bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of in-office laryngology procedures
Authors: Marinone Lares Silvia G. , Allen Jacqueline E. 
Published: September 2019

Purpose of review
A wide range of diagnostic and therapeutic laryngology procedures are currently performed in an office setting. In-office laryngology procedures (IOLP) are increasingly seen as standard-of-care, and while generally considered safe, high-quality evidence supporting the latter statement is lacking. This review aims to summarize recent literature regarding the safety of IOLP.

Recent findings
There is a paucity of guidelines and standardized protocols for IOLP. To date, there is one available safety protocol specific to in-office laser procedures. Haemodynamic changes during IOLP have been documented and the significance of these changes continues to be unclear. Therefore, monitoring of vital signs is recommended. Continuing antithrombotic therapy during IOLP also appears safe, and this decision may be left to surgeon discretion. A protocol for management of antithrombotic therapy prior to in-office laser procedures is available. Actual serum lidocaine levels following topical application of mixed lidocaine preparations falls well below reported toxic levels but persists for longer than previously reported.

Summary
IOLP are safer that suspension laryngoscopy under general anaesthetic. Although complication rates of IOLP are low, patient characteristics and potential complications of both the procedure and of topical anaesthetic use must be considered. One must be prepared and equipped to deal with these potential complications.
Diagnosis of primary immunodeficiency diseases in the developing world: the need for education and networking with the developed world
Authors: Villavicencio Maria Fernanda , Pedroza Luis Alberto 
Published: September 2019

Purpose of review
Even with the evident improvement in knowledge about clinical and molecular aspects and the technology used to diagnose primary immunodeficiency diseases (PIDs), there is still a significant delay in recognition of these diseases in the developing world, specifically in Latin America. In this review, the goal is to outline the challenges that need to overcome for the diagnosis of PIDs and the optimization of resources available based on our experience.

Recent findings
We describe the advances achieved in the past decade in Latin America in terms of recognition of PIDs, as well as the need for improvement. We outline the need for continued medical education, the lack of resources for laboratory testing, and how genetic testing through next-generation sequencing (that is becoming a day-to-day tool) can be achieved in the developing world.

Summary
We aim to gather information about the limitations and challenges for the diagnosis of PIDs in a low-resource environment and the opportunities to benefit from the available advanced tools for diagnosis.
Microbiota and Body Composition During the Period of Complementary Feeding
Authors: Smith‐Brown Paula , Morrison Mark , Krause Lutz , Davies Peter S.W. 
Published: September 2019

ABSTRACTObjectives:This study aimed to explore the associations between food group intake, faecal microbiota profile, and body composition during the period of complementary feeding.Methods:Diet was assessed using a quantitative food frequency questionnaire, faecal microbiota profile was assessed using 16S rRNA gene sequencing, and body composition was assessed using bioelectrical impedance analysis and dual energy x‐ray absorptiometry, in a cohort of 50 infants aged 6 to 24 months of age.Results:During this critical period of microbiota development, age was the strongest predictor of microbiota composition with network analysis revealing a cluster of genera positively associated with age. A separate cluster comprised genera associated with fat mass index with Bifidobacterium showing the strongest correlation with fat mass index (rho = 0.55, P = 0.001, false discovery rate [FDR] = 0.018). Dairy intake was both negatively correlated with Bacteroides (rho = −0.49, P < 0.001, FDR = 0.024) and positively correlated with lean mass index (rho = 0.44, P = 0.007, FDR = 0.024). Antibiotics use in the first month of life had the most striking influence on body composition and was associated with an increase in mean body mass index z score of 1.17 (P = 0.001) and body fat of 3.5% (P = 0.001).Conclusions:Our results suggested that antibiotics use in the first month of life had the most striking influence on body composition in this cohort of infants aged 6 to 24 months, whereas dairy intake interacted with both microbiota and body composition in early life.
European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020
Authors: Husby Steffen , Koletzko Sibylle , Korponay‐Szabó Ilma , Kurppa Kalle , Mearin Maria Luisa , Ribes‐Koninckx Carmen , Shamir Raanan , Troncone Riccardo , Auricchio Renata , Castillejo Gemma , Christensen Robin , Dolinsek Jernej , Gillett Peter , Hróbjartsson Asbjørn , Koltai Tunde , Maki Markku , Nielsen Sabrina Mai , Popp Alina , Størdal Ketil , Werkstetter Katharina , Wessels Margreet 
Published: September 2019

