Pediatric Subsets Research Articles

The Catatonia Quick Screen (CQS): A Rapid Screening Tool for Catatonia in Adult and Pediatric Populations.

Catatonia is a neuropsychiatric disorder marked by significant disturbances in motor, cognitive, and affective functioning and that is frequently under-diagnosed. To enhance clinical detection of catatonia, this study aimed to develop a rapid, sensitive Catatonia Quick Screen (CQS) using a reduced set of catatonic signs to facilitate screening in adult and pediatric patients. Data were derived from two retrospective cohorts totaling 446 patients (254 adults, 192 children) who screened positive for catatonia using the Bush Francis Catatonia Screening Instrument (BFCSI). Sensitivity analyses were performed for all combinations of BFCSI signs, with sensitivity defined as the proportion of patients identified by each subset relative to the full BFCSI. The CQS was developed by selecting signs from the BFCSI based on sensitivity, ease of assessment, and relevance to diverse catatonia presentations. Screening for the presence of any one of four signs-excitement, mutism, staring, or posturing-using the CQS yielded a theoretical sensitivity of 97% (95% CI: 95 to 98%) relative to the full BFCSI (which requires two signs out of 14). The CQS demonstrated 97% sensitivity across both pediatric and adult subsets. The Catatonia Quick Screen provides a rapid screening alternative to the BFCSI with high sensitivity, potentially improving early detection of catatonia in clinical settings. Future prospective studies are necessary to validate the CQS's sensitivity and to determine its specificity in clinical populations.

A Retrospective Review of Opioid Prescribing Practices for At-Risk Pediatric Populations Undergoing Ambulatory Surgery.

Pediatric patients with sleep-disordered breathing (SDB) and obesity are at risk for opioid-induced respiratory depression. Although monitoring in the inpatient setting allows for early recognition of opioid-related adverse events, there is far less vigilance after ambulatory surgery as patients are discharged home. Guidelines for proper opioid dosing in these pediatric subsets have not been established. We sought to determine if at-risk children were more likely to receive doses of opioids outside the recommended range. Baseline opioid prescribing data for all outpatient surgery patients receiving an opioid prescription between January 2019 and June 2020 were retrospectively reviewed. Patients with SDB or obesity were identified. To obtain more information about prescribing practices, we analyzed patient demographics, size descriptors used for calculations, and prescription characteristics (dose, duration, and prescribing surgical service). A total of 4674 patients received an opioid prescription after outpatient surgery. Of those, 173 patients had SDB and 128 were obese. Surgical subspecialties rendering most of the opioid prescriptions included otolaryngology and orthopedics. Obese patients were more likely (64%) to be prescribed opioids using ideal weight at higher mg/kg doses (>0.05 mg/kg; 83.3%; p < 0.0001). When providers used actual body weight, lower mg/kg doses were more likely to be used (53.7%; p < 0.0001). No prescriptions used lean body mass. Overweight/obese children were more likely to receive opioid doses outside the recommended range. Variability in prescribing patterns demonstrates the need for more detailed guidelines to minimize the risk of opioid-induced respiratory complications in vulnerable pediatric populations.

Pediatric subset of primary immunodeficiency patients treated with SCIG: post hoc analysis of SHIFT and IBIS pooled data

BackgroundPrimary immunodeficiencies (PID) constitute a heterogeneous group of more than 350 monogenetic diseases. PID patients with antibody impairment require lifelong administration of immunoglobulin G replacement therapy, administered either intravenously (IVIG) or subcutaneously (SCIG). Although the effectiveness of weekly and biweekly (every other week) SCIG administration has been shown in several trials, data on the viability of these two regimens in pediatric PID patients are sparse.MethodsData on the pediatric subsets of PID patients enrolled in SHIFT (weekly) and IBIS (biweekly) studies were pooled and analyzed to indirectly compare two different 20%-concentrated SCIG (Hizentra®) regimens. The primary endpoints were to evaluate trough IgG levels and cumulative monthly doses; the secondary endpoint was to analyze incidence of infections.ResultsFifteen and 13 children from the SHIFT and IBIS studies were included, respectively. Cumulative 20%-concentrated SCIG monthly dose was slight lower for the biweekly regimen (Δ = − 2.04, 90% CI − 8.3 to 4.23). However, the trough IgG levels were similar between the two groups (Δ = 0.28, 90% CI − 0.51 to 1.07) and constantly above the threshold of 5 g/L. After adjusting for potential confounders, the annualized rate of infections was similar between SHIFT and IBIS patients (incidence rate ratio = 1.09, 90% CI 0.72–1.67); only 1 serious bacterial infection was experienced by a patient in the IBIS group.ConclusionIn pediatric PID patients, weekly and biweekly Hizentra® administrations appeared equally effective treatment options.

