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3.
Anaesthesia ; 76 Suppl 1: 74-88, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33426659

RESUMO

Regional anaesthesia in children has evolved rapidly in the last decade. Although it previously consisted of primarily neuraxial techniques, the practice now incorporates advanced peripheral nerve blocks, which were only recently described in adults. These novel blocks provide new avenues for providing opioid-sparing analgesia while minimising invasiveness, and perhaps risk, associated with older techniques. At the same time, established methods, such as infant spinal anaesthesia, under-utilised in the last 20 years, are experiencing a revival. The impetus has been the concern regarding the potential long-term neurocognitive effects of general anaesthesia in the young child. These techniques have expanded from single shot spinal anaesthesia to combined spinal/epidural techniques, which can now effectively provide surgical anaesthesia for procedures below the umbilicus for a prolonged period of time, thereby avoiding the need for general anaesthesia. Continuous 2-chloroprocaine infusions, previously only described for intra-operative regional anaesthesia, have gained popularity as a means of providing prolonged postoperative analgesia in epidural and continuous nerve block techniques. The rapid, liver-independent metabolism of 2-chloroprocaine makes it ideal for prolonged local anaesthetic infusions in neonates and small infants, obviating the increased risk of local anaesthetic systemic toxicity that occurs with amide local anaesthetics. Debate continues over certain practices in paediatric regional anaesthesia. While the rarity of complications makes comparative analyses difficult, data from large prospective registries indicate that providing regional anaesthesia to children while under general anaesthesia appears to be at least as safe as in the sedated or awake patient. In addition, the estimated frequency of serious adverse events demonstrates that regional blocks in children under general anaesthesia are no less safe than in awake adults. In infants, the techniques of direct thoracic epidural placement or caudal placement with cephalad threading each have distinct advantages and disadvantages. As the data cannot support the safety of one technique over the other, the site of epidural insertion remains largely a matter of anaesthetist discretion.


Assuntos
Anestesia por Condução/métodos , Pediatria/métodos , Adolescente , Anestesia por Condução/tendências , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pediatria/tendências
4.
Medicine (Baltimore) ; 99(46): e23251, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181717

RESUMO

BACKGROUND: In pediatric tumors, immunotherapy exhibits less toxicity than chemotherapy and radiation. The current study aims to identify potential immune targets in immune-related genes of C-C motif chemokine ligand genes (CCLs) and C-C motif chemokine receptors (CCRs) in childhood osteosarcoma (OS) and to explore the underlying molecular mechanisms of childhood OS. METHODS: Firstly, we identified immune-related genes in CCLs and CCRs, these genes were used for functional annotation and interaction analysis. Then, the prognostic value of these genes was evaluated using Kaplan-Meier analysis and multivariate COX regression model. And the potential relationship between risk score and immune infiltrating cells was identified. Finally, gene set enrichment analysis was used to determine the underlying molecular mechanism of OS. Immune-related genes in CCLs and CCRs are inextricably linked. RESULTS: The results of survival analysis of these genes show that CCL5, CCL8, CCR4, and CCR5 are significantly associated with the prognosis of childhood OS. The combined effect survival analysis shows that the co-high expression of these 4 genes has a good prognosis for childhood OS. A prognostic signature model was constructed based on the 4 genes mentioned above, and the result of time-dependent receiver operating characteristic curves showed that this model was a good predictor of childhood OS 3- and 5-year prognosis. In addition, the risk score of the constructed prognostic signature model was closely related to immune infiltration. We also found that CCL5, CCL8, and CCR5 may affect the prognosis of OS through complex regulation among Toll-like receptor signaling pathway, mitogen-activated protein kinase (MAPK) family signaling cascade, and nuclear factor-kappaB pathway, whereas CCR4 affects the prognosis of OS by regulating eukaryotic translation. CONCLUSION: CCL5, CCL8, CCR4, and CCR5 are potential prognostic markers for the prognosis of childhood OS, and the underlying molecular mechanisms of childhood OS have been identified.