ABSTRACTObjectives:The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence‐based guideline is presented.Methods:Literature databases and other sources of information were searched for studies that could inform on 10 formulated questions on symptoms, serology, human leukocyte antigen genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations.Results:Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA‐antibodies against transglutaminase 2 (TGA‐IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP‐IgG/IgA) for initial testing. Only if total IgA is low/undetectable, an IgG‐based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA‐IgA is ≥10 times the upper limit of normal (10× ULN) and the family agrees, the no‐biopsy diagnosis may be applied, provided endomysial antibodies (EMA‐IgA) will test positive in a second blood sample. Human leukocyte antigen DQ2‐/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA‐IgA <10× ULN at least 4 biopsies from the distal duodenum and at least 1 from the bulb should be taken. Discordant results between TGA‐IgA and histopathology may require re‐evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA‐IgA/EMA‐IgA+) should be followed closely.Conclusions:CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.
Photoprotection But Not N‐acetylcysteine Improves Intestinal Blood Flow and Oxidation Status in Parenterally Fed Piglets
Authors: Huber Lee‐Anne , Lee Theresa , LeDrew Robyn L. , Dodge M. Elaine , Brunton Janet A. , Bertolo Robert F. 
Published: September 2019

ABSTRACTObjectives:The purpose of the present study was to determine if protecting parenteral nutrition solutions from ambient light and supplementing with N‐acetylcysteine (NAC) improves mesenteric blood flow, gut morphology, and oxidative status of parenterally fed neonates.Methods:Neonatal Yucatan miniature piglets (n = 23, 7–11 days old) were surgically fitted with central venous catheters and an ultrasonic blood flow probe around the superior mesenteric artery. Piglets were fed continuously for 7 days either light‐protected (LP) or light‐exposed (LE) complete parenteral nutrition that was enriched with either NAC or alanine (ALA).Results:There were no differences in body weight or overall gut morphology among groups after 7 days. Plasma concentrations of NAC were greater and total homocysteine lower in NAC‐ versus ALA‐supplemented pigs on day 7 (N‐acetylcysteine: 94 vs 7 μmol/L; P < 0.001; homocysteine: 14 versus 21 μmol/L; P < 0.005); plasma total glutathione was not affected. Hepatic lipid peroxidation was reduced by 25% in piglets that received LP parenteral nutrition (P < 0.05). The mesenteric artery blood flow decreased in all pigs between days 2 and 6 (P < 0.001) because of parenteral feeding. Photoprotection alone (LP‐ALA) attenuated the decrease in mesenteric blood flow to 66% of baseline on day 6 compared with LE‐ALA (37%; P < 0.05) and LP‐NAC pigs (43%; P = 0.062); LE‐NAC piglets had intermediate reductions in blood flow (55%).Conclusions:Photoprotection of parenteral nutrition solutions is a simple, effective method to attenuate decline in blood flow to the gut and hepatic lipid peroxidation, which are both commonly associated with parenteral feeding.
Depression Screening in Pediatric Inflammatory Bowel Disease Clinics
Authors: Mackner Laura M. , Whitaker Brandi N. , Maddux Michele H. , Thompson Suzanne , Hughes‐Reid Cheyenne , Drovetta Megan , Reed Bonney 
Published: September 2019

ABSTRACTObjective: Rates of youth depression are increasing, and approximately 75% of adolescents with depression go unrecognized. Research in pediatric IBD documents increased depression risk, with rates up to 25%, as well as worse adherence and treatment outcomes associated with depressive symptoms. Evidence‐based psychological interventions improve the physical and emotional health of these patients, highlighting the importance of detection and treatment. Psychosocial screening has been shown to increase the accurate identification of psychosocial problems and facilitate timely psychosocial intervention. The objective of this article is to establish clinical guidelines for depression screening in youth diagnosed with IBD and to provide resources for implementation.Methods: The psychosocial screening task force group constituted of psychologists and social workers in the ImproveCareNow (ICN) learning health system reviewed research and clinical guidelines in other fields, and consulted with physicians, nurses, other psychosocial professionals, patients with IBD, and parents of children with IBD in ICN.Results/Conclusions: It is recommended that adolescents with IBD ages 12 and older be screened for depression annually. Additional practical recommendations for implementation, triage, and treatment within the pediatric gastroenterology clinic are also provided.
Neurocognitive Functioning in Early School‐age Children With Intestinal Failure
Authors: Gold Anna , Danguecan Ashley , Belza Christina , So Stephanie , de Silva Nicole , Avitzur Yaron , Wales Paul W. 
Published: September 2019