Progress in individualizing autologous islet isolation techniques for pediatric islet autotransplantation after total pancreatectomy in children for chronic pancreatitis.

Total pancreatectomy with islet autotransplantation is performed to treat chronic pancreatitis in children. Successful islet isolation must address the challenges of severe pancreatic fibrosis and young donor age. We have progressively introduced modifications to optimize enzymatic and mechanical dissociation of the pancreas during islet isolation. We evaluated 2 islet isolation metrics in 138 children-digest islet equivalents per gram pancreas tissue (IEQ/g) and digest IEQ per kilogram body weight (IEQ/kg), using multiple regression to adjust for key disease and patient features. Islet yield at digest had an average 4569 (standard deviation 2949) islet equivalent (IEQ)/g and 4946 (4009) IEQ/kg, with 59.1% embedded in exocrine tissue. Cases with very low yield (<2000 IEQ/g or IEQ/kg) have decreased substantially over time, 6.8% and 9.1%, respectively, in the most recent tertile of time compared to 19.2% and 23.4% in the middle and 34.1% and 36.4% in the oldest tertile. IEQ/g and IEQ/kg adjusted for patient and disease factors improved in consistency and yield in the modern era. Minimal mechanical disruption during digestion, warm enzymatic digestion using enzyme collagenase:NP activity ratio<10:1, coupled with extended distension and trimming time during islet isolation of younger and fibrotic pediatric pancreases, gave increased islet yield with improved patient outcomes.

Efficacy of oral midazolam for minimal and moderate sedation in pediatric patients: A systematic review.

One of the most widely used options for minimal/moderate sedation in pediatric patients is oral midazolam, as it presents an alternative to less well‐accepted routes of administration (eg, intravenous or intranasal) of this well‐known efficacious and well‐tolerated short‐acting benzodiazepine. A systematic review of the literature was conducted in order to identify clinical studies evaluating the effectiveness of oral midazolam for sedation in pediatric patients in the context of premedication before anesthesia or during diagnostic/treatment procedures. The percentage of responders (response rate) after single administration of oral midazolam was evaluated and compared versus placebo in a subset of placebo‐controlled studies. The range of oral midazolam doses providing effective sedation in the different pediatric age subsets was analyzed in order to assess optimum dosing strategies. A total of 25 pediatric clinical studies, utilizing a variety of measures of sedation effectiveness, were selected. These studies included a total of 1472 patients (aged 4 months‐18 years) treated with midazolam (0.25‐1.5 mg/kg) and 138 patients treated with placebo. The response rates [95% confidence interval] with oral midazolam ranged from 36.7% [21.6%, 54.9%] to 97.8% [86.1%, 99.7%], while with placebo response rates ranged from 4.0% [0.6%, 23.5%] to 41.0% [29.4%, 53.6%]. When considering the 4 placebo‐controlled studies, the odds ratios [95% confidence interval] for the comparison of midazolam vs. placebo ranged from 13.4 [5.0, 36.0] to 25.9 [6.7, 100.6]. The analysis of subgroups by context of sedation showed response rates [95% confidence interval] with oral midazolam ranging from 36.7% [21.6%, 54.9%] to 97.0% [94.8%, 98.3%] for anesthetic premedication and from 56.1% [43.1%, 68.4] to 97.8% [86.1%, 99.7%] for medical procedures. The efficacy of midazolam for pediatric minimal/moderate sedation from a dose of 0.25 mg/kg and above was demonstrated. The probability of occurrence of adverse events and over‐sedation increases with increasing doses.

