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1.
J Formos Med Assoc ; 123(3): 366-373, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37689546

RESUMO

BACKGROUND: Little research has been conducted to evaluate the correlation between impulse oscillometry (IOS), Childhood Asthma Control Test (C-ACT), and Test for Respiratory and Asthma Control in Kids (TRACK). METHODS: This study was conducted at China Medical University Hospital between September 1, 2019, and March 31, 2021. Children aged 2-6 years who had been diagnosed with asthma with acute exacerbation were enrolled and followed-up until the end of the study. Correlations between the parameters of IOS, C-ACT and TRACK were assessed. The validity and reliability of TRACK were verified. RESULTS: A total of 114 children with asthma and acute exacerbations were recruited. Their mean age was 4.1 ± 1.1 years, and 60.5% were males. After a year of treatment, the change of R5-R20 from baseline 0.64 ± 0.38 kPa/L/s to 12th month 0.48 ± 0.2 kPa/L/s (p = 0.022). TRACK and C-ACT scores were significantly correlated during the observation period. R5-R20 in IOS at baseline and at the 12th month of follow-up as well as the change in IOS parameters were significantly associated with C-ACT (p = 0.003, 0.015, and 0.001, respectively). R5% and R5-R20 changes in IOS were associated with TRACK (p = 0.04 and 0.025, respectively). Sensitivity and specificity of TRACK were 80.8% (67.5-90.4) and 100% (94.1-100), respectively, with cut-off points >95 and AUC 93.8%. CONCLUSION: TRACK score appears to have a stronger association with the IOS parameter than C-ACT score. Our findings indicate that TRACK is a valid tool for assessing asthma control in preschool children.


Assuntos
Asma , Masculino , Pré-Escolar , Humanos , Criança , Feminino , Oscilometria , Reprodutibilidade dos Testes , Asma/diagnóstico , Testes de Função Respiratória , Sensibilidade e Especificidade , Volume Expiratório Forçado
2.
Dermatology ; 237(3): 444-449, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33032292

RESUMO

BACKGROUND: Facial angiofibromas may be present since early childhood in individuals with tuberous sclerosis complex (TSC), causing substantial cosmetic disfigurement. Current therapies are partially effective, but they are uncomfortable, produce scarring, and are especially expensive. OBJECTIVE: The aim of the present study was to evaluate the efficacy of oral everolimus for TSC-associated angiofibromas. METHODS: This retrospective study included TSC patients being treated with oral everolimus for subependymal giant cell astrocytomas (SEGAs) and angiomyolipomas (AMLs). We recorded the changes in facial angiofibromas. Changes in the Angiofibroma Grading Scale (AGS) indicators were recorded according to erythema, average lesion size, lesion density, and percent involvement on the forehead, nose, cheeks, and chin. The scores were recorded before and after the administration of oral everolimus. RESULTS: Twenty-one patients being treated with oral everolimus were enrolled in this study. The mean age was 20.5 years (range 11-44 years, 4 males, and 17 females). The mean dose of oral everolimus was 3.6 mg/day. Clinically meaningful and statistically significant improvement was observed in erythema (p = 0.001), average lesion size (p < 0.001), lesion density (p < 0.001), and percent involvement (p < 0.001). Changes in the AGS findings were statistically significant on the forehead (p = 0.001), nose (p < 0.001) cheeks (p < 0.001), and chin (p = 0.004). CONCLUSION: Everolimus shows evident improvement and is approved for TSC-associated SEGAs and AMLs. The current study demonstrated the efficacy of oral everolimus in reducing facial angiofibromas, showing the parallel benefits of the treatment protocol for TSC.