ABSTRACTObjectives:Little is known about school‐age functioning in children with intestinal failure (IF). This study examines neurocognitive outcomes of children with IF at ages 4 to 8 years treated at a single centre, along with relevant medical and demographic variables.Methods:Between 2012 and 2016, neurocognitive assessments were administered to 28 children receiving treatment in our IF rehabilitation program, and included measures of intelligence, academics, learning/memory, language, visual‐motor integration, and fine‐motor dexterity. DSM‐IV/V criteria were used to diagnose Learning Disability, Intellectual Disability, and/or Attention Deficit/Hyperactivity Disorder.Results:Intellectual functioning ranged from extremely low to superior (Full Scale IQ range 53–123, mean = 89). Forty‐six percentage received a cognitive/learning DSM diagnosis. Total number of first‐year septic episodes correlated with poorer outcomes on the most cognitive measures. Adjusting for gestational age (61% were born <37 weeks), number of first‐year septic episodes negatively predicted working memory, visual‐motor integration, and visual memory scores. Additional factors correlating with poorer outcomes on ≥2 cognitive measures included length of first‐year admissions, necrotizing enterocolitis diagnosis, and first‐year sustained conjugated hyperbilirubinemia. Having ≥2 first‐year septic episodes increased the likelihood of poorer outcome. Having a sibling was a significant positive predictor of working memory, processing speed, reading, and verbal learning skills.Conclusions:Our data provides preliminary evidence that children with IF are at risk of neurocognitive problems at early school age. Managing septic events during the first year is one strategy that may help reduce long‐term neurocognitive risks in this population.
Factors Associated With Frequent Opioid Use in Children With Acute Recurrent and Chronic Pancreatitis
Authors: Perito Emily R. , Palermo Tonya M. , Pohl John F. , Mascarenhas Maria , Abu‐El‐Haija Maisam , Barth Bradley , Bellin Melena D. , Fishman Douglas S. , Freedman Steven , Gariepy Cheryl , Giefer Matthew , Gonska Tanja , Heyman Melvin B. , Himes Ryan W. , Husain Sohail Z. , Lin Tom , Liu Quin , Maqbool Asim , McFerron Brian , Morinville Veronique D. , Nathan Jaime D. , Ooi Chee Y. , Rhee Sue , Schwarzenberg Sarah Jane , Shah Uzma , Troendle David M. , Werlin Steven , Wilschanski Michael , Zheng Yuhua , Zimmerman Miriam Bridget , Lowe Mark , Uc Aliye 
Published: September 2019

ABSTRACTObjectives:The aim of the study was to understand the association of frequent opioid use with disease phenotype and pain pattern and burden in children and adolescents with acute recurrent (ARP) or chronic pancreatitis (CP).Methods:Cross‐sectional study of children <19 years with ARP or CP, at enrollment into the INSPPIRE cohort. We categorized patients as opioid “frequent use” (daily/weekly) or “nonfrequent use” (monthly or less, or no opioids), based on patient and parent self‐report.Results:Of 427 children with ARP or CP, 17% reported frequent opioid use. More children with CP (65%) reported frequent opioid use than with ARP (41%, P = 0.0002). In multivariate analysis, frequent opioid use was associated with older age at diagnosis (odds ratio [OR] 1.67 per 5 years, 95% confidence interval [CI] 1.13–2.47, P = 0.01), exocrine insufficiency (OR 2.44, 95% CI 1.13–5.24, P = 0.02), constant/severe pain (OR 4.14, 95% CI 2.06–8.34, P < 0.0001), and higher average pain impact score across all 6 functional domains (OR 1.62 per 1‐point increase, 95% CI 1.28–2.06, P < 0.0001). Children with frequent opioid use also reported more missed school days, hospitalizations, and emergency room visits in the past year than children with no frequent use (P < 0.0002 for each). Participants in the US West and Midwest accounted for 83% of frequent opioid users but only 56% of the total cohort.Conclusions:In children with CP or ARP, frequent opioid use is associated with constant pain, more healthcare use, and higher levels of pain interference with functioning. Longitudinal and prospective research is needed to identify risk factors for frequent opioid use and to evaluate nonopioid interventions for reducing pain and disability in these children.
Comparison of Tolerance and Complication Rates Between Early and Delayed Feeding After Percutaneous Endoscopic Gastrostomy Placement in Children
Authors: Peck Jacquelin , Mills Katie , Dey Aditi , Nguyen Anh Thy H. , Amankwah Ernest K. , Wilsey Alexander , Swan Emily , Son Sorany , Karjoo Sara , McClenathan Daniel , Wilsey Michael 
Published: September 2019

