Patterns In Pediatric Patients Research Articles

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children.

An interaction between metabolic glucose impairment and coronavirus disease 2019 is reported. The development of a severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection has been described. We evaluated the impact of MIS-C on glycemic patterns in pediatric patients. A group of 30 children and adolescents affected by MIS-C were considered; all patients were normal weight. Clinical and biochemical assessments, including surrogate markers of insulin resistance (IR) such as homeostasis model analysis-IR (HOMA-IR) and triglyceride–glucose (TyG) indexes, were recorded. Patients were also invited to undergo an intermittently scanned continuous glucose monitoring (isCGM). HOMA-IR index was calculated in 18 patients (60%), of which 17 (94%) revealed a pathological value. TyG index was computed for all patients and pathological values were detected in all cases. In 15 patients, isCGM data were recorded on average for 9 days (±3 days). Overall, average glucose was 105 mg/dL (±16 mg/dL) and average time spent in the 70–180 mg/dL range (TIR) was 93.76%, with nearly 10% of glucose readings in the 141–180 mg/dL range; glycemic fluctuations over the hyperglycemic threshold were detected in four patients. Regular glucose monitoring may be useful to prevent metabolic imbalance and obtain a better outcome.

Objective Controller Medication Adherence Patterns in Pediatric Patients with Asthma in a High-Risk Multidisciplinary Asthma Clinic

Objective Controller Medication Adherence Patterns in Pediatric Patients with Asthma in a High-Risk Multidisciplinary Asthma Clinic

Daily physical activity patterns in children and adolescents with inflammatory bowel disease.

The aim of this study was to assess PA patterns among children and adolescents with inflammatory bowel disease (IBD). Sixty participants with IBD (42 Crohn's disease [CD], 10 ulcerative colitis [UC], and 8 IBD-unclassified [IBD-U], 30 male patients) in remission (n = 45) or with mild disease (n = 15) were compared with 60 healthy age- and sex-matched controls. Each participant wore a triaxial accelerometer during 4 consecutive days for objective daily PA quantification. Overall, there was no significant difference in daily PA patterns between patients with IBD and healthy controls, with 31.7% of patients with IBD and 38.3% of healthy controls fulfilling the recommendation of 60 min of moderate-to-vigorous physical activity (MVPA) daily (NS). Male patients with IBD spent significantly less time in MVPA compared with matched healthy controls (mean difference, 16.2 min day-1; p < 0.05). No difference was observed for female patients with IBD. No difference in sedentary pattern between male patients with IBD and controls was found. Children and adolescents with inactive or mildly active IBD have similar PA patterns compared with healthy controls, except for male patients who have reduced moderate-to-vigorous PA. By far, most patients with IBD do not fulfill the MVPA recommendations for health benefits. There is few data on PA patterns in pediatric patients with IBD. Methodological issues to assess PA limit the strengths of these studies. Pediatric IBD patients with inactive or mildly active IBD have similar physical activity patterns compared with healthy controls, except for male patients who have reduced moderate-to-vigorous PA. Most patients with IBD do not fulfill the MVPA recommendations for health benefits.

Treatment patterns in pediatric patients with multiple sclerosis in Germany-a nationwide claim-based analysis.

