1,720,979 research outputs found
Efficacy of Adalimumab as first-line “top-down” therapy in pediatric Crohn's Disease: 12 months of follow-up
No full textObjectives and Study: Anti-tumour necrosis factor (TNF) agents are highly efficient in inducing and
maintaining remission in pediatric Crohn's disease (CD). The question is who is the right patient and
when is the right moment to introduce anti-TNF medication. Recent ECCO-ESPGHAN guidelines
indicate a clear place of anti-TNF biologics in patients with positive predictors of poor outcome. The
aim of our study was to evaluate the efficacy of adalimumab (ADA) as first-line therapy by comparing
two НiffОrОnt stratОgiОsŚ χDχ “top Нown” in immunomoНulator anН anti-TNF naïve CD patients versus
a “stОp up” stratОgy in patiОnts rОМОiving immunosupprОssivО agОnts (thiopurinО anН/or infliximabΨ
before ADA.
Method: Patients followed for CD at Necker hospital that started their ADA therapy between 2005 and
2017 were retrospectively reviewed. The beginning of the study (M0) was the date of first ADA
injection. Enrolled patients were divided into 2 groups according to the treatment strategy. Group A
was composed of patients naïve of immunosuppressors and anti TNF agents who started early ADA
aftОr inНuМtion of rОmission, rОsulting in a “top Нown” stratОgy whilО group ψ was МomposОН by
patiОnts who startОН χDχ aftОr a morО МlassiМal stratОgy (iО “stОp up” stratОgy using
immunosuppressive agents then infliximab). For each patient were collected data at M0, M3, M6, M9
and M12 regarding the disease activity score (wPCDAI), auxological parameters, biological
parameters (CRP, ESR, Albumin, ADA trough levels and antibodies anti-ADA).
Results: 83 patients (43 boys) were enrolled in the study, 43,3% (n=36) in group A and 56,6% (n=47)
in group B. Mean age at the start of ADA was 13.6 ± 2.6 years. At inclusion the 2 groups were
comparable with a mean wPCDAi of 40.75 ± 14,8 in group A versus 45.6 ± 15,5 in group B.
At 6 months, the 2 groups were in clinical remission with a median wPCDAI of 0 (0-12.5 IQR) in group
A (n = 30) versus 0 (0-7.5 IQR) in group B (n=38) (p: 0.509). CRP level decreased from 15.5 (4.7-35.8
IQR) to 1.1 (0.5-5.6 IQR) in group A vs 17.1 (6.5-37.7 IQR) to 4,8 (0.7-6.1 IQR) in group B (p: 0.945 e
p: 0.086). For the subgroup of patients who reached the 1 year follow up, there were no significant
differences regarding the mean wPCDAI, CRP, ESR and serum allbumin between the 2 groups.
Conclusion: ThО prОsОnt stuНy НОmonstratОs that thО “top Нown” stratОgy using Оarly χDχ
monotherapy in disease course is as effective as a step-up strategy. Moreover, ADA monotherapy is
as effective as combotherapy in maintaining clinical and biological remission at 1 year of follow-up in
paediatric CD patients. Those results are very important to identify the best strategy in pediatric CD
patients, where safety concerns are major
Diagnostic Tests in Pediatric Constipation
No full textConstipation is one of the most common gastrointestinal symptoms in children. With a median reported prevalence of 12%, it accounts for about 25% of all pediatric gastroenterology consultations. The majority of children experiences functional constipation and do not usually require any diagnostic testing. For those children not responding to conventional medical treatment or in the presence of a more significant clinical picture, however, an accurate instrumental assessment is usually recommended to evaluate either the underlying pathophysiologic mechanisms or a possible organic etiology. The present review analyzes the possible diagnostic investigations for severely constipated children, focusing on their actual indications and their utility in clinical practice. During the last decade, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed and are discussed in this narrative review
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Childhood obesity: prevention and strategies of intervention. A systematic review of school-based interventions in primary schools.
No full textPlasma dosage of ghrelin, IGF-1, GLP- 1 and leptin related to gastric emptying and esophageal pH-impedance in children with obesity
No full textPurpose The main aim of the study was to assess the relationship between leptin, ghrelin, insulin-like growth factor 1 (IGF-1), and glucagon-like peptide 1 (GLP-1) blood levels and gastric motility in children with obesity compared to healthy children. Secondary aims were to assess the possible association between these hormones and obesity, reflux impedance parameters, reflux symptoms, other GI disorders, and quality-of-life scores within the same groups. Methods Children with obesity plus GERD symptoms and 2 control groups of children with obesity without GERD and healthy lean children aged 4-17 years underwent an auxological evaluation, an assessment of gastro-intestinal symptoms and quality of life, hormonal dosages, and an evaluation of gastric emptying time (GET) through 13C-octanoic acid breath test. Results No significant association was found between hormones and gastric motility. Leptin and ghrelin levels were significantly associated with obesity parameters. No significant differences were found between GET and hormones of the patients with obesity, either with or without GERD. Conclusion Although we found an association between auxological parameters and both leptin and ghrelin levels, this association did not imply an effect on the upper GI motility. Therefore, our hypothesis that alterations of these hormones in children with obesity could affect gastric emptying, triggering GERD, was not supported by our data
Post-infectious glomerulonephritis with nephrotic syndrome secondary to Rotavirus infection
No full textN/
A child with a severe multisystemic inflammatory syndrome following an asymptomatic COVID-19 infection. A novel management for a new disease?
No full textNo abstract availabl
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
True Precocious Puberty Following Treatment of a Leydig Cell Tumor. Two Case Reports and Literature Review
Full text linkLeydig cell testicular tumors are a rare cause of precocious pseudopuberty in boys. Surgery is the main therapy and shows good overall prognosis. The physical signs of precocious puberty are expected to disappear shortly after surgical removal of the mass. We report two children, 7.5 and 7.7 year-old boys, who underwent testis-sparing surgery for a Leydig cell testicular tumor causing precocious pseudopuberty. During followup, after an immediate clinical and laboratory regression, both boys presented signs of precocious puberty and ultimately developed central precocious puberty. They were successfully treated with gonadotropin-releasing hormone (GnRH) analogs. Only six other cases have been described regarding the development of central precocious puberty after successful treatment of a Leydig cell tumor causing precocious pseudopuberty. Gonadotropin-dependent precocious puberty should be considered in children treated for a Leydig cell tumor presenting persistent or recurrent physical signs of puberty activation. In such cases, therapy with GnRH analogs appears to be the most effective medical treatment
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