Assuntos
Angiofibroma/tratamento farmacológico , Antineoplásicos/uso terapêutico , Everolimo/uso terapêutico , Neoplasias Faciais/tratamento farmacológico , Esclerose Tuberosa/complicações , Adolescente , Adulto , Angiofibroma/complicações , Angiofibroma/patologia , Angiomiolipoma/complicações , Angiomiolipoma/tratamento farmacológico , Astrocitoma/complicações , Astrocitoma/tratamento farmacológico , Criança , Neoplasias Faciais/complicações , Neoplasias Faciais/patologia , Feminino , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/tratamento farmacológico , Masculino , Estudos Retrospectivos , Esclerose Tuberosa/patologia , Esclerose Tuberosa/terapia , Adulto Jovem
4.
J Pediatr Gastroenterol Nutr ; 64(1): 26-30, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27035379

RESUMO

OBJECTIVES: The aim of the study was to systemically investigate the risk of subsequent irritable bowel syndrome (IBS) in children with antecedent allergic diseases in a population-based case-control study in Taiwan. METHODS: We evaluated 11,242 children (age range: 7-18 years) with IBS and 44,968 age- and sex-matched control subjects who had been examined between 2000 and 2008. IBS odds ratios were calculated for children with antecedent allergic diseases, including allergic conjunctivitis, allergic rhinitis, asthma, atopic dermatitis, urticaria, and food allergy. RESULTS: Children with antecedent allergic diseases had a greater risk of IBS than did control subjects (P < 0.001). Among the 6 evaluated diseases, the highest adjusted odds ratio of 1.78 was observed with allergic rhinitis (95% confidence interval [CI], 1.69-1.87). With 2 or more allergic diseases, the adjusted odds ratios increased to 2.06 (95% CI, 1.93-2.19) for all subjects, 2.07 (95% CI, 1.88-2.28) for girls, and 2.18 (95% CI, 2.02-2.35) for children 12 years or older. CONCLUSIONS: Preschoolers with a history of allergic disease had an increased risk of subsequent IBS development upon reaching school age. This risk increased in the presence of concurrent allergic disease and a higher clinical allergy burden.


Assuntos
Asma/complicações , Dermatite Atópica/complicações , Eczema/complicações , Hipersensibilidade Alimentar/complicações , Síndrome do Intestino Irritável/etiologia , Rinite Alérgica/complicações , Adolescente , Estudos de Casos e Controles , Criança , Conjuntivite Alérgica/complicações , Feminino , Humanos , Masculino , Razão de Chances , Fatores de Risco , Taiwan , Urticária/complicações
5.
Nephrology (Carlton) ; 22(12): 1017-1022, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27565896

RESUMO

AIM: Tuberous sclerosis complex (TSC) presents with multisystem benign neoplasm induced by dysregulation of the mammalian target of rapamycin pathway. This study aimed to examine the effects of oral everolimus at either 2.5 or 5.0 mg daily on the treatment of TSC-associated renal angiomyolipoma (AML). METHODS: Between July 2012 and August 2015, patients with TSC-associated renal AML were selected for everolimus therapy protocol. An oral everolimus starting dose at 2.5 mg was administered daily, and was gradually increased to 5.0 mg daily. All patients were evaluated using magnetic resonance imaging or computed tomography scanning at baseline, 12, 24, and 36 months after the start of treatment for measuring the changes of renal AML mass volume. RESULTS: Eight patients were finally enrolled for analysis in this study. Everolimus treatment had a statistically significant effect on the renal AML volume reduction during follow-up (P < 0.05). Renal AML mass volume reduction rates were 10.5-45.3% in four patients with everolimus 2.5 mg and 40.7-73.1% in four patients with everolimus 5.0 mg daily; the difference was statistically significant between the two groups (P < 0.05). Longitudinal follow-up for response to everolimus showed volume reduction rates to be around 10.5-73.1% in the initial 6-24 months after everolimus treatment, which remained stable during follow-up up to 36 months. CONCLUSION: The results suggest that an oral everolimus is effective and provides a non-invasive way to treat TSC-associated renal AML, and patients are likely to require maintenance therapy to continue to derive benefit.