Incidence and Epidemiology of Perioperative Transfusion-Related Pulmonary Complications in Pediatric Noncardiac Surgical Patients: A Single-Center, 5-Year Experience.

Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related fatalities. While these transfusion-related pulmonary complications (TRPCs) have been well detailed in adults, their burden in pediatric subsets remains poorly defined. We sought to delineate the incidence and epidemiology of pediatric TRPCs after intraoperative blood product transfusion. In this retrospective cohort study, we evaluated all consecutive pediatric patients receiving intraoperative blood product transfusions during noncardiac surgeries between January 2010 and December 2014. Exclusion criteria were cyanotic heart disease, preoperative respiratory insufficiency, extracorporeal membrane oxygenation, and American Society of Anesthesiologists physical status VI. Medical records were electronically screened to identify those with evidence of hypoxemia, and in whom a chest x-ray was obtained within 24 hours of surgery. Records were then manually reviewed by 2 physicians to determine whether they met diagnostic criteria for TACO or TRALI. Disagreements were adjudicated by a third senior physician. Of 19,288 unique pediatric surgical patients, 411 were eligible for inclusion. The incidence of TRPCs was 3.6% (95% confidence interval [CI], 2.2-5.9). TACO occurred in 3.4% (95% CI, 2.0-5.6) of patients, TRALI was identified in 1.2% (95% CI, 0.5-2.8), and 1.0% (95% CI, 0.4-2.5) had evidence for both TRALI and TACO. Incidence was not different between males (3.4%) and females (3.8%; P = .815). Although a trend toward an increased incidence of TRPCs was observed in younger patients, this did not reach statistical significance (P = .109). Incidence was comparable across subsets of transfusion volume (P = .184) and surgical specialties (P = .088). Among the 15 patients experiencing TRPCs, red blood cells were administered to 13 subjects, plasma to 3, platelets to 3, cryoprecipitate to 2, and autologous blood to 3. Three patients with TRCPs were transfused mixed blood components. TRPCs occurred in 3.6% of transfused pediatric surgical patients, with the majority of cases attributable to TACO, congruent with adult literature. The frequency of TRPCs was comparable between genders and across surgical procedures and transfusion volumes. The observed trend toward increased TRPCs in younger children warrants further consideration in future investigations. Red blood cell administration was the associated component for the majority of TRPCs, although platelets demonstrated the highest risk per component transfused. Mitigation of perioperative risk associated with TRPCs in pediatric patients is reliant on further multiinstitutional studies powered to examine patterns and predictors of this highly morbid entity.

Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system.

While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic. Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme. After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards. Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.

A Pediatric Approach to Ventilator-Associated Events Surveillance.

OBJECTIVE Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children. DESIGN Retrospective cohort SETTING Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals PATIENTS Patients ≤18 years old ventilated for ≥1 day METHODS We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models. RESULTS In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on "pediatric VAC with antimicrobial use" (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test ("pediatric PVAP") occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls. CONCLUSIONS We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes. Infect Control Hosp Epidemiol 2017;38:327-333.

Unfolding the Mutational Landscape of Human Melanoma

Over the preceding two decades, sophisticated sequencing techniques have been used to characterize the genetic drivers of adult melanoma. However, our understanding of pediatric melanomas is still rudimentary. In this report, we comment on a thorough multi-platform analysis of common pediatric melanoma subsets, including pediatric conventional melanoma (CM), congenital nevus-derived melanoma (CNM), and Spitzoid melanoma (SM), contributed by Lu et al.