Background:The manifestation of multiple sclerosis (MS) in childhood and adolescence occurs in 3%−5% of all MS cases. However, the immunomodulatory and symptomatic treatment options in this population group are still limited.Objective:We aimed to elucidate the prescription frequency of medications used in pediatric patients with multiple sclerosis (PwMS) compared with the general population, considering the entire spectrum of medications prescribed.Methods:Based on nationwide outpatient drug prescription data and statutory health insurance (SHI) physicians’ claims data from 2018, we conducted a population-based cross-sectional study in Germany. Children and adolescents aged ⩽17 years (n = 11,381,939) diagnosed with MS (n = 613), and a matched (age, sex, and health insurance sector) control group (n = 6130) were included. The prescription prevalence was measured as the proportion of MS patients with ⩾1 prescription.Results:Of the 613 pediatric PwMS with a median age of 16 years, 403 (65.7%) were female. For 15 out of the 18 different active agents analyzed, PwMS had a significantly higher prescription prevalence than the control group (Fisher’s exact test: p ⩽ 0.037). The most frequently prescribed drugs in PwMS were ibuprofen (28.4%; anti-inflammatory drug), cholecalciferol (23.0%; vitamin D3), and interferon beta-1a (21.5%; disease-modifying drug, DMD). The proportions of DMD prescriptions and antibiotic prescriptions were higher among PwMS aged 15–17 years than among those ⩽14 years (DMD: 43.4% vs 34.2%, p = 0.05; antibiotic: 34.1% vs 24.8%, p = 0.031). In contrast, younger PwMS were more likely to receive a prescription for anti-inflammatory/anti-rheumatic drugs (36.6% vs 26.5%, p = 0.02).Conclusion:Our study analyzing real-world medication data showed that interferon beta, anti-inflammatory drugs, and vitamins play an essential role in the treatment of pediatric PwMS. Future research should evaluate longitudinal treatment patterns of pediatric PwMS, paying particular attention to the time of diagnosis, time of first DMD initiation, and therapy switches.

Drug utilization pattern in outdoor patients of pediatric tertiary care hospital: a cross sectional study

Background: Drug utilization study is essential, as safe and effective therapeutic regimen in paediatric population is challenging. Pattern of use of drugs in pediatrics vary as compared to adults, also there is limited data available. The objective of this study was to study drug utilization pattern in pediatric patients attending pediatric outpatient department of Maindarkar pediatric hospital, Latur.Methods: A cross sectional study was carried out for a period of six months from September 2019 to February 2020, by analysing a total 1000 prescriptions of patients who had visited the OPD of Maindarkar pediatric hospital. Prescriptions were selected by simple random sampling method.Results: In our study, out of the total of 1000 prescriptions, 244 (24.4%) were of neonates, 556 (55.6%) were of infants (1 month to 1 year) and 200 (20%) were of children above 1 year. 547 (54.7%) prescriptions were of male patients and 453 (45.3%) were of female patients. The most frequent classes of drugs prescribed were nonsteroidal anti-inflammatory drugs 704 (70.4%), followed by drugs used for respiratory disorders 655 (65.5%) and supplements (60%). Antimicrobials were prescribed in 498 (49.8%) prescriptions. The average number of drugs per prescription was 2.45. About two third of all the prescribed drugs (74.41%) were from national essential medicine list. Most of the prescriptions had oral drug formulation 825 (82.5%) followed by inhalational 208 (20.8%) followed by injectables 150 (15%). All the drugs were prescribed by brand names.Conclusions: Our study helps health-care system to understand, interpret and improve prescribing, administration, to minimize adverse events and promote rational use of medicines.

Epilepsy surgery for pediatric patients with mild malformation of cortical development

PurposeThe observation of mild malformation of cortical development (mMCD) has yet to have a major clinical impact due to the lack of clinical and research data. We characterized the clinical features, surgical outcomes, and postoperative seizure control patterns in pediatric patients with mMCD. MethodsWe examined 40 patients with isolated mMCD who underwent resective surgery during a 10-year period. ResultsThe median age at seizure onset was 1.2 years, and the median age at surgery was 7.9 years. Twenty-seven patients (67.5%) presented with childhood-onset epileptic encephalopathy (21 Lennox-Gastaut syndrome, 6 West syndrome), and 13 patients (32.5%) presented with intractable focal epilepsy (10 extratemporal lesions, 3 temporal lesions). Twenty-one patients (52.5%) showed “suspected focal cortical malformation” on MRI, whereas 16 patients (40.0%) and 3 patients (7.5%) showed normal MRI findings or mild brain atrophy, respectively. The most common surgical procedures were two lobar resections (18 patients, 45.0%), followed by unilobar resections (12 patients, 30.0%) and resections exceeding two lobar boundaries (10 patients, 25.0%). As a final surgical outcome, 24 patients (60.0%) were ILAE Class 1−3. Discontinuation of all AEDs was possible for 36.8% of ILAE Class 1 patients. Regarding the seizure control pattern, fluctuating seizure control was observed most frequently (21 patients, 52.5%). ConclusionOur results suggest that mMCD is an important pathological finding in children related to a significant degree of epileptogenicity, and resective surgery can have positive outcomes. However, these patients showed unstable postoperative seizure control patterns with a high rate of late recurrence, suggesting difficulties in the surgical treatment of intractable epilepsy.

