Malnutrition among hospitalized patients has clinical implications, and interest has arisen to find screening tools able to identify subjects under risk. At present, there is no consensus about the ...most suitable nutrition screening tool for pediatric patients.
To validate STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics) pediatric screening tool in Spain.
Descriptive cross-sectional study of patients admitted to a 3rd level children's hospital with both medical and surgical specialities. During the first 24 hours of admission, STAMP screening tool was applied. For its validation, results were compared with those obtained from a nutritional assessment performed by specialist staff, which included clinical, anthropometric and body composition data.
A sample of 250 children was studied. Nutritional assessment identified 64 patients (25.6%) under risk, 40 of whom were malnourished (16%). STAMP classified 48.4% of the patients as being under nutritional risk. This tool showed 75% sensitivity and 60.8% specificity when identifying patients under risk according to nutritional assessment. It showed 90% sensitivity and 59.5% specificity when identifying malnourished patients.
Malnutrition was less frequent than that reported in other European countries, although diagnosis technique was different. STAMP is a simple and useful tool for nutritional screening, avoiding the need to assess all patients on admission in order to identify those under nutritional risk.
Abstract
Background
Inflammatory bowel disease causes increased granulocyte and monocyte activation. Leukocytapheresis (LCA) is a safe technique that has shown efficacy in ulcerative colitis wich ...replaces activated leukocytes decreasing the cytokines involved in inflammatory response.
The objective of this report is to describe the main characteristics of patients in whom LCA was made and evaluate the response to different types of LCA.
Methods
A descriptive and retrospective study that analyses clinical and analytical data of patients diagnosed with IBD who underwent LCA a cause of refractory to conventional treatment, in a tertiary paediatric hospital between 2006 and 2022.
The following variables were studied: Demographic data, treatments before and during LCA, reason for the onset of LCA, clinical and analytical situation, characteristics of the sessions, beneficial and side effects.
Results
10 patients (3 women and 7 men) diagnosed with ulcerative colitis (E4S1) were included. The mean age at diagnosis was 11,6 +/- 1,9 years. 6 patients received combination therapy (biologic + inmunomodulator), 2 immunomodulator in monotherapy, 1 biologic in monotherapy and 1 neither immunomodulator nor biologic.
14 cycles were analyzed during a median follow-up of 37 +/- 31 months. The main indication to initiate LCA was steroid-dependence (55%). The rest of indication: Steroid-refractoriness (15%), primary non response to biologics (15%) and secondary loss of response to biologics (15%). The mean age at the start of LCA was 14,1 +/- 1,8 years. In 78% corticotherapy was added. The average duration was 93 +/- 84 days with a mean of 8,6 +/- 4,5 sessions. 1 adverse effects were reported: Transient hypertransaminasemia. The effect of the therapy was beneficial in 71% and corticotherapy could be withdrawn > 3 months in 9 instances; in 2 of them > 12 months. In addition, 1 patient continued his treatment with Infliximab despite primary failure and 1 patient recovered from the secondary loss of response to Adalimumab. 4 of 7 patients had to switch to a different biologic agent. Average decrease in the PUCAI score of 33 +/- 30 points was observed as and average decrease in the values of leukocytes, neutrophils, lymphocytes and monocytes of 1,8 +/- 5,2 × 109/L, 1,9 +/- 5,1 × 109/L, 0,1 +/- ,1 × 109/L and 0,2 +/- 0,3 × 109/L and a decrease in the CRP, ESR and FC of 4,8+/- 10,6 mg/dL, 4,1 +/- 36,3 mm/h and 536 +/- 977 mcg/g. LCA was more effective when the indication was corticodependence versus other indications (p<0,05). No significant differences were found in the subgroup analyisis.
Conclusion
In our experience, LCA has proven to be a safe and effective treatment in more than 50% of paediatric patients with refractory CU, especially in corticodependent patients.
Abstract
Background
In the recent decades, the incidence of Clostridioides difficile (Cd) infection in children with inflammatory bowel disease (IBD) has increased, possibly due to underlying ...dysbiosis. The main objective of this study is to compare the prevalence of this infection in patients with IBD and without it, as well as secondarily to describe risk factors for Cd and its impact on the evolution of IBD.
Methods
Unicentric, observational and retrospective study of paediatric patients (<18 years old) undergoing Cd screening at the Hospital Infantil Universitario Niño Jesús in the last 5 years. Patients with IBD were those who met the Porto criteria. Statistical analysis was performed using SPSS.
Results
3,360 paediatric patients were included. Of the 150 patients whose screening was requested by the Digestive Section, 87 had IBD. There were no statistically significant differences in the prevalence of infection in patients with IBD compared to other patients (p=0,061).
According to the Paris Classification, no differences were found in relation to the prevalence of Cd infection, except for patients with growth impairment (G1), with a higher prevalence of infection compared to those without (G0) (33.3% vs. 13.9%) p<0.05. Regarding treatment, a higher prevalence of Cd infection was observed in patients receiving aminosalicylates monotherapy (42.9% vs. 13.4%) p<0.05 and in patients receiving NEE in monotherapy (60% vs. 15.8%) p<0.05. In contrast, a lower prevalence of Cd was observed in patients treated with azathioprine (with or without other therapies) compared to those not receiving azathioprine (10.3% vs. 26.2%) p<0.05. A lower prevalence of positives was also observed among those treated with biologics (with or without other therapies) (8% vs. 23.2%) p<0.05.
Patients with IBD in whom the test was positive required more frequent changes in their baseline treatment than those who had negative screening (72.2% vs. 14.9%, p<0.05).