Assuntos
Biomarcadores Tumorais/análise , Osteossarcoma/diagnóstico , Prognóstico , Biomarcadores Tumorais/genética , Criança , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Perfilação da Expressão Gênica/métodos , Regulação Neoplásica da Expressão Gênica/genética , Regulação Neoplásica da Expressão Gênica/imunologia , Humanos , Imunoterapia/métodos , Estimativa de Kaplan-Meier , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Osteossarcoma/genética , Pediatria/métodos , Pediatria/tendências , Estudos Prospectivos , Análise de Sobrevida
5.
Arch Pediatr ; 27(8): 423-427, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33011025

RESUMO

BACKGROUND: The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. METHODS: We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pre-tested Google Form®. RESULTS: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%), of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (P<0.000). According to the occupancy rate of hospitalisation beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalisation beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (P<0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (P<0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). CONCLUSION: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus , Pandemias , Pediatras/psicologia , Pediatria/tendências , Pneumonia Viral , Padrões de Prática Médica/tendências , Adulto , Camarões , Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Relações Profissional-Família , Telemedicina
6.
Lancet Oncol ; 21(9): e444-e451, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32888473

RESUMO

Population-based cancer registries (PBCRs) generate measures of cancer incidence and survival that are essential for cancer surveillance, research, and cancer control strategies. In 2014, the Toronto Paediatric Cancer Stage Guidelines were developed to standardise how PBCRs collect data on the stage at diagnosis for childhood cancer cases. These guidelines have been implemented in multiple jurisdictions worldwide to facilitate international comparative studies of incidence and outcome. Robust stratification by risk also requires data on key non-stage prognosticators (NSPs). Key experts and stakeholders used a modified Delphi approach to establish principles guiding paediatric cancer NSP data collection. With the use of these principles, recommendations were made on which NSPs should be collected for the major malignancies in children. The 2014 Toronto Stage Guidelines were also reviewed and updated where necessary. Wide adoption of the resultant Paediatric NSP Guidelines and updated Toronto Stage Guidelines will enhance the harmonisation and use of childhood cancer data provided by PBCRs.


Assuntos
Guias como Assunto/normas , Neoplasias/terapia , Pediatria/tendências , Prognóstico , Criança , Assistência à Saúde , Humanos , Estadiamento de Neoplasias , Neoplasias/epidemiologia , Sistema de Registros
8.
Pediatr Ann ; 49(9): e403-e404, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32929516

RESUMO

Two pediatricians share perspectives on patient experience and delivery, future health care encounters, and social implications during the coronavirus 2019 pandemic. Collateral effects may comprise the most significant impacts on children, from limitations on hospital visitors, to closures of child-friendly hospital playrooms during this pandemic, to an alarming decrease in vaccination rates. Educational disparities will also likely widen, especially among those with limited access to technology at home. [Pediatr Ann. 2020;49(9):e403-e404.].


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Assistência à Saúde/métodos , Pediatria/métodos , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Quarentena/psicologia , Isolamento Social/psicologia , Criança , Assistência à Saúde/tendências , Humanos , Pandemias , Pediatria/tendências
11.
Nat Med ; 26(8): 1285-1294, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32719487

