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Systematic review of case series and case reports on pediatric pulmonary embolism.
No full textBACKGROUND: Pediatric pulmonary embolism is a rare yet potentially life-threatening condition, presenting significant diagnostic and therapeutic challenges owing to its nonspecific symptoms and diverse underlying risk factors. This systematic review aims to consolidate data from case series and case reports to provide a comprehensive overview of pediatric pulmonary embolism, focusing on clinical characteristics, diagnostic approaches, treatment strategies, and outcomes.
METHODS: This systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and the Cochrane Handbook for Systematic Reviews of Interventions, version 6.3. The study protocol was registered with PROSPERO (ID: CRD42024532471). We utilized the Covidence systematic review software for deduplication and screening of search results. The literature search was developed with a subject specialist and included Medical Subject Headings terms and free-text keywords such as pulmonary embolism, pediatric, and case reports. Databases searched included PubMed, Scopus, Web of Science, and the Cochrane Library up to April 2024, limited to English-language publications. Reference lists of relevant articles were also reviewed.
RESULTS: Pulmonary embolism affected males and females with age ranging from 1 to 18 years. Common underlying conditions included malignancies (for example, Wilms tumor), chronic diseases (for example, nephrotic syndrome), and recent surgical interventions. Diagnostic practices primarily relied on computed tomography pulmonary angiography, supplemented by chest X-ray and ultrasound. Treatment typically involved anticoagulation therapy with unfractionated heparin and low-molecular-weight heparin, transitioning to oral anticoagulants for long-term management. Thrombolytic therapy was used in severe cases. Outcomes varied, with many patients recovering well, though complications such as recurrent embolism and pleural effusion were observed. Fatal cases underscored the critical need for early detection and prompt treatment.
CONCLUSION: This systemic review underscores the rarity and complexity of pediatric pulmonary embolism, highlighting the necessity for increased clinical vigilance given its nonspecific presentation and diverse underlying risk factors. Accurate diagnosis, primarily via computed tomography pulmonary angiography, with the prompt initiation of anticoagulation therapy are essential for optimal outcomes. Despite favorable recovery rates for most patients, the potential for severe complications and fatalities reinforces the value of timely diagnosis and personalized management approaches. Further research is essential to refine diagnostic protocols, optimize treatment approaches, establish evidence-based guidelines, and improve long-term outcomes for children with pulmonary embolism
Long-Term Changes to Cardiovascular Biomarkers After Hormone Therapy in the Women\u27s Health Initiative Hormone Therapy Clinical Trials.
No full textOBJECTIVE: To assess the long-term changes in cardiovascular biomarkers during the WHI (Women\u27s Health Initiative) hormone therapy (HT) clinical trials of conjugated equine estrogens (CEE) alone and CEE plus medroxyprogesterone acetate (MPA).
METHODS: HT trial participants from the CEE alone (n=1,188, 0.625 mg/d CEE or placebo) and the CEE+MPA (n=1,508, 0.625 mg/d CEE plus continuous 2.5 mg/d MPA or placebo) trials provided blood samples at baseline and after 1, 3, and 6 years. Low-density lipoprotein cholesterol (LDL-C; primary endpoint), high-density lipoprotein cholesterol (HDL-C), triglycerides, total cholesterol, lipoprotein(a), glucose, insulin, and homeostatic model assessment for insulin resistance were measured. Repeated-measures regression models estimated the geometric means of each log-transformed biomarker by restricted maximum likelihood. A constant treatment effect across visits was used to estimate the overall effect, expressed as a ratio of geometric means, and was complemented with geometric means (95% CIs) by randomization group and corresponding ratios of geometric means (95% CI; HT vs placebo) at each visit.
RESULTS: During the intervention phase of the CEE-alone trial, randomization to CEE reduced LDL-C by 11% over 6 years (ratio of geometric means 0.89, 95% CI, 0.88-0.91, P
CONCLUSION: Lipoprotein(a), LDL-C, and homeostatic model assessment for insulin resistance were lower and HDL-C levels were higher for HT compared with placebo. Triglycerides increased in both the CEE and CEE+MPA trials, however. Future research should assess whether other progestogens attenuate the effect of estrogen on HDL-C. These results may be used to counsel younger menopausal women with bothersome symptoms who are deciding whether to initiate oral HT within the context of published effects of oral HT on rates of cardiovascular events.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT00000611
Pseudobulbar Affect Among Patients With Dementia.
No full textOBJECTIVE: Dementia is a neurocognitive disorder characterized by memory loss and deficits in multiple cognitive domains, caused by damage to or loss of neurons in the brain, which impairs one\u27s abilities and capabilities for independent daily living. The etiologies of dementia are diverse, including vascular, infectious, traumatic, and neurodegenerative causes. The most common types of dementia include Alzheimer\u27s dementia, vascular dementia, Lewy body dementia, and frontotemporal dementia. Patients with dementia frequently develop cognitive, psycho-behavioral, emotional, and mood symptoms. One largely unstudied mood symptom seen in dementia patients is pseudobulbar affect (PBA). PBA is a state of emotional incontinence characterized by episodes of uncontrolled crying or laughter that are inconsistent with the social context or the patient\u27s emotional state. Although many neurological disorders may present with PBA, only a small fraction of the literature focuses on PBA in dementia patients. In the present study, we used the TriNetX database to identify a cohort of patients with both PBA and dementia. We describe this cohort to provide a foundation for further research on this patient population.