Assuntos
Angiomiolipoma/tratamento farmacológico , Antineoplásicos/uso terapêutico , Everolimo/uso terapêutico , Neoplasias Renais/tratamento farmacológico , Esclerose Tuberosa/complicações , Adolescente , Adulto , Feminino , Humanos , Masculino
6.
Pediatr Res ; 79(4): 559-64, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26690714

RESUMO

BACKGROUND: Some allergic inflammation-associated mediators have been reported in acute stage of Henoch-Schönlein purpura (HSP). However, the association of children with allergic diseases and their subsequent risks of HSP and HSP nephritis remain unknown. METHODS: In this study, we included 2,240 children with HSP diagnosed between 2000 and 2008 as well as 8,960 non-HSP controls matched for age, sex, and level of urbanization. The odds ratios (ORs) of HSP were calculated with respect to associations with pre-existing allergic diseases. RESULTS: Children with allergic diseases had an increased subsequent risk of HSP; the lowest adjusted OR (aOR) was 1.33 for allergic conjunctivitis (95% confidence interval (CI): 1.17-1.52) and the highest was 1.68 for asthma (95% CI: 1.48-1.91). The aOR increased to 2.03 (95% CI: 1.80-2.31) in children with at least two allergic diseases. Children who visited medical institutes more often per year for associated allergic diseases had an increased risk of HSP. Of the 2,240 children with HSP, 249 (11%) had HSP nephritis and 45.8% of those with nephritis had history of any allergic disease. CONCLUSION: Atopic children had an increased subsequent risk of HSP but not an increased risk of HSP nephritis.


Assuntos
Hipersensibilidade/complicações , Vasculite por IgA/complicações , Nefrite/complicações , Vigilância da População , Criança , Pré-Escolar , Feminino , Humanos , Masculino
7.
BMC Pulm Med ; 16(1): 152, 2016 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-27852248

RESUMO

BACKGROUND: Sjögren's syndrome (SS) has been associated with bronchial hyperresponsiveness and asthma; however, no population-based cohort study has been performed. We evaluated the risk of asthma in patients with primary SS in a nationwide population. METHODS: We conducted a retrospective cohort study using data from the National Health Insurance Research Database in Taiwan. The primary SS group included 4725 adult patients diagnosed between 2000 and 2006. Each patient was frequency-matched with four people without SS by sex, age and year of diagnosis. The occurrence and hazard ratio (HR) of asthma was monitored by the end of 2011. RESULTS: The overall incidence density of asthma was 1.62-fold higher in the primary SS group than in the non-SS group (9.86 vs. 6.10 per 1000 person-years), with a multivariable Cox proportional hazards model measured adjusted HR of 1.38 [95% confidence interval (CI) = 1.21-1.58]. Stratified analyses by sex, age group, and presence of comorbidity revealed that asthma incidences were all higher in the primary SS group than in the non-SS group, and the relative HRs of asthma associated with primary SS were significant in all subgroups. CONCLUSION: Patients with primary SS are associated with an increased risk of developing asthma. We should pay more attention to this group of individuals and provide them with appropriate support.


Assuntos
Asma/epidemiologia , Síndrome de Sjogren/complicações , Adulto , Idoso , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
8.
Childs Nerv Syst ; 32(1): 89-95, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26552385

RESUMO

PURPOSE: The most common neurological complications associated with tuberous sclerosis complex (TSC) include intractable seizures that begin in infancy and subependymal giant cell astrocytoma (SEGA) complicated by hydrocephalus with increasing age. Information on SEGA growth of TSC patients is limited. This study aimed to examine the TSC-SEGA growth rates by periodic neuroimaging. METHODS: This study evaluated the TSC-SEGA growth rates by serial neuroimaging. Fifty-eight patients with TSC underwent systematic evaluation, including a review of medical history and serial brain neuroimaging. RESULTS: While magnetic resonance imaging was more sensitive in detecting cortical tubers than computed tomography (73.1 vs. 0 %, p < 0.001), its efficacy in identifying intracranial lesions was comparable to that of computed tomography (96.2 vs. 100 %, p = 0.658). Significant tumor growth was observed in children (p = 0.012) and adults (p = 0.028) during follow-up periods, respectively (median for children 23.5 months, interquartile range 18-40 months and median for adults 23 months, interquartile range 12-34 months). Further, the SEGA growth rate in children was significantly higher than that in adults (75.6 vs. 16.5 %, p = 0.03). CONCLUSIONS: The results of the study show that SEGA has a significantly higher growth rate in children using serial follow-up brain imaging, suggesting the importance of performing follow-up neuroimaging at yearly intervals in childhood to identify and prevent potential comorbidities.