RESUMO

We asked whether pharmacological stimulation of endogenous neural precursor cells (NPCs) may promote cognitive recovery and brain repair, focusing on the drug metformin, in parallel rodent and human studies of radiation injury. In the rodent cranial radiation model, we found that metformin enhanced the recovery of NPCs in the dentate gyrus, with sex-dependent effects on neurogenesis and cognition. A pilot double-blind, placebo-controlled crossover trial was conducted (ClinicalTrials.gov, NCT02040376) in survivors of pediatric brain tumors who had been treated with cranial radiation. Safety, feasibility, cognitive tests and MRI measures of white matter and the hippocampus were evaluated as endpoints. Twenty-four participants consented and were randomly assigned to complete 12-week cycles of metformin (A) and placebo (B) in either an AB or BA sequence with a 10-week washout period at crossover. Blood draws were conducted to monitor safety. Feasibility was assessed as recruitment rate, medication adherence and procedural adherence. Linear mixed modeling was used to examine cognitive and MRI outcomes as a function of cycle, sequence and treatment. We found no clinically relevant safety concerns and no serious adverse events associated with metformin. Sequence effects were observed for all cognitive outcomes in our linear mixed models. For the subset of participants with complete data in cycle 1, metformin was associated with better performance than placebo on tests of declarative and working memory. We present evidence that a clinical trial examining the effects of metformin on cognition and brain structure is feasible in long-term survivors of pediatric brain tumors and that metformin is safe to use and tolerable in this population. This pilot trial was not intended to test the efficacy of metformin for cognitive recovery and brain growth, but the preliminary results are encouraging and warrant further investigation in a large multicenter phase 3 trial.


Assuntos
Neoplasias Encefálicas/complicações , Disfunção Cognitiva/tratamento farmacológico , Metformina/administração & dosagem , Pediatria/tendências , Adolescente , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/patologia , Sobreviventes de Câncer , Criança , Pré-Escolar , Cognição/efeitos dos fármacos , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/patologia , Método Duplo-Cego , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Metformina/efeitos adversos , Neurogênese/efeitos dos fármacos , Projetos Piloto , Resultado do Tratamento , Adulto Jovem
12.
Pediatr Cardiol ; 41(6): 1081-1091, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32656626

RESUMO

Due to the COVID-19 pandemic, there has been an increased interest in telehealth as a means of providing care for children by a pediatric cardiologist. In this article, we provide an overview of telehealth utilization as an extension of current pediatric cardiology practices and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. Our panel will review helpful tips into the selection of appropriate patient populations and specific cardiac diagnoses for telehealth that put patient and family safety concerns first. Numerous practical considerations in conducting a telehealth visit must be taken into account to ensure optimal use of this technology. The use of adapted staffing and billing models and expanded means of remote monitoring will aid in the incorporation of telehealth into more widespread pediatric cardiology practice. Future directions to sustain this platform include the refinement of telehealth care strategies, defining best practices, including telehealth in the fellowship curriculum and continuing advocacy for technology.


Assuntos
Cardiologia , Infecções por Coronavirus , Cardiopatias/terapia , Monitorização Fisiológica , Pandemias , Pediatria , Pneumonia Viral , Consulta Remota , Telemedicina , Betacoronavirus , Cardiologia/educação , Cardiologia/tendências , Criança , Currículo , Previsões , Cardiopatias/diagnóstico , Humanos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/tendências , Pediatria/educação , Pediatria/tendências , Consulta Remota/métodos , Consulta Remota/tendências , Telemedicina/métodos , Telemedicina/tendências
13.
Pediatr Clin North Am ; 67(4): 707-724, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650868

RESUMO

This article explores the impact of digital technologies, including telehealth, teleconsultations, wireless devices, and chatbots, in pediatrics. Automated digital health with the Internet of things will allow better collection of real-world data for generation of real-world evidence to improve child health. Artificial intelligence with predictive analytics in turn will drive evidence-based decision-support systems and deliver personalized care to children. This technology creates building blocks for a learning child health and health care ecosystem.


Assuntos
Saúde da Criança , Pediatria/tendências , Telemedicina/tendências , Inteligência Artificial , Big Data , Prioridades em Saúde , Humanos , Internet
16.
Compr Child Adolesc Nurs ; 43(3): 159-165, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32662686

RESUMO

Emeritus Professor Alan Glasper, from the University of Southampton, discusses what can be done to protect certain groups of children with long-term health conditions from catching SARS-Cov-2 disease caused by the novel coronavirus COVID-19. Furthermore, it is now being reported that a number of children appear to be reacting to the new coronavirus by developing a multisystem hyperinflammatory state with similar symptoms to that seen in toxic shock syndrome and which necessitates intensive care (Campbell & Sample, 2020).