2248 BODY WEIGHT CORRELATES WITH TOTAL URINARY CALCIUM AND OXALATE IN PEDIATRIC AND ADULT STONE FORMERS

You have accessJournal of UrologyStone Disease: Evaluation & Medical Management II1 Apr 20122248 BODY WEIGHT CORRELATES WITH TOTAL URINARY CALCIUM AND OXALATE IN PEDIATRIC AND ADULT STONE FORMERS Mark D. Sawyer, John C. Thomas, Tracy E. Hunley, Ryan B. Pickens, Mary S. Dietrich, S. Duke Herrell, and Nicole L. Miller Mark D. SawyerMark D. Sawyer Nashville, TN More articles by this author , John C. ThomasJohn C. Thomas Nashville, TN More articles by this author , Tracy E. HunleyTracy E. Hunley Nashville, TN More articles by this author , Ryan B. PickensRyan B. Pickens Nashville, TN More articles by this author , Mary S. DietrichMary S. Dietrich Nashville, TN More articles by this author , S. Duke HerrellS. Duke Herrell Nashville, TN More articles by this author , and Nicole L. MillerNicole L. Miller Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2425AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Obesity appears to increase stone risk in adults. However, since adipose tissue is not very metabolically active and patients with identical body mass index (BMI) can have very different body weights, absolute body weight may be a more important predictor of stone risk. The intent of this study is to further evaluate the relationship between body weight and calcium and oxalate in both adult and pediatric stone formers. METHODS All pediatric and adult stone patients at our institution with a 24 hour urine study analyzed by Litholink were identified. Selected for inclusion were initial baseline urine studies with an adequate collection without cystinuria. 338 patients (children <17 (n=135) and adults (n=203)) met inclusion criteria (M=162, F=176; ages 2-78; weight 11.6-147kg). Patients were grouped in 10 kg intervals (except for patients >100 kg who were grouped together) and compared (figure and table 1). Univariate linear regression was then used to compare the effect of weight in pediatric and adult subsets to the entire cohort (table 2). Table 1. Urine Constitutuents and Body Weight (Adult and Pediatric Combined) Group 1 2 3 4 5 6 7 8 9 10 Weight (kg) 10−19.9 kg 20−29.9 kg 30−39.9 kg 40−49.9 kg 50−59.9 kg 60−69.9 kg 70−79.9 kg 80−89.9 kg 90−99.9 kg >100 kg N 9 18 36 37 48 42 53 34 37 24 Calcium (mmol/24h) 2.15±0.89 2.37±1.08 3.00±1.55 3.16±1.93 3.94±1.65 5.53±2.87 5.40±2.74 6.14±2.44 6.12±2 .61 9.05±4.49 Oxalate (mmol/24h) 0.203±0.057 0.319±0.213 0.349±0.104 0.319±0.13 0.34±0.15 0.43±0.27 0.43±0.20 0.407±0.14 0.450±0.15 0.53±0.22 Table 2. Univariate Linear Regression Coefficients of Regression for Body Weight (β) with Standard Error (SE) and Coefficients of Determination (R2) for Children, Adults and Combined Pediatric Adult Combined β±SE R2 β±SE R2 β±SE R2 Calcium 0.066±0.009 0.303 0.065±0.010 0.167 0.071±0.0084 0.333 Oxalate 0.00253±0.00072 0.078 0.00206±0.00071 0.036 0.00208±0.00068 0.055 RESULTS Both calcium and oxalate excretion increase with weight in adults and children. The correlation with total calcium in the combined group is very high (r=0.58). With linear regression, the coefficients of regression for body weight as a predictor of total calcium and oxalate are nearly identical in children and adults. CONCLUSIONS Body weight is an important predictor of calcium and oxalate excretion in both children and adults. Overall, it explains 33.3% and 5% of total variation in the daily urinary calcium and oxalate, respectively. These findings could help explain the observed increase in stone prevalence with increasing obesity and suggests that there should be increased emphasis on overweight patients losing weight to prevent recurrence, regardless of age. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e906-e907 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark D. Sawyer Nashville, TN More articles by this author John C. Thomas Nashville, TN More articles by this author Tracy E. Hunley Nashville, TN More articles by this author Ryan B. Pickens Nashville, TN More articles by this author Mary S. Dietrich Nashville, TN More articles by this author S. Duke Herrell Nashville, TN More articles by this author Nicole L. Miller Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Age-Related Trends in Pediatric B-Cell Subsets

There are few studies of the developmental changes in B-cell subsets in children. Recent data from adult populations demonstrate that alterations to B-cell subsets have functional consequences and can be helpful diagnostically. Comparable studies in children have been hindered by the lack of normative data and by significant changes with age. This study evaluated B-cell subsets by 4-color flow cytometry in 47 children of different ages. The use of a 4-color platform is compatible with broad use in clinical laboratories. We found that there are rapid changes in the B-cell compartment in infancy and early childhood. Total B-cell numbers decline early in life, and this correlates with a decline in transitional B cells and naïve B cells. The decline is most rapid between 1 and 5 years of age, with a slower decline later in childhood. In contrast, nonswitched and switched memory B cells both increase during the 1st 5 years of life. The decline in B-cell numbers did not occur until after 1 year of age, suggesting that the period after birth is a unique developmental window. These data provide a reference set for further studies on B-cell dysfunction in pediatric disorders. The changes occurring in early childhood document the need for age-related assessments and serve to underscore the B-cell-specific kinetics of immunologic development in humans.

