Treatment Outcomes In Children Research Articles

Extracranial germ cell tumours: Mature and immature (1990-2015). First report by the South African Association of Paediatric Haematology Oncology (SAAPHO).

Outcomes of rare paediatric teratomas have not previously been reported nor treatment regimens standardised in low- and middle-income settings. We sought to evaluate treatment outcomes of children and adolescents with histologically confirmed extracranial germ cell tumours, both mature teratomas (MT) and immature teratomas (IT) in preparation for the development of the South African national treatment guideline. Retrospective data by folder review were collated from nine South African paediatric oncology units. Kaplan-Meier analysis with Cox regression was performed to determine 5-year overall survival (OS) and prognostic factors. From January 1990 to December 2015, 60 patients were diagnosed with MTs; 14 males (median age 2months; interquartile range [IQR]: 0-8.75months) and 46 females (median age 9months; IQR: 0-88.5months). Forty patients were diagnosed with ITs; 10 males (median age less than 1month; IQR: 0-1.75months) and 30 females (median age 4.5months; IQR: 1-162months). There were high rates of upfront surgical resections in patients with MTs (58/60; 96.6%) and ITs (36/40; 90%), and similarly satisfactory rates of complete resection in patients with both MTs (55/60; 91.7%) and ITs (32/40; 80%). The 5-year OS for the whole group was 85.4%, significantly influenced by stage: Stage I (96.9%), Stage II (100%), Stage III (38.9%) (p<.001 [MT]; p=.013 [IT]). The event-free survival (EFS) ratio for the whole cohort was 78.7%. Five-year OS for those with low-stage disease was excellent, but was poorer for patients with advanced disease. The implementation of a national treatment guideline will facilitate the standardising of surgical approaches, indications for chemotherapy and specifications for follow-up to improve survival and to collect more robust late effects data.

Treatment outcomes for children with chronic food refusal in a community behavioral health center

AbstractAbnormal patterns of feeding behavior are seen in children with and without developmental disabilities; if not treated early, these patterns may lead to a diagnosis of avoidant/restrictive food intake disorder (ARFID). A multitude of treatments for ARFID varying in theoretical orientation, intensity, and modality exist in the literature. Given the potential for complexity in the clinical presentation of ARFID, intensive interdisciplinary treatment programs are often the preferred intervention choice. However, due to the limited availability of these highly controlled settings, underserved populations are often limited to any outpatient feeding therapy that is available locally. This study focused on examining the outcomes of a behavioral outpatient feeding program in a community behavioral health center. Results show that there were statistically significant treatment outcomes when comparing observable feeding behaviors and caregiver satisfaction measures from admission to discharge. Moreover, these gains were maintained at follow‐up supporting the treatment efficacy of such programs.

Retinoblastoma in Asia: Clinical Presentation and Treatment Outcomes in 2112 Patients from 33 Countries

PurposeTo describe the clinical presentation and treatment outcomes of children diagnosed with retinoblastoma (RB) in the year 2017, throughout Asia. DesignMulti-national prospective study including treatment-naïve patients diagnosed with retinoblastoma in Asia during 2017 and followed up thereafter. ParticipantsA total of 2112 patients (2797 eyes) from 96 RB treatment centers in 33 Asian countries. InterventionChemotherapy, radiotherapy, enucleation, orbital exenteration Main Outcome MeasuresEnucleation and death ResultsWithin the cohort, 1021 (48%) patients were from South Asia (SA), 503 (24%) from East Asia (EA), 310 (15%) from South-East Asia (SEA), 218 (10%) from West Asia (WA) and 60 (3%) from Central Asia (CA). Mean age at presentation was 27 months (median, 23 months; range, <1 to 261 months). There were 1195 (57%) males and 917 (43%) females. The most common presenting complaints were leukocoria (72%) and strabismus (13%). Based on 8th edition American Joint Committee for Cancer, tumors were staged as cT1 (n=441; 16%), cT2 (n=951; 34%), cT3 (n=1136; 41%), cT4 (n=267; 10%), N1 (n=48; 2%), and M1 (n=129; 6%) at presentation. RB was treated with intravenous chemotherapy in 1450 (52%) eyes and 857 (31%) underwent primary enucleation. Three-year Kaplan-Meier estimates for enucleation and death were 33% and 13% for CA, 18% and 4% for EA, 27% and 15% for SA, 32% and 22% for SEA, 20% and 11% for WA (p<0.0001 and p<0.0001), respectively. ConclusionAt the conclusion of this study, there was a significant heterogeneity in treatment outcomes of RB between the regions of Asian continent. East Asia displayed better outcomes with higher rates of globe and life salvage, while South-East Asia had poorer outcomes compared to the rest of Asia.