Domperidone prescribing patterns in pediatric patients before and after safety warning in South Korea

In 2014, the Korean Ministry of Food and Drug Safety (MFDS) issued a safety warning to carefully consider adverse cardiac effects when prescribing domperidone for children. We conducted this study to compare the trends of domperidone prescription in pediatrics before and after the MFDS safety warning. This study included patients < 18 years old who used national health insurance services within the year 2011 and the year 2016, sampled from Health Insurance Review Agency data. We analyzed domperidone prescribing patterns including prescribed daily dosage, maximum period of continuous prescription, and number and types of co-prescribed medications and compared two different years pre and post safety warning. A total of 16,614 pediatric patients (1.74%) received domperidone prescriptions in 2011, and 11,317 patients (1.23%) in 2016. The probability of receiving at least one prescription in 2016 has been reduced by 30% compared to 2011. Gastritis was the most common indication in both years. The number of prescriptions containing a maximum daily dosage of over 30 mg was significantly lower in 2016. In the same time period, the number of cases with a maximum continuous prescription period of more than 7 days significantly decreased (p<0.001). In addition, from 2011 to 2016, comorbid diseases of domperidone-treated patients were similar, but the number of co-prescriptions of interacting medication to domperidone decreased (p<0.001). After the 2014 safety letter was released, the pattern of prescribing domperidone in pediatrics has enhanced drug safety for children in terms of frequency of prescriptions, maximum duration of domperidone use, and the prescription of drugs interacting with domperidone.

Obesity and Attention Deficit Hyperactivity Disorder (ADHD) -When epidemics collide: A longitudinal study of body mass index (BMI) patterns in pediatric patients with ADHD treated with stimulant medication

Obesity and Attention Deficit Hyperactivity Disorder (ADHD) -When epidemics collide: A longitudinal study of body mass index (BMI) patterns in pediatric patients with ADHD treated with stimulant medication

Utilization and Treatment Patterns of Disease-Modifying Therapy in Pediatric Patients with Multiple Sclerosis in the United States.

The current landscape and treatment patterns of disease-modifying therapy (DMT) use in pediatric patients with multiple sclerosis (MS) are not yet well understood. This study examined DMT utilization and treatment patterns in pediatric patients newly diagnosed as having MS. Pediatric patients (<18 years old) with two MS diagnosis claims from January 1, 2010, to December 31, 2016, were identified from the MarketScan Commercial Database. The index date was defined as the date of first MS diagnosis, and patients were followed up for 1 year post-index date. Outcomes evaluated included percentage of patients who initiated treatment after MS diagnosis, different DMTs initiated, treatment discontinuation, and switching treatment during follow-up. Of 182,057 patients newly diagnosed as having MS, 288 pediatric patients (mean age, 14 years; 61% female) were identified. Within the first year of diagnosis, 188 patients (65.3%) did not receive any DMT. The most common first-initiated treatments were interferons and glatiramer acetate (83%), but 28% of patients switched or discontinued from first-initiated treatment within 6 months of treatment initiation. This study suggests that a considerable proportion of pediatric patients with MS remain untreated within 1 year of diagnosis. Patients most commonly initiated injectables as their first DMT. Overall, therapy failed early in approximately one in three patients. Thus, the study warrants urgency in treating these patients with currently approved treatment options.