ABSTRACTBackground:Enteral nutrition is commonly initiated 24 hours after percutaneous endoscopic gastrostomy (PEG) in children. Adult studies report safe refeeding within 1 to 6 hours of PEG, and these findings have been cautiously applied to children. Comparative studies assessing early versus next‐day refeeding in children are currently lacking. This study evaluates feeding tolerance and complications following early versus next‐day refeeding in children.Methods:This is a single‐center, pre‐post study. In June 2015 our clinical practice changed to begin refeeding within 6 hours of PEG. Children receiving early refeeding from December 2015 to August 2017 were included. A retrospective cohort from February 2013 to April 2015 was used for comparison.Results:Forty‐six children received early refeeding after PEG and 37 received next‐day refeeding. Gender distribution was similar in the 2 groups. Early refeeding patients were slightly older (3.5 vs 2.2 years) and heavier (15.5 vs 11.5 kg) at PEG placement compared to next‐day refeeding patients. Early refeeding patients experienced greater postprocedural nausea and/or vomiting (19% vs 8%, P < 0.001) and leakage, irritation, and infection around the stoma (19% vs 0.0%, P < 0.001). Compared to early refeeders, next‐day refeeding patients experienced higher occurrence of fever (35% vs 13%, P = 0.021), longer nutritional disruption (24.6 vs 3.7 hours, P < 0.001), and longer length of stay (51 vs 27 hours; P < 0.001). One next‐day refeeding patient experienced peritonitis. One early refeeding patient experienced cellulitis requiring hospitalization and a second experienced gastrostomy tube migration into the peritoneal cavity requiring removal.Conclusion:Early refeeders experienced higher rates of postprocedural nausea or vomiting and irritation, leakage, or infection around the stoma; but experienced lower rates of postoperative fever. Early refeeding resulted in reduced nutritional interruption and hospital length of stay.
Utility of Colon Manometry in Guiding Therapy and Predicting Need for Surgery in Children With Defecation Disorders
Authors: Rodriguez Leonel , Heinz Nicole , Nurko Samuel 
Published: September 2019

ABSTRACTObjectives:Colon manometry (CM) has emerged as a tool to evaluate children with defecation problems. Our aim was to evaluate the utility of CM in guiding therapy and predicting surgery in pediatric constipation.Methods:Retrospective review of children undergoing CM for 4 indications: constipation, fecal incontinence, postsurgical evaluation and chronic intestinal pseudo‐obstruction. Variables included age, sex, follow‐up, and CM parameters: gastrocolonic response (GC) and quality/quantity of high‐amplitude propagating contractions (HAPCs). Interventions: medical, surgical or no intervention. Outcomes: response to change of therapy guided by CM, response to first intervention guided by CM (CMI) and CM predicting surgery (CMS). Response to therapy was classified according to study indication.Results:Five hundred fifty‐five studies (448 patients, 54.4% female; median age 8.9 years) were included, 24% of studies were normal. Change of therapy guided by CM was associated with a high response rate (P = 0.003). Overall response to stimulant laxatives was 48% and was not associated with CM findings. Surgical interventions had a higher response rate than medical or other interventions (P < 0.001). We found no association between the CM interpretation and CMI, but an abnormal CM was predictive of surgery (P < 0.01). GC and presence/number of HAPCs were not associated with CMI or CMS. We also found no association between HAPC quality and CMI but partially propagated HAPCs were predictive of surgery (P < 0.001). Logistic regression analysis showed no factors associated with CMI; however, longer follow up and partially propagated HAPCs were predictive of surgery.Conclusions:CM is useful in pediatric defecation disorders, although not predictive of successful medical intervention, an abnormal CM is predictive of surgery. CM should be performed only after medical interventions have failed and surgery is contemplated.
Quantitative Liver Fibrosis Using Collagen Hybridizing Peptide to Predict Native Liver Survival in Biliary Atresia
Authors: Jaramillo Catalina , Guthery Stephen L. , Lowichik Amy , Stoddard Gregory , Kim Taegun , Li Yang , Jensen Michael Kyle 
Published: September 2019