Assuntos
Astrocitoma/patologia , Neoplasias Encefálicas/patologia , Encéfalo/patologia , Proliferação de Células/fisiologia , Adolescente , Adulto , Fatores Etários , Idoso , Alcaloides , Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hidrocefalia/complicações , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estatística como Assunto , Tomografia Computadorizada por Raios X , Esclerose Tuberosa/complicações , Adulto Jovem
9.
Pediatr Res ; 78(2): 223-30, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25950455

RESUMO

BACKGROUND: Only a few studies have systemically analyzed the association between neonatal jaundice and childhood-onset allergic diseases. METHODS: From 2000 to 2007, 27,693 neonates with newly diagnosed neonatal jaundice and 55,367 matched nonneonatal jaundice cohorts were identified. The incidences and hazard ratios (HRs) of five allergic diseases, namely allergic conjunctivitis (AC), allergic rhinitis (AR), atopic dermatitis (AD), asthma, and urticaria, by the end of 2008 were calculated. RESULTS: The incidence density and HRs of the five allergic diseases were greater in the neonatal jaundice cohort than in the nonneonatal jaundice cohort, and the HRs declined modestly with age. The HRs for AR (HR = 2.51, 95% confidence interval (CI) = 2.43-2.59) and AD (HR = 2.51, 95% CI = 2.40-2.62) were the highest, and that for urticaria was the lowest (HR = 2.06, 95% CI = 1.94-2.19). The HRs of allergic diseases were substantially greater for boys and those requiring phototherapy. The HRs of the allergic diseases, except urticaria (HR = 2.49, 95% CI = 1.57-3.97), were not significantly different between the neonatal jaundice regardless of whether the patients received exchange transfusion. CONCLUSION: Neonatal jaundice is associated with the development of allergic diseases in early childhood.


Assuntos
Hipersensibilidade/complicações , Icterícia Neonatal/complicações , Estudos de Coortes , Feminino , Humanos , Incidência , Recém-Nascido , Masculino
10.
Pediatr Res ; 78(2): 212-7, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25927542

RESUMO

BACKGROUND: Although clinical and immunological studies have shown a possible link between allergy and idiopathic nephrotic syndrome (INS), the nature of the relationship remains unclear. Asthma is the most common chronic allergic airway inflammation. However, no study has used a longitudinal design with a population cohort to investigate INS in children with asthma. METHODS: Using nationwide claims data from 2000 through 2007, we randomly selected 251,698 asthma cases and 1,006,791 frequency-matched controls. Incidence rates of INS and hazard ratios (HRs) were calculated. RESULTS: The INS incidence was 3.36-fold greater in the asthma cohort than in the nonasthma control (9.26 vs. 2.76 per 100,000 person-years; 95% confidence interval (CI): 2.65-4.26). The HR for INS increased for those with more asthma-related medical visits per year, from 1.49 (95% CI: 1.06-2.11) for <3 visits to 15.7 (95% CI: 11.5-21.5) for ≥6 visits (trend test, P < 0.0001). The HR for INS slightly decreased during the follow-up period, from 3.41 (95% CI: 2.66-4.38) for ≤5.5 y to 2.90 (95% CI: 1.33-6.30) for >5.5 y. CONCLUSION: We conclude that children with asthma had an increased incidence rate of INS, and increased incidence rate correlated with asthma-related medical visits.


Assuntos
Asma/complicações , Síndrome Nefrótica/complicações , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino
11.
Pediatr Res ; 77(4): 597-601, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25580738

RESUMO

BACKGROUND: Growing evidence has revealed a link between autoimmune and allergic diseases. However, few studies have assessed the relationship between allergic diseases and primary immune thrombocytopenia (ITP), an autoimmune disease frequently occurring in children. This population-based case-control study investigated the association between common allergic diseases and the subsequent risk of developing ITP during childhood. METHODS: This study investigated 1,203 children younger than 18 y of age who were diagnosed with ITP between 1998 and 2008, as well as 4,812 frequency-matched controls. The odds ratios of the association between ITP and preexisting allergic diseases were calculated. RESULTS: Children with every type of allergic disease examined in this study (except asthma) exhibited an increased risk of developing ITP; the lowest adjusted odds ratio (aOR) was 1.39 for allergic conjunctivitis (95% confidence interval (CI) = 1.09-1.79), whereas the greatest aOR was 1.84 for allergic rhinitis (95% CI = 1.49-2.27). The aORs increased with the number of concurrent allergic diseases to 2.89 (95% CI = 1.98-4.22) for children with at least three allergic diseases. CONCLUSION: Children with atopic diathesis have a greater risk of subsequently developing ITP. The fundamental determinants of this relationship warrant further study.