Epidemiology and Imaging Classification of Pediatric Cervical Spine Injuries: 12-Year Experience at a Level 1 Trauma Center.

OBJECTIVE. The purpose of this study was to describe the epidemiology and imaging characteristics of cervical spine injuries in children with blunt trauma. MATERIALS AND METHODS. We conducted a retrospective review of the records of all patients 16 years old or younger with a diagnosis of cervical spine injury in the trauma registry of our level 1 trauma center between July 2006 and June 2018. RESULTS. Two hundred thirty-five patients were included in the study: 125 with subaxial cervical spine injuries, 87 with upper cervical spine injuries, and 23 with both subaxial and upper cervical spine injuries. The frequency of isolated upper cervical spine injuries was 73% in patients younger than 3 years old, 48% in patients 3-8 years old, and 29% in patients older than 8 years old. Seventy-one percent of occipital condyle fractures were avulsions, and 26% of dens fractures were avulsions. Type II dens fractures were found only in patients older than 8 years old. Type I and III dens fractures were almost exclusively in patients 8 years old or younger. Injuries classified as AOSpine types A, B, and C comprised 65.6%, 17.2%, and 17.2% of subaxial injuries, respectively. Despite similar mechanism of injury distribution across age groups, the frequency of AOSpine type A injuries in patients older than 8 years old (70.6%) was significantly higher compared with patients younger than 3 years old (40.0%) and those who were 3-8 years old (45.0%). The frequency of AOSpine type B injuries in patients younger than 3 years old (40.0%) was slightly higher than patients who were 3-8 years old (30.0%) and almost three times higher than in patients older than 8 years old (13.8%). CONCLUSION. Pediatric patients have high rates of upper cervical spine injuries, which tend to be distraction injuries that are frequently associated with avulsion fractures. Injury patterns in pediatric patients vary significantly by age, with patients younger than 3 years old being particularly prone to distraction type injuries.

Drug Prescription Pattern in Pediatric Patients of Bronchial Asthma Attending outpatient Department in a Private Hospital

Bronchial asthma, being a chronic airway disease, requires long-term pharmacotherapy. Since, a wide range of antiasthmatic drugs are available, study of prescription pattern is essential to promote rational use of drugs. The aim of the study was to evaluate prescription pattern in paediatric patients of bronchial asthma in a private hospital. An observational, non-interventional cross-sectional study was conducted in paediatric outpatient department at a private hospital in Aurangabad after institutional ethical clearance. Asthmatic children of either gender or age group 1-17 years were enrolled and patients details such as demographic details, drugs used etc. were filled in the specially designed case record form. Data was presented in percentages. SPSS software version 20.0 was used to analyse data using statistical test ANOVA. ‘P’ value ≤ 0.05 was considered as significant. Out of total 300 children enrolled in the study, 43.33% children had intermittent asthma, 16.33% had mild persistent, 21.34% had moderate persistent and 19% had severe persistent asthma. Asthma in majority of the children (40%) was partly controlled. Maximum study population was males of 6-10 years of age. Most of the children received multiple anti-asthmatic drugs (66%) and prevalence of two drug combinations was the highest (46%). Average drugs per prescription were 2.7. Inhalational route was preferred. Most commonly encountered anti-asthmatic drugs were short acting beta 2 agonists (74.33%) followed by inhalational corticosteroids (56.33%). Inhalational corticosteroid usage was profound in children with persistent asthma. Encounter with antibiotics was found to be 18.33%. All the drugs were prescribed by their brand names. Inhaled and oral corticosteroids were prescribed more often in children with persistent asthma than children with intermittent asthma and differences were statistically significant (p=0.001). However, no statistically significant difference was observed among intermittent and persistent asthma in terms of prescription of drugs like salbutamol, levosalbutamol, levosalbutamol plus ipratropium bromide and salmeterol plus fluticasone. The findings of the study suggested a rational approach in providing anti-asthmatic pharmacotherapy to children. Health care professionals seemed to be well versed with the current treatment guidelines. Only matter of concern is prescribing with brand names. Promotion of educational strategies and programmer will incur awareness about benefits of prescribing generic drugs.