Assuntos
Infecções por Coronavirus/complicações , Efeitos Adversos de Longa Duração/prevenção & controle , Pediatria/métodos , Pneumonia Viral/complicações , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/patogenicidade , Infecções por Coronavirus/fisiopatologia , Humanos , Pandemias , Pediatria/tendências , Pneumonia Viral/fisiopatologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-32536339

RESUMO

Introduction: The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is a hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine-preventable diseases and potential adverse events following immunisation (AEFI). This report presents surveillance data for 2017 and 2018. Methods: Specialist nurses screened hospital admissions, emergency department (ED) records, laboratory and other data on a daily basis in seven paediatric tertiary referral hospitals across Australia to identify children with the conditions under surveillance. In 2017 and 2018 these included acute flaccid paralysis (AFP; a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal, and invasive Group A streptococcus diseases. An additional social research component was added to evaluate parental attitudes to vaccination. Results: PAEDS captured 1,580 and 925 cases for 2017 and 2018, respectively, across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach the World Health Organization reporting targets; identification of a third human parechovirus outbreak among other infectious diseases linked to ACE; demonstration of variable influenza activity between 2017 and 2018, with vaccine effectiveness (VE) analysis demonstrating that the protection offered through vaccination is season-dependent. All IS cases associated with vaccine receipt were reported to the relevant state health department. Varicella and herpes zoster case numbers remained unchanged, with vaccine uptake found to be suboptimal among eligible children under the NIP. Enhanced pertussis surveillance continues to capture controls for VE estimation. Surveillance for invasive meningococcal disease showed predominance for serotype B at 57% over 2 years among 77 cases where serotyping was available, and surveillance for invasive group A streptococcus captured severe disease in children. Conclusion: PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using hospital-based sentinel surveillance.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Sistemas de Notificação de Reações Adversas a Medicamentos/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Pediatria/estatística & dados numéricos , Pediatria/tendências , Vigilância da População , Doenças Preveníveis por Vacina/epidemiologia , Adolescente , Austrália/epidemiologia , Criança , Pré-Escolar , Feminino , Previsões , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos
19.
Tumori ; 106(5): 362-368, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32539655

RESUMO

AIM: To compare the efficacy of a high-intensity psychosocial intervention with standardized usual care in countering psychosocial complexity among child-parent units in a pediatric oncology setting. METHODS: Two hundred pediatric oncology patients and their parents were recruited from Italian hospitals. A total of 81 child-parent units were assigned to the high-intensity psychosocial intervention and 119 child-parent units to standardized usual care. Psychosocial factors were assessed before and 1 year after intervention to measure efficacy. RESULTS: More improvements over time were observed in the high-intensity intervention group of child-parent units compared to the standard intervention group. CONCLUSION: An intensive, structured, and tailored high-intensity intervention positively affects the psychosocial factors of child-parent units. Patients and families should have access to intensive psychosocial support throughout the cancer trajectory.


Assuntos
Oncologia/tendências , Neoplasias/epidemiologia , Neoplasias/psicologia , Pais/psicologia , Criança , Feminino , Humanos , Itália/epidemiologia , Masculino , Neoplasias/patologia , Neoplasias/terapia , Pediatria/tendências , Qualidade de Vida/psicologia
20.
Int Braz J Urol ; 46(suppl.1): 133-144, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32568499

RESUMO

Medical and surgical priorities have changed dramatically at the time of this pandemic. Scientific societies around the World have provided rapid guidance, underpinned by the best knowledge available, on the adaptation of their guidelines recommendations to the current situation. There are very limited scientific evidence especially in our subspecialty of pediatric urology. We carry out a review of the little scientific evidence based mainly on the few publications available to date and on the recommendations of the main scientific societies regarding which patients should undergo surgery, when surgery should be performed and how patient visits should be organize.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Coronavirus , Assistência à Saúde/tendências , Pediatria/tendências , Pneumonia Viral/complicações , Urologia/tendências , Criança , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia
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