Assuntos
Hipersensibilidade/complicações , Púrpura Trombocitopênica Idiopática/complicações , Adolescente , Asma/complicações , Asma/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Hipersensibilidade/epidemiologia , Incidência , Lactente , Masculino , Razão de Chances , Modelos de Riscos Proporcionais , Púrpura Trombocitopênica Idiopática/epidemiologia , Rinite Alérgica/complicações , Rinite Alérgica/epidemiologia , Fatores de Risco
12.
J Child Psychol Psychiatry ; 56(4): 460-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25056274

RESUMO

BACKGROUND: Previous studies have posited conflicting results regarding the relationship between neonatal jaundice and the subsequent risk of attention-deficit hyperactivity disorder (ADHD). We therefore performed a large population study with a defined neonatal jaundice cohort to investigate the incidence and risk of physician-diagnosed ADHD in Taiwan. METHODS: From 2000 to 2004, 24,950 neonatal jaundice cases and 69,964 matched nonjaundice controls were identified. At the end of 2008, the incidence rate and hazard ratios (HRs) of physician-diagnosed ADHD were calculated. RESULTS: The incidence of ADHD was 2.48-fold greater in the jaundice cohort than in the nonjaundice cohort (3.84 vs. 1.51 per 100,000 person-years) in the study period. The HR of ADHD was substantially greater for male, preterm, and low-birth-weight infants with neonatal jaundice. The risk of developing ADHD in the jaundice cohort was greater after a diagnosis of neonatal jaundice for more than 6 years (HR: 2.64; 95% confidence interval: 2.13-3.28). The risk of ADHD increased for neonates with higher serum bilirubin levels requiring phototherapy and with longer admission days. CONCLUSION: Neonates with jaundice are at high risk for developing physician-diagnosed ADHD during their growth period. A risk alert regarding neurologic consequences is urgently required after a neonatal jaundice diagnosis. Additional studies should be conducted to clarify the pathogenesis of these relationships.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Icterícia Neonatal/complicações , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Icterícia Neonatal/epidemiologia , Masculino , Risco , Taiwan/epidemiologia
13.
J Epidemiol ; 25(5): 370-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25843432

RESUMO

BACKGROUND: Clinical and immunological studies have consistently shown a possible link between atopy and idiopathic nephrotic syndrome (INS). However, whether allergic diseases occur after INS develops is unknown. METHODS: From Taiwan's National Health Insurance database, 1340 children with newly diagnosed INS and 5360 non-INS matched controls were identified in 2000-2007. By the end of 2008, the incidences and hazard ratios of four allergic diseases (allergic conjunctivitis, allergic rhinitis, atopic dermatitis, and asthma) were calculated. RESULTS: The incidence rates of all four allergic diseases were greater in the INS cohort than in the non-INS cohort in all age groups and decreased sharply as age increased in both cohorts. Children with INS had the highest adjusted hazard ratio (4.13; 95% confidence interval [CI], 2.50-6.83) for atopic dermatitis and the lowest adjusted hazard ratio (1.71; 95% CI, 1.39-2.09) for allergic rhinitis. Most of the allergic diseases appeared within 2-6 months after INS developed, and the incidences declined with increasing follow-up duration. CONCLUSIONS: Allergic disorders are common in children with INS, especially within the first year after diagnosis. The role of INS in the development of allergic disorders should be elucidated to establish innovative disease intervention programs.