Drug Prescription Pattern in Pediatric Patients of Bronchial Asthma Attending outpatient Department in a Private Hospital

Bronchial asthma, being a chronic airway disease, requires long-term pharmacotherapy. Since, a wide range of antiasthmatic drugs are available, study of prescription pattern is essential to promote rational use of drugs. The aim of the study was to evaluate prescription pattern in paediatric patients of bronchial asthma in a private hospital. An observational, non-interventional cross-sectional study was conducted in paediatric outpatient department at a private hospital in Aurangabad after institutional ethical clearance. Asthmatic children of either gender or age group 1-17 years were enrolled and patients details such as demographic details, drugs used etc. were filled in the specially designed case record form. Data was presented in percentages. SPSS software version 20.0 was used to analyse data using statistical test ANOVA. ‘P’ value ≤ 0.05 was considered as significant. Out of total 300 children enrolled in the study, 43.33% children had intermittent asthma, 16.33% had mild persistent, 21.34% had moderate persistent and 19% had severe persistent asthma. Asthma in majority of the children (40%) was partly controlled. Maximum study population was males of 6-10 years of age. Most of the children received multiple anti-asthmatic drugs (66%) and prevalence of two drug combinations was the highest (46%). Average drugs per prescription were 2.7. Inhalational route was preferred. Most commonly encountered anti-asthmatic drugs were short acting beta 2 agonists (74.33%) followed by inhalational corticosteroids (56.33%). Inhalational corticosteroid usage was profound in children with persistent asthma. Encounter with antibiotics was found to be 18.33%. All the drugs were prescribed by their brand names. Inhaled and oral corticosteroids were prescribed more often in children with persistent asthma than children with intermittent asthma and differences were statistically significant (p=0.001). However, no statistically significant difference was observed among intermittent and persistent asthma in terms of prescription of drugs like salbutamol, levosalbutamol, levosalbutamol plus ipratropium bromide and salmeterol plus fluticasone. The findings of the study suggested a rational approach in providing anti-asthmatic pharmacotherapy to children. Health care professionals seemed to be well versed with the current treatment guidelines. Only matter of concern is prescribing with brand names. Promotion of educational strategies and programmer will incur awareness about benefits of prescribing generic drugs.

Urine Proteomic Analysis Reveals Disease-Specific Patterns in Pediatric Patients with Classical Hodgkin's Disease(HD). an Addon Study to the Euronet-PHL-C2 Trial