Two‐year, single‐centre, real‐life experience with permethrin 5% and benzyl benzoate 25% in 228 children with scabies: A retrospective report

AbstractBackgroundScabies are a significant health issue for institutions and represent a health burden in children. Topical treatments such as permethrin 5% are usually effective but lately, a loss of efficacy has been observed.ObjectivesTo describe demographic data, topical treatment schemes (permethrin 5%; benzyl benzoate 25%) and outcomes in children with scabies over the past 2 years.MethodsWe retrospectively evaluated records of children aged 0 to 14 years with scabies treated in our outpatient clinic from 1 January 2021 to 31 December 2022.ResultsTwo hundred and thirty‐one records were evaluated. Permethrin 5% (P5%) was used as first‐line treatment in 103 children with a success rate of 81.5%; benzyl benzoate 25% (BB25%) was successful in 94.3% of 123 patients. Three patients were lost for follow up and two received other therapies. Mean days of application using P5% increased from 4.1 to 6.8 in 2 years, whereas BB25% showed an opposite trend, from 10 days to 4.7. With the same days of application, the success rate with BB25% was higher (repeated cycle of 2 treatment days, 7 days apart [2 + 2]: 93.3% for BB25% vs. 82.9% for P5%; 3 + 3‐day regime: 91.9% for BB25% vs. 83% for P5%). Twenty‐three out of 26 patients who still had active scabies after the first cycle cleared with a second treatment cycle, with the same topical treatment, or with a different agent. Mild to moderate skin irritation was the only side effect observed (18.4%), more frequently associated with BB25% (81%).ConclusionsDuring the observational period, the use of permethrin decreased while regimen duration increased, probably due to a perceived lack of efficacy. Conversely the use of benzyl benzoate both as first‐line treatment and after permethrin failure increased, despite being more correlated to local inflammation. Both 2 + 2 and 3 + 3 regimes for P5% and BB25% may be considered as suitable first‐line treatment of scabies in children.

Clinical and therapeutic outcomes of pediatric pituitary adenomas: a single pituitary center experience.

Pediatric pituitary adenomas (PPA) are rare. Although PPAs are mostly benign, they can be challenging to manage. Most studies evaluating PPA are based on surgical series. We aimed to present the clinical features, hormonal status and treatment outcomes of children with PPA managed in a joint neuroendocrine setting. In this single-center study, demographic, clinical and endocrinological data of patients under 19 years old who were followed up with the diagnosis of PPA between 2002-2022 were retrospectively reviewed. A total of 21 studies published in the past 20 years were also systematically reviewed. There were 79 patients (52 girls, 27 boys) with a median age of 15.8 years. Median follow-up time was 30 months. The most common adenoma subtype was non-functioning adenoma (NFA) (35.5%), followed by prolactinoma (29.1%), corticotropinoma (21.5%), and somatotropinoma (13.9%), respectively. The frequency of micro and macroadenomas was almost equal while 38% of all adenomas were invasive. Headache, visual impairment and menstrual irregularity were the most common complaints, while the most common hormonal deficiency at diagnosis was central hypothyroidism (31.6%), followed by hypogonadotropic hypogonadism (22.7%), growth hormone deficiency (15.2%) and central adrenal insufficiency (11.4%), respectively. Fifty patients (63.2%) underwent endoscopic endonasal transsphenoidal surgery (EETS). Following the surgery, impaired endocrine functions recovered at a rate of 62% while permanent central diabetes insipidus was observed in 6%, and new onset hypopituitarism developed in 4%. NFA was more common in this cohort than in previous reports, which is one of the largest PPA series in the literature. Hormonal disorders, which were common at the time of diagnosis, were largely resolved with appropriate endocrinological and surgical approaches, while the rate of pituitary hormonal deficiencies after EETS was relatively low. Therefore, we recommend that children with PPA be managed in the setting of a high-volume pituitary center to provide long-term low morbidity.

