and 12 months, and 25 mg per kg for older children. The maximal dose did not exceed 700 mg in this study. The dosage of midazolam was 1 mg per kg for all children. A modified cocktail was described as a formulation including 11 mg/mL of meperidine, 2.8 mg/mL of chlorpromazine and 2.8 mg/mL of pheniramine maleat. The dosage of modified cocktail was 0.1 mL per kg for all children. The mean induction time for the i.m. cocktail was significantly longer than that for rectal thiopental (P < 0.001). The mean duration of deep sedation was 60.79 +/- 27.00 min with rectal thiopental and 58.74 +/- 39.70 min with i.m. cocktail (P > 0.05). Although the mean duration of sleep for rectal thiopental and i.m. cocktail was similar, the mean discharge duration for i.m. cocktail was significantly longer than that for rectal thiopental (P < 0.05). Children sedated with the cocktail therapy also required a longer period of observation in the department. Significant decreases in heart rate, systolic blood pressure and oxygen saturation occurred in three groups (P < 0.001). Significant decreases in body temperature occurred after rectal thiopental and i.m. cocktail therapy (P < 0.01). The effect of rectal midazolam was minimal. Rectal thiopental may be the drug of choice for pediatric sedation because it has a more rapid onset and offset of action. It is also safe and effective at the dosage studied in children undergoing MRI. Rectal midazolam also may be used in children undergoing CT imaging because of minimal side-effects.

Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for bothrops snake bites

Objective: To investigate the efficacy of the H1 antihistamine promethazine against early anaphylactic reactions to antivenom.Design: sequential randomised, double blind, placebo controlled trial.setting: Public hospital in a venom research institute,...

Increased Height Gain of Children Fed a High-Protein Diet during Convalescence from Shigellosis: A Six-Month Follow-Up Study

The impact of dietary supplementation on catch-up growth was evaluated in 69 malnourished children ages 24–60 mo after recovery from shigellosis. They were fed either a high-protein (HP) diet with 15% of energy as protein, or a standard-protein (SP) diet with 7.5% energy as protein, for 3 wk in a metabolic study ward. Children were followed up bi-weekly for 6 mo by trained health assistants when anthropometric measurements and information of any illness were collected. Thirty-one children in the HP group and 28 children in the SP group completed 6-mo follow-up. The increase in height (mean ± SD) was 5.3 ± 1.0 cm vs. 4.1 ± 1.1 cm for HP and SP groups, respectively (P < 0.001), whereas increase in body weight was 1.39 ± 0.58 and 1.29 ± 0.72 kg for children fed HP and SP, respectively (P = 0.59). The proportion of children who were severely stunted (< −2 SD height-for-age) decreased from 45 to 29% in the HP group compared to 50 to 46% in the SP group (P < 0.05) at 6-mo follow-up. The number of diarrheal episodes per child tended to be lower in the HP vs. SP than in the SP group (1.9 vs. 2.3, P = 0.41). These results demonstrate that feeding an HP diet to the malnourished children during recovery from shigellosis enhanced linear growth with a modest reduction in diarrheal morbidity during the 6-mo follow-up period.

Nitrate, nitrite, and N-nitroso compounds in Finnish foods and the estimation of the dietary intakes

An estimate of the dietary intakes of nitrite, nitrate and N-nitroso compounds is presented, based on the analytical data supplied by the Finnish Food Quality Control. Figures on the food consumption of the Finnish population, taken from a national dietary survey, and food consumption of 1768 children and adolescents over a 48-h recall period were used. The mean daily dietary nitrate intakes were estimated to be about 55 mg for the total population and for children and adolescents. The mean nitrite intakes were 1.88 mg for the total population and 1.07 mg for children and adolescents. The intake of N-nitroso compounds (NDMA) was estimated to be 0.08 micrograms for the total population and 0.02 micrograms for children. Nitrates were found to originate mainly from vegetables (80%), nitrites from meat products (97%) and nitrosamines mostly from fish products and beer. A comparison of the estimate of dietary intake of with ADI values indicated that the nitrite intake of the total population was 23% and by children 39% of ADI. The average weight was approximately 60 kg for adults and 20 kg for children. When measured average weight (39 kg) was used, and the nitrite intake was found to be 28% of ADI. Nitrate intakes from food additives were 2.5% and 1.4% of the ADI value, respectively. When the total nitrate intake from various food sources was compared with the ADI (which is given only for food additives), the estimated nitrate intake of the total population was 25% and that of children 28% of the ADI value.