Assuntos
Hipersensibilidade/epidemiologia , Síndrome Nefrótica/epidemiologia , Adolescente , Asma/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Conjuntivite Alérgica/epidemiologia , Bases de Dados Factuais , Dermatite Atópica/epidemiologia , Feminino , Humanos , Incidência , Masculino , Programas Nacionais de Saúde , Rinite Alérgica/epidemiologia , Taiwan/epidemiologia
14.
Pediatr Allergy Immunol ; 25(4): 374-9, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24953297

RESUMO

BACKGROUND: Children with systemic lupus erythematosus (SLE) have an especially aggressive disease course and poor outcomes. Previous studies demonstrated a possible association between SLE and allergies, but the relationship between these disorders remains unclear. This population-based cohort study aimed to investigate the incidence and risk of juvenile-onset SLE (JSLE) among children with asthma. METHODS: From 2000 to 2003, 120,939 children with newly diagnosed asthma and 483,756 randomly selected non-asthma controls were enrolled. We used a multivariable Cox proportional hazard regression model to measure and compare the incidence rate and risk of JSLE in the asthma and non-asthma cohorts. RESULTS: The overall incidence of JSLE was 2.52 times greater in the asthma cohort than that in the non-asthma cohort [3.49 vs. 1.53 per 100,000 person-years; 95% confidence interval (CI): 1.59-3.99]. The risk of JSLE was greatest among boys [hazard ratio (HR) 3.02, 95% CI: 1.21-7.52] and children aged 6-10 yr (HR 3.50, 95% CI: 1.75-7.02). The HR of JSLE increased with greater frequency of asthma-related medical visits from 1.22 (95% CI: 0.67-1.41) for those with ≤2 visits/yr to 5.88 (95% CI: 3.43-10.1) for subjects with >2 visits/yr (trend test p < 0.001). However, the risk of JSLE declined over time. CONCLUSION: We found an increased incidence of JSLE among children with asthma. The mechanism of asthma on JSLE development should be elucidated to establish innovative disease intervention programs.


Assuntos
Asma/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Adolescente , Fatores Etários , Idade de Início , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Risco , Fatores Sexuais , Taiwan/epidemiologia
15.
Pediatr Nephrol ; 29(1): 139-47, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24037143

RESUMO

BACKGROUND: Nephrotic syndrome (NS) is among the most common kidney diseases seen in children. The major complications of NS include infection, acute kidney injury (AKI), and thromboembolism (TE). The objective of this study was to analyze long-term trends in the epidemiology of major complications of pediatric NS. METHODS: We used the Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 2000-2009 to perform an analysis of U.S. hospitalizations of children diagnosed with NS with or without infection, AKI or TE. RESULTS: The frequency of NS hospitalizations complicated by AKI increased by 158 % between 2000 and 2009 (p < 0.001). The frequency of NS hospitalizations with infection and TE remained stable overall. Pneumonia was the most common infectious complication while peritonitis decreased by 50 % (p < 0.001). Importantly, development of any of these major complications of NS resulted in ∼2-3-fold increases in both hospital charges and length of stay. CONCLUSIONS: It is concerning that the frequency of AKI in children hospitalized with NS has more than doubled in the past decade. Strategies to prevent or initiate earlier treatments for complications of NS could have a major impact on both morbidity and health care expenses.


Assuntos
Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Síndrome Nefrótica/complicações , Pré-Escolar , Feminino , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino
16.
Pediatr Nephrol ; 29(11): 2157-63, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25034498

RESUMO

BACKGROUND: Clinical and immunological studies have consistently shown a relationship between atopic diathesis and idiopathic nephrotic syndrome (INS). However, no large population cohort study has yet to demonstrate the nature of the relationship between these disorders. METHODS: Claims data from a random selection of children representing half of the insured population in Taiwan were examined. During the period from 1998 to 2007, we identified 192,295 children aged <18 years with newly diagnosed atopic dermatitis (AD) and 769,169 frequency-matched controls. Incidence of INS and hazard ratios (HRs) were calculated. RESULTS: The AD cohort had a 2-fold higher overall incidence of INS than the non-AD cohort [7.20 vs. 3.60 per 100,000 person-years, respectively; 95 % confidence interval (CI) 1.50-2.66]. The HR for INS increased with age and was higher among females. The HR for INS was also higher in AD children with more medical visits per year, ranging from 0.94 for those having ≤3 visits to 38.6 for those having >6 visits (trend test P < 0.0001). In particular, the risk of INS clearly increased during the initial 5 years after AD onset. CONCLUSIONS: Children with AD have a greater incidence and risk of developing INS and this risk increases with AD severity.