An observational analysis of profile and outcome of children with malnutrition admitted at malnutrition treatment centre

ABSTRACT Introduction: Nutritional status is an important health indicator and children bear maximum burden of it. Poor nutrition during first thousand days of a child’s life can lead to stunted growth. Comorbid condition adversely affects treatment outcome of malnutrition. This study is aimed to describe the profile and treatment outcome of malnourished children. Materials and Methods: This record-based retrospective, analytical observational study was conducted from October to December 2020. Data of severe acute malnourished children who were admitted in malnutrition treatment centre during August 2017 to September 2020, collected. Totally, 264 eligible children were enrolled in the study. The data were collected through medical records of patients. Data were entered in excel spreadsheet and analysed. Results: Most of the children belonged to 6-24 months of age, almost equal proportion of male and female, and more than three-fourth of children were from rural area. The mean length of stay in hospital was 15.19 ± 6.64 days and average weight gain of children was 7.6 ± 6.7 gm/kg/day. There was significant increase in Z-score (Weight/Height) and MUAC at the time of discharge (P value &lt;0.05). There was no significant association of treatment outcome with the presence of comorbidities (P value &gt;0.05). Conclusion: Most vulnerable age group for malnutrition was 6 months to 2 years. Majority of children with malnutrition improve with standard treatment protocol of malnutrition. We can improve the ability of community health workers to significantly reduce child malnutrition at the primary care level and in the community by equipping them with the required knowledge, tools, and assistance.

Outcomes of Children Diagnosed with Unilateral Retinoblastoma: Retrospective Audit

To evaluate treatment outcomes of children diagnosed with unilateral retinoblastoma. Retrospective study of children diagnosed with unilateral retinoblastoma registered at the Tata Memorial Hospital (TMH), Mumbai from January 2013 to December 2018 and completed the planned curative treatment protocol. For the 98 cases that were analyzed, the median age of presentation was 24 months. The majority of patients had the intraocular disease (n = 72), whereas orbital retinoblastoma was in 26 patients. At the time of presentation, on imaging extra scleral spread was observed in 16 patients whereas 18 patients had optic nerve involvement, 11 patients had both extra scleral invasion and optic nerve involvement. We used the International Classification of Retinoblastoma for grouping. Out of 98 patients, 71 patients were in Group E, 21 were in Group D and 4 were in Group B and 2 were in Group C. For Staging of Retinoblastoma, we used International Retinoblastoma Staging System (IRSS) in our study and 14 patients had Stage 0 disease, 52 patients had Stage I disease, 10 patients had Stage II, 21 patients had Stage III A and 1 patient had Stage III B disease. High-risk features on surgical specimen histopathology were optic nerve cut margin positive in 6 patients, optic nerve involvement in 21 patients, extra scleral spread in 3 patients, Choroidal invasion in 38 and Iris involvement in 10 patients. Primary enucleation was offered in 52 patients whereas 26 patients underwent secondary enucleation. Systemic chemotherapy was received by the patient in the neoadjuvant setting in 17 patients as a form of chemo-reduction and 51 patients received systemic chemotherapy in the adjuvant setting. Intra-arterial chemotherapy was offered to 27 patients as a primary treatment or in conjugation with focal therapy (n = 11). Definitive radiotherapy was offered to only 2 patients and 22 patients received adjuvant radiotherapy. At a median follow-up of 62 months, 2patients had local relapse, which was salvaged by focal therapy in one and enucleation in the other. Ten patients who had leptomeningeal relapse had died. The 5-year local control (LC) is 97.6%, event-free survival (EFS) is 88% and overall survival (OS) is 89.5%. Globe was salvaged in only 16 cases. On univariate analysis, we observed a significant association between overall survival and extraocular and intraocular disease (p-value 0.0), Extra scleral spread (p-value 0.0), optic Nerve involvement (imaging), and an optic nerve cut margin positive (p-value 0.045), ICRB Groups (p-value 0.0) and IRSS stage (p- value 0.024). Retinoblastoma is curable if detected early. Extra ocular disease and high-risk features are associated with inferior outcomes and poor globe salvage rates.