Modifications in endoscopic practice for pediatric patients

Pediatric endoscopy is largely in the domain of the pediatric gastroenterologist. Occasionally, pediatric surgeons may be trained in endoscopy. Because children are not simply young adults, optimal performance of endoscopy in these patients requires an adequate knowledge and understanding of pediatrics and a thorough understanding of the child's medical background. 1 Hassall E. NASPGN position paper: requirements for training to ensure competence of endoscopists performing invasive procedures in children. J Pediatr Gastroenterol Nutr. 1997; 24: 345-347 Crossref PubMed Scopus (33) Google Scholar In many practice settings, however, adult endoscopists are called upon to provide advanced therapeutic endoscopic services, such as ERCP and EUS, or basic endoscopic services when pediatric gastroenterologists are unavailable. To provide appropriate care for the child in such circumstances, a team approach is required with the pediatrician or the pediatric gastroenterologist and the adult endoscopist. This document is intended to provide guidance regarding endoscopic practice issues that may differ in children. Because physiologic age is a continuum, this document is not intended to apply to rigidly defined age ranges. Where useful, such as among pediatric subsets, ages will be specified.

Impact of Parenteral Nutrition-Associated Liver Disease on Intestinal Transplant Waitlist Dynamics

United Network for Organ Sharing (UNOS) reports indicate that waiting list mortality for intestinal transplant candidates greatly exceeds that for all other organ transplant candidates. But United Network for Organ Sharing outcomes reports have not routinely distinguished between the intestine candidate subgroups that are listed only for an intestine and those that are also listed for a liver. Data were obtained by request from the collaborative Organ Procurement and Transplantation Network (United Network for Organ Sharing)/Scientific Registry of Transplant Recipients (University Research and Education Association) database. Waiting list data for intestinal transplant recipients from 1995 to 2004 were divided into those candidates listed for only an intestine and those listed for both an intestine and a liver. Additional data concerning overall waiting list outcomes and posttransplant survival rates stratified into pediatric and adult subsets were also obtained and analyzed. The overall number of candidates on the intestinal transplant waiting list has increased steadily since 1995 and, consistently, the majority of candidates have also been listed for a liver. This subset was found to have both a higher relative risk of dying while awaiting transplantation and lower relative odds of receiving transplants. In addition, parenteral nutrition-associated liver disease is a major problem across all age groups, as evidenced by the combined liver and intestine listings that compose the majority of both adult and pediatric waiting list populations. Posttransplant survival data were found to be superior for isolated intestine recipients compared with liver-intestine recipients. The preponderance of dual listings and their associated inferior outcomes, before and after transplantation, has skewed overall intestinal transplant outcomes. Because progression of parenteral nutrition-associated liver disease can be insidious, and recognition of irreversibility is often difficult, intestine-only transplants should be considered early for high-risk patients before parenteral nutrition-associated liver disease progression mandates inclusion of a liver graft also.

Comparative study of safety and efficacy of imatinib mesylate therapy in pediatric and adult chronic myeloid leukemia