Background HD is a B-lineage lymphoma characterized, depending on subtype, by a prominent inflammatory infiltrate and fibrosis. Clinically, inflammatory symptoms like fever, weight loss and night sweats (B-symptoms) and increased blood biomarkers of inflammation, including ESR and CRP, are characteristic of more advanced disease. The clinical trial EURONET-PHL-C2 (Second International Inter-Group Study for Classical Hodgkin's Lymphoma in Children and Adolescents) is a randomized, prospective trial that compares chemo- and radiotherapy treatment concepts of different intensities in patients with intermediate and advanced HD. Patients are stratified by risk into 3 therapy groups (TL-1 to TL-3). An ESR&gt; 30mm/h had been a risk factor for relapse in previous studies and leads to upstaging from the lowest (TL-1, Ann Arbor stage I and IIa without additional risk factors) to the intermediate risk group TL-2 in the current study. This addon pilot study tested urine proteomic patterns from pediatric patients with HD at diagnosis and compared them to the patterns of normal children. The questions were: Is there a HD-specific pattern, a pattern that identifies high risk or a pattern that correlates with inflammatory markers? Patients and methods Capillary electrophoresis coupled to mass spectrometry (CE-MS) was used to compare the peptide profiles in the mass range of 0.8 to 20 kDa of urine samples (N=34) from 16 children with pediatric Hodgkin lymphoma (PHL) as case and 32 age-matched children with no evidence of a disease (N=28) or with urinary tract infection (N=4) as control groups. Marker selection was based on a two-step strategy. First, a group-wise comparison of rank sum differences was performed on a set of 2418 annotated peptides with distribution frequencies above 30% in at least one of the groups with subsequent adjustment for multiple testing by the method of Bonferroni. In the second step marker candidates were further restricted to those demonstrating a significant positive or negative Spearman rho correlation coefficient (≥0.34 or ≤-0.34) to the Ann-Arbor classification criteria. From the resulting peptides a multivariate peptide marker classifier was established by support vector machine modeling and applied to an independent confirmation set of PHL (N=16, 31 urine samples) and control (N=18, 18 urine samples) patients to determine classification accuracy in receiver operating characteristics (ROC) analysis. Peptides included in the PHL classifier were resolved in their amino acid sequence by tandem mass spectrometry to identify the proteins from which the peptide markers are derived. Results The established multivariate peptide marker model consisting of 40 naturally occurring urinary peptides enabled absolute differentiation between PHL patients and children without signs of disease or urinary tract infection in independent validation as revealed by an area under the ROC curve value of 1.0 (95% confidence interval: 0.93 to 1.00, p&lt;0.0001). Amino acid sequencing revealed that the majority of peptides are interstitial collagen fragments from specific hot-spot regions within the proteins linear sequence and in part with overlapping amino acid sequences indicative for the activity of specific extracellular matrix degrading proteases. Other PHL peptide markers are derived from the tumor associated proteins S100-A9, Prostaglandin-H2 D-isomerase and Cytokeratin-8. Conclusions and perspective We were able to identify a proteomic pattern characteristic for HD, markers for relapse risk group or HD-associated inflammation were not yet identified. Disclosures Metzger: Mosaiques Diagnostics: Employment.

EP.37Whole-body MRI pattern in pediatric patients with sarcoglycanopathies

EP.37Whole-body MRI pattern in pediatric patients with sarcoglycanopathies

Changing face of Candida colonization pattern in pediatric patients with hematological malignancy during repeated hospitalizations, results of a prospective observational study (2016\u20132017) in shiraz, Iran

BackgroundSurveillance of current changes in the epidemiology of Invasive Fungal Diseases (IFDs) as an important component of the antifungal stewardship programs (ASP), requires careful regular monitoring, especially in high-risk settings such as oncology centers. This study aimed to examine Candida colonization status and corresponding current changes in children with malignancy during repeated admissions and also investigate the possible epidemiological shifts after the implementation of ASP.MethodsIn this prospective observational study, all eligible patients younger than 18 years were recruited during 2016–2017 at Amir Medical Oncology Center (AMOC) in Shiraz, Iran. Totally, 136 patients were enrolled and 482 samples were collected from different sites (oral/nasal discharges, urine and stool). Weekly regular sampling was carried out during hospitalization. Candida colonization status and epidemiological changes were monitored during repeated admissions. Samples were cultivated on Sabouraud Dextrose agar medium and identified by Polymerase Chain Reaction -Restriction Fragment Length Polymorphism (PCR-RFLP).ResultsEstimated Candida colonization incidence was 59.9% (82/136) in our patients. Candida colonization was found to be higher in oral cavity and rectum than that in nasal cavity. Among those long-term follow ups and repetitive hospitalizations, a significant number of patients exhibited changes in their colonization patterns (37.7%). Candida colonization did not reveal any significant relationship with age, sex, oncologic diseases and degree of neutropenia. C. albicans (72.0%) was found as the most common Candida species in colonized patients, followed by C. krusei, C. kefyr, C. glabrata and C. parapsilosis.ConclusionGiven the high incidence of Candida infections in children with cancers, close monitoring of epidemiologic changes is essential for judicious management, based on local surveillance data and improvement of overall quality of care in high risk patients.