Factors affecting the benefit of glasses alone in treating childhood amblyopia: an analysis of PEDIG data

BackgroundTo evaluate factors associated with better outcomes from optical treatment alone in amblyopic children from 3 up to 7 years.MethodsData extracted from two studies with similar protocols, Amblyopic Treatment Studies 5 (n = 152) and 13 (n = 128) from the Pediatric Eye Disease Investigator Group database, were used to determine by regression analysis the factors associated with improvements in visual acuity in the amblyopic eye, inter-ocular visual acuity difference and stereoacuity. Input variables were aetiology of amblyopia (anisometropic, strabismic and combined-mechanism amblyopia), treatment compliance, visual acuity, interocular visual acuity difference, stereoacuity, tropia size at distance and near, age and refractive error at baseline.ResultsDespite the range of clinical factors considered, our models explain only a modest proportion of the variance in optical treatment outcomes. The better predictors of the degree of optical treatment success in amblyopic children are visual acuity of the amblyopic eye, interocular visual acuity difference, stereoacuity, treatment compliance and the amblyopic eye spherical-equivalent refractive error. While the aetiology of the amblyopia does not exert a major influence upon treatment outcome, combined-mechanism amblyopes experience the smallest improvement in visual acuity, tropia and stereoacuity and may need longer optical treatment periods.ConclusionsWhile results identify the factors influencing optical treatment outcome in amblyopic children, clinicians will be unable to predict accurately the benefits of optical treatment in individual patients. Whether this is because relevant clinical or non-clinical factors (e.g. nature and volume of daily activities undertaken) influences the outcomes from optical treatment has not yet been identified and remains to be discovered.

Metabolic and growth outcome of two-years growth hormone treatment in children born small for gestational age (SGA): A retrospective study

Metabolic and growth outcome of two-years growth hormone treatment in children born small for gestational age (SGA): A retrospective study

Do the features of juvenile psoriatic arthritis change according to age? A comprehensive evaluation of the PeRA Research Group Registry.

To describe the clinical features and treatment outcomes of children with juvenile psoriatic arthritis (JPsA) and to compare the distinct patterns of the disease between early-onset and late-onset age groups. Patients with JPsA followed regularly for at least 6 months between 2010-2020 in 7 pediatric rheumatology centers in Turkey were included in the study. The demographic features, clinical manifestations, treatment strategies, and outcomes of the patients were evaluated retrospectively. Eighty-seven (46 male/41 female) patients were included in the study. The mean age at diagnosis was 11.9 ± 4.5. Fifty-seven (65.5%) patients had psoriasis at the time of diagnosis, arthritis preceded psoriasis in 10 (11.5%) patients. Thirty (34.5%) patients had dactylitis, 28 (32.2%) had nail pitting, 36 (41.4%) had involvement of the small joints, 20 (23%) had enthesitis. Sacroiliitis was detected in 11 (12.6%) patients by magnetic resonance imaging. Anti-nuclear antibodies (ANA) were positive in 35 (40.2%) patients. Twelve children (%13.8) were in the early-onset (<5 years) group. Uveitis and ANA positivity were more common in the early-onset group. Active joint counts and activity scores of our patients showed significant improvement at 6th month and at the last control compared with baseline. About one-third of patients with JPsA do not have psoriasis at the time of diagnosis. In some patients, no skin lesion is seen during the course of the disease. Children with psoriatic arthritis seem to display two different phenotypes. Younger children have female predominance, ANA positivity, and uveitis, while older children have more axial involvement.

Clinical presentation, radiographic findings, and treatment outcomes in children with adenoid hypertrophy in a paediatric outpatient clinic in Enugu, Nigeria.