RESULTS: Seventy-three percent (n=182) of the cohort had postconcussion syndrome, 18% (n=44) had overt dementia, 49% (n=121) had mild cognitive impairment, and 42% (n=105) had some form of amnesia. Many patients had comorbid psychiatric disorders, including anxiety and depressive disorders.
CONCLUSIONS: The multitude of comorbid mood disorders and symptoms can complicate the clinical management of dementia patients, adding to their distress and that of their caregivers. Understanding these symptoms is essential for providing an accurate diagnosis and effective management of PBA in dementia
Safety and Efficacy of Genicular Artery Embolization for Knee Joint Osteoarthritis Associated Pain: A Systematic Review.
No full textPURPOSE: To systematically review the literature on the effectiveness, safety, and long-term outcomes of genicular artery embolization (GAE) for knee joint osteoarthritis (OA) associated pain.
MATERIALS AND METHODS: After registering the protocol with the PROSPERO database, a search was conducted from inception until July 31, 2023, in MEDLINE, Cochrane Central Register of Controlled Trials, and ScienceDirect databases to gather studies evaluating GAE\u27s safety and efficacy in knee OA. A total of 4979 studies were identified and evaluated against the inclusion criteria. Data on study characteristics, success parameters, and adverse events were collected and synthesized.
RESULTS: Twenty-three studies, primarily single-center prospective studies with a total of 657 patients, were included. Most studies reported a 100% technical success rates, except one study reporting a rate of 84.2%. Clinical success rates, defined variably across studies, ranged from 30% to 100%, depending on the study\u27s follow-up period and outcome measures. The most frequent adverse events included skin discoloration without an ulcer (15.6%, n = 98) and transient post-procedural knee pain (10.2%, n = 64). Most studies were rated as fair in terms of quality, but the lack of robust randomized controlled trials highlighted the need for further comparative studies to standardize outcome reporting.
CONCLUSION: GAE appears to be a promising option for knee OA pain, particularly for patients unresponsive to conservative treatments or ineligible for surgery. High-quality studies are needed to confirm long-term effectiveness and standardize outcome measures.Clinical ImpactThis study highlights the safety and efficacy of genicular artery embolization as a minimally invasive treatment for knee osteoarthritis, particularly in patients who are unresponsive to conservative treatments or unsuitable for surgery. By targeting neovascularization and reducing inflammation, genicular artery embolization provides pain relief and functional improvement. Clinicians can consider genicular artery embolization as an alternative to surgery for mild-to-moderate OA, offering a lower adverse event rate and faster recovery
Caregiver/Family Characteristics and Healthcare Experiences in an Urban Pediatric Oncology Clinic
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Erythropoietin and Thrombopoiesis in Sickle Cell Anemia - Effects of Hydroxyurea Treatment and Red Blood Cell Transfusions
Get PDFMotivations and Barriers of Student Volunteer Engagement in Student-Run Free Clinics and Projects
Get PDFVD5K58YKDZ Association Between Weight Lost and Diabetes Resolution After Bariatric Surgery With Preoperative GLP-1 Agonist Use
No full textEllen Pekar University of Pennsylvania; John Fam Tower Health/Drexel University; Roshan Shaik Tower Health Introduction: GLP1 agonists have rapidly emerged as effective tools for management of obesity and obesity related complications. With the shared mechanism between bariatric surgery and GLP-1 agonists, it would lead to reason that a combination approach between surgery and medical management would lead to increased postoperative weight loss in the long term. This study will aim to evaluate if there is a benefit postoperatively from preoperative GLP-1 use in bariatric surgery patients. Method: Retrospective study looking at all patients from a single bariatric center undergoing primary bariatric surgery (sleeve, SADI, RYGB) from 2021- July 2024. Data on BMI at different time points pre/postoperatively, medication use from time of program until weight loss surgery, type of bariatric surgery performed, diabetes status, A1c pre and post op, complications, and readmissions was collected. Results: Preliminary results were collected from 60 patients. 30 (50%) patients received a GLP-1 agonist preoperatively for at least 6 weeks. For the GLP1 group there was a 11.5 ± 14.7 BMI change at 6 months postoperatively vs a 12.6 ± 17.3 change in the control group (p=.28). There was no statistically significant BMI reduction between groups. There was no difference in perioperative complications between groups (p=0.36). There was no statistically significant rate of diabetes resolution between groups (p=1.59). Conclusion: From preliminary results there is no additional postoperative benefit in regards to weight loss or diabetes resolution from addition of GLP1 agonist preoperatively. Further analysis will be done on the data in order to increase sample size and accuracy. Further studies are required in order to evaluate the long term effects of GLP-1 agonists on bariatric surgery patients