Characterization of all-terrain vehicle-related chest injury patterns in children.

To evaluate chest injury patterns in pediatric patients involved in all-terrain vehicle (ATV) accidents. Retrospective review of patients 0-18years old admitted to a level I trauma institute following an ATV-related incident from 2004 to 2013 was performed. Chest injury type, accident mechanism, driver/passenger status, and demographic and clinical data were compared between patients with and without chest injury. Chest injury was present in 102 (22%) of total 455 patients. The most common chest injuries were pulmonary contusion (61%), pneumothorax (45%), and rib fracture (34%). There were no cardiac, esophageal, or tracheobronchial injuries. Pulmonary lacerations, hemothoraces, and scapular fractures were predominantly not detected on radiography and recognized on CT only (86-92%). Patients with chest injury had longer median hospital stays (3days vs 2days, p = 0.0054). There was no significant difference in admission to intensive care after controlling for injury severity scores in patients with chest injury compared to those without (17 vs 9). Eight patients with chest injury died (8%) compared to 2 patients without chest injury (0.6%) (p = 0.0002). Chest injuries are common in children following ATV accidents and may be a marker of more severe trauma. Increased public awareness of these potentially devastating injuries and continuing safety efforts are needed.

Susceptibility weighted imaging in infants with staged embolization of vein of Galen aneurysmal malformations

Background and purposeThe vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation with a higher morbidity and mortality, especially in neonates. Ultrasound, CT and MR are usually used in diagnosis and treatment monitoring of these disorders. In this current study, we aim to examine utility of SWI in evaluation of treatment response in infants with VGAM. Materials and methodsWe performed a retrospective chart analysis of children with VGAM in our institution between January 2008 and December 2016. Inclusion criteria included; confirmed VGAM on DSA; available SWI sequence at baseline and at follow up after at least a single embolization session; age at initial MR of 18 years or younger. Signal intensity and Angioarchitecture of VGAM and cerebral veins on SWI, as well as hydrocephalus and clinical outcome were evaluated. ResultsOf 11 patients identified with VGAM in our institution, 5 children (3 males and 2 females) satisfied the inclusion criteria. The average age at initial MR was 29 days (range 1–120). Fourteen MRI were available for review. All children had VGAM of mural type. Intramedullary veins were dilated and SWI-hypointense in all children, while subependymal and sulcal veins were dilated and SWI-hypointense in 4 patients on initial MRI. On the first available follow up MRI, cerebral veins have mostly normalized in 4 children and remained mostly dilated and SWI-hypointense in 1 child; even after complete treatment of the VGAM. ConclusionOur preliminary findings show that SWI seems to offer a beneficial non-invasive tool in evaluating passive venous congestion patterns in pediatric patients with VGAM. It remains to be determined in larger studies, the clinical significance of these SWI changes.

Antimicrobial Utilization Pattern in Pediatric Patients in Tertiary Care Hospital, Eastern Ethiopia: The Need for Antimicrobial Stewardship.