To determine the clinical presentation, imaging features and outcomes of children with adenoid hypertrophy in our setting. A retrospective study. The paediatric clinic of a private hospital in Enugu. 51 children, aged 2 to 108 months, with suggestive clinical features and radiographic report of adenoid hypertrophy who presented over 3 years. Clinical information was obtained from the patient's medical records. Data was analysed for the clinical characteristics of the patients, the relationship between the degree of airway narrowing on a postnasal space (PNS) radiograph and treatment outcomes. Degree of airway narrowing as measured on a PNS radiograph, the type of and outcomes of treatment. There was an almost equal male (54.7%): female (45.1%) ratio in the occurrence of adenoid hypertrophy, with a mean age of occurrence of 31.50 ± 3.64 months. Noisy breathing was the commonest symptom (94.1%); history of atopic rhinitis in 64.7% of cases and hyperactive airway disease in 45.1% more than 50% of cases with airway narrowing resolved with medical management only. Adenoid hypertrophy should be considered in evaluating the upper airway in children under five. Paediatricians should be conversant with diagnosing and managing this common cause of upper airway obstruction. None declared.

Long-term efficacy and safety of adjunctive perampanel in pediatric patients aged 4–19 years with epilepsy: a real-world study

This study determined the 24-month outcomes of perampanel treatment in children and adolescents with epilepsy. The percentage of ≥ 50% responders was 47.3% (139/294) at 12 months and 49.0% (144/294) at 24 months. A 100% reduction in seizures for more than 12 months was observed in 12.2% (36/294). Discontinuation occurred in 39.8% (117/294). The most common reason for discontinuation was adverse events (29.1%, 34/117). Baseline seizure frequency was higher in children aged < 12 years than in patients aged ≥ 12 years; however, the percentage of seizure reduction and ≥ 50% responders did not significantly differ between the two groups. The rate of early discontinuation was higher (p < 0.001) and the duration of perampanel treatment was shorter in children aged < 12 years (p = 0.001). Most children aged < 12 years discontinued PER due to inadequate effectiveness, while adverse event was the most common reason in patients aged ≥ 12 years (p = 0.045). Only slow titration was significantly associated with ≥ 50% of responders. In conclusion, this study showed that perampanel can be utilized effectively and safely for a prolonged period in pediatric patients aged 4 to < 12 years, as well as in patients aged 12 years and older.

Age at treatment initiation predicts response in children with chronic hepatitis B.

Accumulating evidence suggests that age has a significant impact on disease progression and outcome of hepatitis B virus (HBV) infection. However, its effect on treatment response has not yet been fully elucidated. To investigate the associations of age at treatment initiation with clinical treatment outcomes in children with chronic hepatitis B (CHB). This study included 306 treatment-naïve children with CHB. Participants were divided into three groups based on the age at which they started antiviral treatment: 1-3 years, 4-6 years and 7-17 years. The primary outcome of this study was HBsAg loss; secondary outcomes included HBeAg clearance and DNA undetectability. Of the 306 subjects, 200 (65.4%) were male. Median (IQR) duration of follow-up was 26 (17, 42) months. There were 139 (45.4%), 79 (25.8%) and 88 (28.6%) of participants in the 1-3 years, 4-6 years and 7-17 years groups, respectively. After adjusting for other covariates, age at treatment initiation was negatively associated with the occurrence of HBsAg loss (1-3 years: HR = 5.07, 95% CI = 2.91-8.82; 4-6 years: HR = 2.42, 95% CI = 1.31-4.46) and HBeAg clearance (1-3 years: HR = 1.73, 95% CI = 1.18-2.53). In addition, we observed linear dose-responses relationships between age at treatment initiation and the probability of HBsAg loss and HBeAg clearance. In children with CHB receiving antiviral treatment, HBsAg loss and HBeAg clearance were frequently observed. Age at treatment initiation can predict treatment response, including HBsAg loss and HBeAg clearance.