Assuntos
Dermatite Atópica/epidemiologia , Síndrome Nefrótica/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Dermatite Atópica/complicações , Suscetibilidade a Doenças , Feminino , Humanos , Incidência , Lactente , Estimativa de Kaplan-Meier , Masculino , Nefrose Lipoide/complicações , Nefrose Lipoide/epidemiologia , Síndrome Nefrótica/complicações , Risco , Fatores Sexuais , Fatores Socioeconômicos , Taiwan/epidemiologia , População Urbana
17.
Pediatr Nephrol ; 29(5): 885-91, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24375011

RESUMO

BACKGROUND: To estimate the subsequent cancer risk of children receiving post voiding cystourethrography (VCUG), a nationwide population-based retrospective cohort study with the data from the Taiwan National Health Insurance Research Database (NHIRD) were used for the analysis. METHODS: In the VCUG cohort, 31,908 participants younger than 18 years of age who underwent VCUG between 1997 and 2008 were identified from the NHIRD. A comparison cohort, the non-VCUG cohort, was randomly selected among children without VCUG examination histories during 1997-2008, frequency matched for age (every 5 years), sex, geographic region area, parents' occupation, and index year based on a 1:4 ratio. Cox's proportional hazard regression analysis was conducted to estimate the subsequent cancer risk of children receiving VCUG. RESULTS: The overall cancer risk of the VCUG cohort is 1.92-fold (95 % CI = 1.34-2.74) higher than that of the non-VCUG cohort with statistical significance. The genital cancer and urinary system cancer risks of the VCUG cohort are respectively 6.19-fold (95 % CI = 1.37-28.0) and 5.8-fold (95 % CI = 1.54-21.9) higher than those of the non-VCUG cohort with statistical significance. The hazard ratios are higher in genital cancer, urinary system cancer (the major radiation exposure area), and cancer of the abdomen, except for the genitourinary system (the minor radiation exposure area), in sequence. CONCLUSIONS: Pediatric VCUG is associated with increased subsequent cancer risk, especially in the genitourinary system.


Assuntos
Neoplasias/epidemiologia , Urografia/efeitos adversos , Refluxo Vesicoureteral/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Neoplasias/etiologia , Neoplasias/mortalidade , Estudos Retrospectivos , Risco , Fatores Sexuais , Fatores Socioeconômicos , Análise de Sobrevida , Taiwan/epidemiologia , Refluxo Vesicoureteral/diagnóstico , Refluxo Vesicoureteral/diagnóstico por imagem
18.
J Emerg Med ; 46(2): e47-50, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24113482

RESUMO

BACKGROUND: The most common cause of facial palsy is idiopathic or Bell's palsy. Although uncommon in the postantibiotic era, otomastoiditis should receive more attention as a cause of facial palsy, especially in young children. Delay of identification and treatment may result in permanent neurological sequelae. OBJECTIVES: To describe a 3-month-old infant eventually diagnosed with masked otomastoiditis with initial presentation of facial palsy. CASE REPORT: We report a case of facial palsy complicated by masked otomastoiditis in a 3-month-old male infant. The facial palsy completely recovered after parenteral antibiotics and myringotomy. CONCLUSION: We use this case to emphasize that otomastoiditis should be considered in the differential diagnosis of young children with facial palsy. Diagnosis may be difficult as signs and symptoms of otitis media in young children are often nonspecific and subtle, particularly in infants. Early diagnosis and careful investigation of middle ear regions should be performed to avoid permanent sequelae.


Assuntos
Paralisia Facial/etiologia , Otite Média/complicações , Doença Aguda , Humanos , Lactente , Masculino , Mastoidite/complicações
19.
J Tradit Complement Med ; 14(1): 109-120, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38223810