Background: Antimicrobials are among the most frequently prescribed medications for pediatric patients. However, inappropriate use of them can increase morbidity, mortality, healthcare costs, and largely antimicrobial resistance. This study aims to assess the antimicrobial utilization pattern in the pediatric ward of Hiwot Fana Specialized University Hospital. Methods: Retrospective cross-sectional study was conducted to assess the antimicrobial utilization. In this study, 403 pediatric medical records selected by systematic random sampling were reviewed. Data were collected using structured data abstraction format. Results: Ceftriaxone (n = 176, 26.5%), gentamicin (n = 125, 18.82%), and ampicillin (n = 119, 17.9%) were the most frequently prescribed antimicrobials, whereas ampicillin and gentamicin combination took the largest percentage share (n = 91, 43.3%). The most common reasons for which antimicrobials prescribed were severe pneumonia (n = 93, 18.82%), severe acute malnutrition (n = 69, 13.97%), and meningitis (n = 67, 13.56%). On average, the highest number of antimicrobials per card was observed in neonates. The percentage of antimicrobials administered by parenteral route was found to be 84.33%. Less than half of antimicrobials (46.98%) were prescribed with dosage form. Besides, strength and duration were recorded in 20.03% and 4.21% of antimicrobial agents, respectively. Conclusion: Generally, there was an overuse of injectables despite the fact that oral formulations are safer alternatives. This result is too far from World Health Organization (WHO) standard (13.4%-21.1%). The degree of polypharmacy of antimicrobials falls within the WHO cutoff point (<2). There are no antibiogram tests conducted in the hospital. By and large, this study provides an impetus towards the establishment of antimicrobial stewardship programs.

Characteristics of orbital wall fractures in preschool and school-aged children.

ObjectiveThis study aimed to evaluate the injury patterns in pediatric patients with an orbital wall fracture (OWF) and to identify the differences in injury patterns between preschool and school-aged patients with OWF who presented to the emergency department.MethodsWe performed a retrospective observational study in the emergency department of a tertiary hospital between January 2004 and March 2014. A total of 177 pediatric patients (<18 years) with OWF who underwent facial bone computed tomography scans with specific discharge codes were included. Patients were categorized into preschool (≤7 years) and school-aged (>7 years) pediatric groups.ResultsThe inferior wall was the most common fracture site in both the preschool and school-aged pediatric groups (50.0% vs. 64.4%, P=0.15). The male-to-female ratio and the mechanism of injury showed significant differences between the two age groups. Violence was the most common mechanism of injury in the school-aged pediatric group (49.3%), whereas falls from a height caused OWF in approximately half of the patients in the preschool pediatric group (42.9%). Concomitant injuries and facial fractures had a tendency to occur more frequently in the school-aged pediatric group.ConclusionSignificant differences according to the sex and mechanisms of injury were identified in preschool and school-aged pediatric patients with OWF.

Assessment of antibiotic prescribing pattern in pediatric patients: A cross-sectional hospital-based survey

Background: Irrational usage of antibiotics increases the risk for the antimicrobial resistance, leads to increase morbidity, mortality, and economic burden for health care. India is a lower-middle income developing country in south Asia that has high potential for overuse and misuse of antibiotics and has less public awareness of antimicrobial resistance. The World Health Organization (WHO) developed the prescribing indicators to measure the rational usage of drugs in primary care and to assess the prescribing pattern of antibiotics. Aim: The aim of the study was to assess the prescribing pattern of antibiotics in pediatric patients of Anantapur district, Andhra Pradesh, India. Subjects and Methods: A cross-sectional and prospective study was carried out in private pediatric specialty hospitals in urban areas of Anantapur district. Sample size was calculated using single population proportion formula. A total number of 845 pediatric in-patients were included for the study. Patients' demographic characters, diagnosis, and drugs prescribed were recorded in a prestructured and validated data collection form. Results: An average of 3.53 drugs prescribed per patient encounter, which was higher than WHO prescribed indicator standard value 2. The present study reveals that the percentage of encounters with antibiotics was 50.05% (423), which was higher than WHO standard (20.0-26.8%). Among 423 antibiotic prescriptions, 23.43% (198) prescribed with generic names and 91.48% antibiotics were prescribed from essential drug formulary list. Conclusion: Prescription patterns and usage of antibiotics in this study was inappropriate in comparing our results with WHO prescribing indicators. Effective interventions are required to reduce inappropriate antibiotic prescriptions.