Characteristics associated with successful treatment outcome in children with overweight and obesity at a tertiary care clinic in Sri Lanka

Background: Lack of response to childhood obesity management programmes is a global concern. Western studies show that the age and the body mass index of the child at the commencement of the treatment, frequency of clinic visits and parental level of education affect the outcome of such treatment programmes.Objectives: To identify factors associated with z-BMI reduction in children with overweight or obesity who underwent a 6-month clinic-based obesity management programme.Methods: A retrospective analysis of medical records was carried out on children between 2 and 15 years of age who had undergone a weight management programme of 6 months duration at the Teaching Hospital, Peradeniya between 2017 and 2020. Reduction in z-BMI was considered as the successful treatment outcome. Anthropometric, demographic and lifestyle factors at the first and the last visits were extracted and described using means with 95% confidence intervals. Adherence to treatment was evaluated under the categories of diet, physical activity and behavioural modification. Logistic regression was applied to create a model that explains the effect on the treatment outcome.Results: Out of 401 subjects, 94 (23.44%) completed follow up. Eighty subjects (85.1%) achieved a mean z-BMI reduction of 1.981±0.584.The Logistic regression returned a model with screen time as the only statistically significant explanatory variable for changes in BMI. Compared to no screen time those with screen times of over 4 hours were 5.85 (CI 1.25 – 27.28) times more likely to have a negative response.Conclusion: Strategies to minimize screen time are needed to enhance the effectiveness of weight management interventions.

Risk-Adapted Treatment Strategies with Pre-Irradiation Chemotherapy in Pediatric Medulloblastoma: Outcomes from the Polish Pediatric Neuro-Oncology Group.

Craniospinal irradiation (CSI) has been a major component of the standard of care treatment backbone for childhood medulloblastoma. However, chemotherapy regimens have varied based on protocol, patient age, and molecular subtyping. In one of the largest studies to date, we analyzed treatment outcomes in children with newly-diagnosed medulloblastoma treated with pre-irradiation chemotherapy followed by risk-adapted radiotherapy and maintenance chemotherapy. A total of 153 patients from the Polish Pediatric Neuro-Oncology Group were included in the analysis. The median age at diagnosis was 8.0 years, and median follow-up time was 6.4 years. Sixty-seven patients were classified as standard-risk and eighty-six as high-risk. Overall survival (OS) and event-free survival (EFS) for standard-risk patients at 5 years (±standard error) were 87 ± 4.3% and 84 ± 4.6%, respectively, while 5-year OS and EFS for high-risk patients were 81 ± 4.3% and 79 ± 4.5%, respectively. Only one patient had disease progression prior to radiotherapy. This study demonstrates promising survival outcomes in patients treated with pre-irradiation chemotherapy followed by risk-adapted CSI and adjuvant chemotherapy. Such an approach may be useful in cases where the initiation of radiotherapy may need to be delayed, a common occurrence in many institutions globally.

Treatment Outcomes of Children with Primary Versus Secondary Callous-Unemotional Traits.

Recent efforts to improve outcomes for young children with conduct problems and callous-unemotional (CU) traits involve adapting treatments to meet the unique needs of this subgroup. However, these efforts have ignored accumulating evidence for distinct primary and secondary variants within the CU subgroup. Existing treatment adaptations uniformly target risk factors associated with primary CU traits and no studies have investigated variant-specific patterns of responsiveness to treatment adaptations among young children with CU-type conduct problems. Participants were 45 families with a 3- to 7-year-old clinic-referred child (M = 4.84 years, SD = 1.08, 84% boys) with conduct problems and CU traits. Primary and secondary CU variants were defined based on baseline parent-rated anxiety scores. All families received Parent-Child Interaction Therapy adapted for CU traits (PCIT-CU) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems and affective outcomes. Linear mixed-effects modeling showed that the rate and shape of change over time in conduct problems differed between variants, such that children with secondary CU traits showed deterioration in defiant and dysregulated behaviors from post-treatment to follow-up, whereas primary CU traits were associated with maintained gains. There were no variant differences in rate of improvement in CU traits. Affective empathy did not improve for either variant. Internalizing problems meaningfully improved by follow-up for children with secondary CU traits. Findings suggest that PCIT-CU is a promising intervention for children with conduct problems and primary CU traits, but may require further personalization for children with secondary CU traits. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000280404).