20016 Background: Chronic Myeloid Leukemia (CML) is one of the rare pediatric cancers. Imatinib is now the standard of care in adult CML (ACML) with newer compounds being investigated to overcome the burden of Imatinib resistance. Pediatric CML (PCML) has been an area little explored and effective strategies are not yet defined. Although, allogenic hematopoietic stem cell transplantation (HSCT) still remains the gold-standard treatment, the choice of drug in the subset in which HSCT is not a suitable option remains to be determined. Methods: This was a single-institution prospective study conducted from April 2004-March 2006, analyzing and comparing 293 Philadelphia chromosome (PH) positive CML patients in pediatric and adolescent subsets (i.e. age =18 years) not eligible for allogenic HSCT with ACML. After obtaining a written informed consent, a starting dose of 400 mg/m2/d Imatinib mesylate was administered in adults, whereas in pediatric and adolescents it was 400 mg/m2/d if the body surface area (BSA) was &lt;1 m2, or 400 mg/d if BSA was &gt;1m2. Results: 27 patients were in the age group =18 years; male to female ratio was 1.07:1. Gender ratio in 266 ACML patients showed a male preponderance (2.5:1). The mean age in ACML was 37.4 years. In pediatric subsets, a trend toward CML in adolescents was observed with mean age 14.85 years. Majority of the patients were in chronic phase (81.5% PCML and 85.7% ACML) with overall 93% patients receiving prior hydroxyurea as a cytoreductive agent. An unusual finding was higher incidence of Hypodiploidy (significance undetermined) and 5 patients had double PH. 80.1% ACML patients achieved complete hematological response, but it was significantly lower (59.3%) in PCML. 39.5% ACML achieved major cytogenetic response which was less than most published western data. Hematologic and non-hematologic toxicities (GI, dermatological etc) were found to be higher in ACML. Low toxicities in PCML were attributed to good tolerance to Imatinib therapy; however a higher dropout rate in pediatric subsets was possibly due to poor social and parental support. Conclusion: We conclude that imatinib mesylate is both safe and efficacious drug for ACML, however further research is warranted in pediatric and adolescent population to establish its efficacy. No significant financial relationships to disclose.

Is the autologous serum skin test useful only in chronic urticaria? A study in respiratory patients

Chronic idiopathic urticaria is an allergy-like skin disorder. Autologous serum skin test (ASST) is regarded as a reliable in vivo diagnostic test in these patients. About 30% of rhinitis and asthma patients doesn't show sensitization to any allergen. No data are available on the application of ASST to respiratory patients. A cohort of respiratory patients was SPT screened using inhalant allergens. Patients were divided in “allergy” and “allergy-like” whether or not they react to at least one allergenic source. Representative group of patients were ASSTested. Allergy-like children were prevalent before age 6, whereas the prevalence of allergics increased with age. The ratio of allergy/allergy-like subjects continues to increase in adult males, whereas adult females represent the large majority of the allergy-like subset. 58% of CIU control patients reacted to the ASST. Among allergy-like patients ASST was positive in 47% of the adults and in 84% of the children. Pure allergy patients reacted in 73% (children) and 40% (adults). 45% percent of 58 healthy controls reacted to the ASST. An ASST reactivity is reported for the first time in allergy-like respiratory patients. A higher prevalence has been recorded in pediatric subsets, whereas female reactivity is prevalent among adults. The ASST reactivity seems to parallel the patient distribution within the entire respiratory cohort. Further studies are needed to demonstrate that the serum factors causing the ASST reactivity in respiratory patients are the same as for CIU. The ASST reactivity of healthy subjects could lead to a new interpretation of the autologous serum reactivity.