ABSTRACTBackground/Rationale:Biliary atresia (BA) is a cholangiopathy characterized by bile flow obstruction due to destruction of the biliary tree. Without surgical correction with Kasai portoenterostomy (KPE), BA leads to death or liver transplant (LTx). Early‐onset, progressive liver fibrosis is a defining characteristic of BA. Collagen hybridizing peptide (CHP) is a synthetic peptide which binds to denatured collagen strands allowing quantification of fibrosis. This technique has not been used on human liver tissue. The aim of this pilot study was to evaluate the utility of CHP as a measurement of quantitative fibrosis to allow earlier survival with native liver prognostication.Results:We identified 21 patients with wedge liver biopsies available, of which 14 required LTx. No deaths occurred. Patients requiring LTx tended to be girls with a significantly different mean bilirubin (P = 0.002), albumin (P = 0.001), and alanine aminotransferase (P = 0.03) at 3 months post‐KPE. By 1 year post‐KPE, 50% of patients in the high CHP intensity group required LTx versus 27% in the low CHP. Overall, fibrosis as quantified by CHP at time of KPE was associated with more than 3 times the risk of requiring LTx by 4 years of age (hazard ratio 3.6, 95% confidence interval 1.15–10.93, P = 0.03). When controlling for sex and total bilirubin >2 mg/dL and albumin at 3 months post‐KPE, it predicted nearly 7 times the risk of LTx (hazard ratio 6.89, 95% confidence interval 1.38–34.32, P = 0.02).Conclusion:Our results suggest that quantitative assessment of fibrosis at the time of KPE holds promise as an earlier predictor of LTx requirement in BA. A larger study is justified to assess quantitative fibrosis as a BA prognostic tool.
Antibiotic Susceptibility and Therapy in Central Line Infections in Pediatric Home Parenteral Nutrition Patients
Authors: Raphael Bram P. , Fournier Greg , McLaughlin Sarah R. , Puder Mark , Jones Sarah , Flett Kelly B. 
Published: September 2019

ABSTRACTBackground:Patients receiving home parenteral nutrition (HPN) are at high‐risk for central line‐associated bloodstream infections (CLABSI). There are no published management guidelines, however, for the antibiotic treatment of suspected CLABSI in this population. Historical microbiology data may help inform empiric antimicrobial regimens in this population.Objective:The aim of the study was to describe antimicrobial resistance patterns and determine the most appropriate empiric antibiotic therapy in HPN‐dependent children experiencing a community‐acquired CLABSI.Methods:Single‐center retrospective cohort study evaluating potential coverage of empiric antibiotic regimens in children on HPN who developed a community‐acquired CLABSI.Results:From October 1, 2011 to September 30, 2017, there were 309 CLABSI episodes among 90 HPN‐dependent children with median age 3.8 years old.Fifty‐nine percent of patients carried the diagnosis of surgical short bowel syndrome. Organisms isolated during these infections included 60% Gram‐positive bacteria, 34% Gram‐negative bacteria, and 6% fungi. Among all staphylococcal isolates, 51% were methicillin sensitive. Among enteric Gram‐negative organisms, sensitivities were piperacillin‐tazobactam 71%, cefepime 97%, and meropenem 99%. Organisms were sensitive to current institutional standard therapy with vancomycin and piperacillin‐tazobactam in 69% of cases compared with vancomycin and cefepime or vancomycin an meropenem in 85% and 96% of cases (both P < 0.01).Conclusions:Empiric antimicrobial therapy for suspected CLABSI in HPN‐dependent children should include therapy for methicillin‐resistant staphylococci as well as enteric Gram‐negative organisms. Future studies are needed to evaluate clinical outcomes based upon evidence‐based antimicrobial regimens.