RESUMO

Purpose: Obstructive sleep apnea (OSA) is a chronic disease that affects 1%-6% of children. Our study aims to explore the effectiveness and clinical characteristics of integrative Traditional Chinese Medicine (ITCM) for pediatric OSA. Materials and methods: In this retrospective cohort study, we assessed differences of polysomnography (PSG) parameters and clinical characteristics between 2009 and 2020. Children <12 years old diagnosed with OSA (n = 508) were included and were categorized into ITCM cohort, western medicine (WM) cohort ,and surgery cohort. Outcomes were apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and body mass index (BMI). Results: There were 56 (11%), 324 (63.8%), and 128 (25.2%) patients in the ITCM, WM, and surgery cohorts. Among 17, 26, and 33 patients in the ITCM, WM, and surgery cohorts underwent follow-up PSG studies, respectively. In the ITCM follow-up cohort, AHI were significantly reduced (9.59 to 5.71, p < 0.05). BMI significantly increased in the WM follow-up cohort (19.46 to 20.50, p < 0.05) and the surgery follow-up cohort (18.04 to 18.85, p < 0.01). Comparing ITCM to WM cohort, a significant difference was found between the changes in RDI (ITCM: -6.78, WM: 0.51, p < 0.05) after treatment. Among ITCM follow-up cohort, the most prescribed TCM formula was Forsythia and Laminaria Combination. The most prescribed TCM herb was Ephedrae Herba. Conclusions: ITCM therapy can significantly reduce RDI and control BMI. We identified potential TCM treatments for pediatric OSA. Further study of the pharmacological mechanisms and clinical efficacy is warranted.

20.
JAMA Netw Open ; 7(7): e2419366, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38949811

RESUMO

Importance: The long-term estimated risk of development of cataracts among pediatric patients with uveitis is not clear. Objective: To describe factors associated with the development of cataracts among pediatric patients with uveitis. Design, Setting, and Participants: This cohort study used the international TriNetX database to enroll pediatric patients with and without uveitis from January 1, 2002, to December 31, 2022. The nonuveitis cohort consisted of randomly selected control patients matched by age, sex, race and ethnicity, and specific comorbidities. Exposure: Diagnosis of uveitis, identified using diagnostic codes. Main Outcomes and Measures: The primary outcome was the risk of developing cataracts among the uveitis group compared with the nonuveitis comparison group, with hazard ratios (HRs) and 95% CIs reported. Results: A total of 22 687 pediatric patients with uveitis (mean [SD] age, 10.3 [5.6] years; 54.2% male) and 22 687 comparators without uveitis (mean [SD] age, 10.3 [5.6] years; 54.5% male) were enrolled in the study. The risk of cataracts was increased among pediatric patients with uveitis up to a follow-up duration of 20 years (HR, 17.17; 95%CI, 12.90-22.80) from the index date. Subgroup analyses revealed an elevated cataract risk across age groups: 0 to 6 years (HR, 19.09; 95% CI, 10.10-36.00), 7 to 12 years (HR, 27.16; 95% CI, 15.59-47.20), and 13 to 18 years (HR, 13.39; 95% CI, 8.84-20.30); both female sex (HR, 13.76; 95% CI, 9.60-19.71) and male sex (HR, 11.97; 95% CI, 8.47-16.91); and Asian (HR, 13.80; 95% CI, 3.28-58.07), Black or African American (HR, 10.41; 95% CI, 5.60-19.36), and White (HR, 15.82; 95% CI, 11.05-22.60) race. Furthermore, increased cataract risks were also observed among those with and without a history of immunosuppressive agents (with: HR, 26.52 [95% CI, 16.75-41.90]; without: HR, 17.69 [95% CI: 11.39-27.40]), a history of steroid eye drop use (with: HR, 29.51 [95% CI, 14.56-59.70]; without: HR, 16.49 [95% CI, 11.92-22.70]), and a history of intraocular procedures (with: HR, 11.07 [95%CI, 4.42-27.71]; without: HR, 14.49 [95% CI, 10.11-20.70]). Conclusions and Relevance: In this cohort study of pediatric patients with uveitis, an elevated risk of cataracts following a uveitis diagnosis was found compared with pediatric patients without uveitis. The findings suggest that pediatric patients with uveitis should be monitored for cataract development.


Assuntos
Catarata , Uveíte , Humanos , Uveíte/epidemiologia , Uveíte/etiologia , Catarata/epidemiologia , Catarata/complicações , Catarata/etiologia , Masculino , Feminino , Criança , Adolescente , Pré-Escolar , Fatores de Risco , Estudos de Coortes , Lactente , Modelos de Riscos Proporcionais
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