Evaluating student pharmacist knowledge, attitudes, and confidence in caring for paediatric patients with HIV

Background: Despite advances in the management of human immunodeficiency virus (HIV), people living with HIV (PLWH) experience stigma that impacts the healthcare they receive. Numerous studies demonstrate that provider education regarding HIV helps alleviate bias. Pharmacy schools significantly vary in their curriculum surrounding HIV education, with a limited focus on HIV in the paediatric population. Being one of the most accessible healthcare providers, improving pharmacist education and attitudes could positively impact treatment outcomes for children living with HIV. Method: An Advanced HIV Elective course that included content in the management of children living with HIV (CLWH) was developed and implemented by faculty at a Doctor of Pharmacy program in the United States. Student pharmacist knowledge, confidence, and perceptions of providing care for this population were assessed before and after the didactic module. Results: The incorporation of a paediatric HIV module increased the knowledge and confidence of student pharmacists in the management of PLWH and CLWH. Areas of improvement include the selection of antiretroviral therapy (ART), ART medication counselling, and paediatric immunisations. However, a significant difference in attitudes and perceptions towards PLWH and CLWH was not observed. Conclusion: Although improvement in student pharmacist knowledge and confidence was seen after the implementation of a paediatric HIV module, innovative ways to address bias, stigma, and misinformation are needed to promote positive health outcomes for marginalised communities, including those living with HIV.

Childhood Grave’s-an experience from a tertiary care center

Background: Graves’ disease (GD) attributes for important cause for childhood hyperthyroidism with a prevalence of 0.02%. Initial treatment for GD is the use of antithyroid drugs (ATDs), which is well accepted. The remission rate is around about 30% of children treated with ATD. Aims and Objective: (1) To assess the predictors of relapse and remission after ATD in children with Grave’s disease. (2) To study the clinical profile at presentation and treatment outcome of children with Grave’s disease. Materials and Methods: We conducted a prospective cohort study of children diagnosed for GD (n=27) and treated with either carbimazole (0.6–0.8 mg/kg), methimazole (0.2–1 mg/kg), or (propylthiouracil, 5–10 mg/kg) and continued till euthyroid state was achieved. The dose was titrated every 2 months once till the achievement of the euthyroid state. Assessment of remission and relapse was done within a year of stopping the drug. Results: The overall estimated relapse rate for hyperthyroidism was 54.1% (13 patients), within a year of stopping ATD with a mean duration treatment of 24.23±7.44 months. Multivariate survival analysis showed that the risk of relapse (87.5%) was higher for patients of a body mass index SD score &lt;0.5 and a large goiter. Pre-pubertal patients had higher relapse rate than pubertal patients (OR- 3.24, P=0.04). No other clinical variables such as age, gender, and Wayne Index were significantly associated with relapse, though patients in the relapse group were younger, and had a male predominance with higher Wayne index scores. Conclusion: GD in children has a high relapse rate. Severity of the disease as measured by various clinical methods is important in predicting relapse.

Front-Line Tyrosine Kinase Inhibitors in Pediatric Chronic Myeloid Leukemia: A Study on Efficacy and Safety.

We conducted a retrospective study on 51 pediatric patients with newly diagnosed chronic myeloid leukemia chronic phase or accelerated phase. The patients were classified into the IMA group (N = 33), treated with imatinib, and the DSA group (N = 18), treated with dasatinib, as front-line tyrosine kinase inhibitors (TKIs). At 12 months, the rates of complete cytogenetic response were similar between the IMA group (92.3%) and DSA group (100%) (p = 0.305). However, the rate of early molecular response was higher in the DSA group than in the IMA group (100.0% vs. 80.0%, p = 0.043). By 12 and 24 months, the DSA group showed faster and higher cumulative rates of both major (DSA group: 72.2% and 100%, respectively; IMA group: 41.2% and 68.7%, respectively; p = 0.002) and deep molecular responses (DSA group: 26.0% and 43.6%, respectively; IMA group: 13.8% and 17.5%, respectively; p = 0.004). Both TKIs were well tolerated. Although the height standard deviation scores decreased in both groups, the height decline was greater in the DSA group between one and two years from the start of TKI therapy. In this study, dasatinib achieved faster and higher molecular responses with an acceptable safety profile. Further follow-up is necessary to assess the long-term outcomes of TKI treatment in children.

Treatment results of children and adolescents with relapsed AML who were initially treated according to the AML-MM-2006 protocol

Treatment results of children and adolescents with relapsed AML who were initially treated according to the AML-MM-2006 protocol