Allergy-Like Asthma and Rhinitis

Background: Chronic idiopathic urticaria is considered an allergy-like skin disorder, and in some cases an auto-reactivity caused by mast cell degranulating factors has been demonstrated. A positive reaction to the autologous serum skin test (ASST), reflecting the presence of factors capable to degranulate the mast cells, is regarded as a reliable in vivo diagnostic test in chronic urticaria patients. About one out of three patients complaining for rhinitis or asthma does not show sensitization to any allergenic source. No data are available on the application of ASST to respiratory patients. Methods: A cohort of respiratory patients, aged 1 to 80 years, complaining about suspected respiratory symptoms was screened using a panel of inhalant allergens by means of SPT and IgE. Current and past information on skin and respiratory symptoms were recorded for each patient. Patients were divided in ‘allergy’ and ‘allergy-like’ whether or not they react to at least one allergenic source. Age and gender distribution were analyzed. A control group fulfilling criteria for chronic idiopathic urticaria (CIU) was selected as well. The ASST was applied to the control CIU group, to the allergy-like and allergy subsets, and to a group of 58 healthy adult subjects. Results: Allergy and allergy-like patients were differently distributed in relation to age and gender. Allergy-like children were prevalent before age six, whereas the prevalence of allergics steadily increased with age representing the large majority of patients in late childhood. The ratio of allergy/allergy-like subjects continues to increase in adult males, whereas adult females represent the large majority of the adult patients mainly within the allergy-like subset. Fifty-eight percent of CIU control patients reacted to the ASST. Among allergy-like patients ASST was positive in 47% of the adults (male 26%, female 54%), and in 84% of the children (no gender differences). The percentage of reactive subjects increased in the adult allergy-like subset if a CIU was associated (65%). Eighty-six percent of the pediatric patients and 61% of the adults having an allergy respiratory disease associated with an allergy-like condition had a positive ASST reactivity. Pure allergy patients reacted in 73% and 40% of the cases in the children and adults subgroups, respectively. Forty-five percent of healthy controls reacted to the ASST as well, and statistically significant gender differences were still recorded. Conclusions: An ASST reactivity is reported for the first time in allergy-like respiratory patients. A higher prevalence of reactive subjects has been recorded in all the pediatric subsets without gender differences, whereas female reactivity is prevalent among adults. The ASST reactivity seems to parallel the patient distribution within the entire respiratory cohort. Further studies are needed to demonstrate that the serum factors causing the ASST reactivity in respiratory patients are the same as for CIU affected subjects. In the light of recent in vitro findings, the ASST reactivity of healthy subjects could lead to a new interpretation of the autologous serum reactivity.

Modifications in endoscopic practice for pediatric patients

Pediatric endoscopy is largely in the domain of the pediatric subspecialist. As such, the performance of endoscopy in children assumes an adequate knowledge and understanding of pediatrics. 1 Hassel E. NASPGN Position Paper: Requirements for Training to Ensure Competence of Endoscopists Performing Invasive Procedures in Children. J Pediatr Gastroenterol Nutr. 1997; 24: 345-347 Crossref PubMed Scopus (33) Google Scholar In many practice settings, however, adult endoscopists are called upon to provide basic endoscopic services for those delivering primary pediatric care, or advanced endoscopic services for pediatric gastroenterologists. In order to provide appropriate care for the child in such circumstances, a team approach is often required between the pediatrician or the pediatric gastroenterologist and the adult endoscopist. This document is intended to provide guidance regarding endoscopic practice issues that may differ in children. As physiologic age is a continuum, this document is not intended to apply to rigidly defined age ranges. Where useful, such as among pediatric subsets, ages will be specified.

Perceived Exertion: Applications in Clinical, Behavioral and Environmental Settings.

756 This symposium will focus on applications of perceived exertion in clinical, behavioral and environmental domains. Initial consideration will be given to the functional link between exertional perceptions and underlying psychophysiological mediators during exercise performance as conceptualized in Borg's Model of the Effort Continua. The seminal importance of Borgs' Range Model in the application of exertional perceptions using category scaling techniques will follow. The symposium will then examine two interrelated themes: application domains and application methodologies. Application domains will include: (a) normal and clinically involved pediatric sub-sets, (b) clinical and performance based exercise testing and prescription, (c) psychobehavioral exercise settings and (d) environmental extremes involving heat, cold and high altitude. Application methodologies will be explored within each domain, emphasizing; (a) scale type, (b) response validity/reproducibility, (c) interpretation constraints and reference standards, d) scope of response generalization, (e) measurement utility, (f) perceptual adaptations and (g) exercise intensity preference. The symposium will conclude with a panel discussion that considers the need to develop a standardized scale and scaling methodology appropriate for international application.

Pediatric germ cell tumors.

Germ cell tumors historically have been considered to be a single nosologic category comprising tumors with different histologic manifestations and different degrees of malignancy and arising at different sites of origin. Only in the last decade has the biologic heterogeneity of germ cell tumors been recognized and addressed. Therapy tailored for the many biologically distinct subsets of germ cell tumors has yet to be defined. Because many categories exclusively involve children, this challenge has been assumed by pediatric oncologists, resulting in the multi-institutional and multinational cooperative studies currently in progress. Current protocols utilize regimens that have been effective in adult germ cell tumors. The probability that the biologically unique pediatric subsets may be best treated by other regimens awaits future protocols.