Conclusion
Although it has not been demonstrated that Cd is more prevalent in patients with IBD, it does seem to condition the course of the disease, being patients in whom more treatment changes have been made. Given the complexity of the data related to infection rates in relation to the different treatments, further studies in pediatric patients with concomitant IBD and Cd are considered necessary to confirm such differences and explain the possible pathophysiology.
BackgroundThe disease modifying antirheumatic drugs (DMARD) impair the immune response of patients with immune-mediated inflammatory diseases (IMID).ObjectivesTo analyze the seroprevalence of ...SARS-CoV-2 in patients with IMID treated with biological disease modifying antirheumatic drugs (bDMARD) or targeted synthetic (tsDMARD).MethodsAn ambispective cross-sectional study was performed in patients with IMID treated with bDMARD or tsDMARD. Seroprevalence was compared by measuring IgG against SARS-CoV-2 between October 2020 and May 2021.ResultsA total of 550 patients with IMID were studied, all of them on bDMARD or tsDMARD therapy, none of them vaccinated at that time against SARS-CoV-2. Patients receiving anti-TNFα therapy had a higher seroprevalence than other biologic and synthetic targeted therapies (OR= 1.792; 95% CI 1.088-2.951; p= 0.021).Patients with bDMARD or tsDMARD treated concomitantly with some type of conventional synthetic DMARD (csDMARD) presented a lower seroprevalence compared to patients treated in monotherapy, 10.7 vs. 19.9% (p= 0.003). When analyzing the treatments with the different csDMARD separately (methotrexate, leflunomide, sulfasalazine, azathioprine, hydroxychloroquine and the others), methotrexate was determined to influence in a lower seroprevalence, compared to those who did not receive any csDMARD, 9.8 vs 19.9% (OR= 0.439, 95% CI 0.232-0.828; p= 0.011). When evaluating the influence of methotrexate on seroprevalence among the different groups of bDMARD or tsDMARD, a lower seroprevalence was demonstrated in the group of patients receiving anti-TNFα and methotrexate in combination, versus patients on this bDMARD in monotherapy, 10.1 vs 24.1% (OR= 0.355, 95% CI 0.165 - 0.764; p=0.006). No significant differences were identified with the other bDMARD.Regarding the patients’ IMIDs, no differences in seroprevalence were observed when compared by disease groups with each other.ConclusionSeroprevalence in the group of patients with IMID is influenced according to the therapy received, being higher in patients receiving anti-TNFα monotherapy, but significantly lower if concomitant to this drug they receive methotrexate. These differences are not seen with the other b/tsDMARD and csDMARD.References1Muñoz-Fernández S, Cebrian L, Thuissard IJ, Martina Steiner M, García-Yubero C, Esteban AV et al. Incidence of COVID-19 in 902 Patients With Immunomediated Inflammatory Diseases Treated With Biologics and Targeted Synthetic Disease-Modifying Antirheumatic Drugs-Findings From the BIOCOVID Study. J Clin Reumatol. 2022 Mar 1; 28(2): e348-e352.2Favalli EG, Gobbini A, Bombaci M, Maioli G, et al. The Impact of Anti-rheumatic Drugs on the Seroprevalence of Anti-SARS-CoV-2 Antibodies in a Cohort of Patients With Inflammatory Arthritis: The MAINSTREAM Study. Front Med (Lausana), March 2022.3Simon D, Tascilar K, Kleyer A, Fagni F, Krönke G, Médeet C et al. Impact of cytokine inhibitor therapy on the prevalence, seroconversion rate and longevity of the humoral immune response against SARSCoV- 2 in an unvaccinated cohort. Arthritis & Rheumatology Vol. 74, No. 5, May 2022, pp 783–790AcknowledgementsOlga Reillo from Hospital Universitario Infanta Sofía (Librarian - Documentalist)Disclosure of InterestsNone Declared.
Introducción: La malnutrición en los pacientes hospitalizados tiene implicaciones clínicas y evolutivas, por lo que existe interés en desarrollar métodos de cribado que identifiquen los individuos de ...riesgo. En la actualidad no existe consenso acerca de la herramienta de cribado nutricional más apropiada para aplicar en población pediátrica. Objetivo: Validar en España la herramienta de cribado nutricional pediátrico STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics). Métodos: Estudio descriptivo transversal en pacientes ingresados en un hospital pediátrico de tercer nivel con diferentes especialidades médicas y quirúrgicas. En las primeras 24 horas de ingreso se aplicó el método de cribado nutricional STAMP. Para la validación de sus resultados se llevó a cabo una valoración del estado nutricional que incluyó datos clínicos, antropométricos y de composición corporal realizada por personal especializado en nutrición. Resultados: Fueron estudiados 250 niños. La valoración nutricional detectó 64 pacientes (25,6%) considerados de riesgo, de los cuales 40 (16%) estaban ya malnutridos. STAMP clasificó un 48,4% de la muestra como de riesgo nutricional elevado. Dicho método mostró una sensibilidad del 75% y una especificidad del 60,8% para identificar los pacientes considerados de riesgo en la valoración nutricional, y una sensibilidad del 90% y especificidad del 59,5% para detectar los malnutridos. Comentarios: La frecuencia de malnutrición fue algo inferior a la de otros países de nuestro entorno, aunque el método diagnóstico fue diferente. El método STAMP es una herramienta sencilla y útil para el cribado nutricional, que evitaría la necesidad de valorar a todos los pacientes al ingreso para detectar los sujetos de riesgo.
Introducción: La malnutrición en los pacientes hospitalizados tiene implicaciones clínicas y evolutivas, por lo que existe interés en desarrollar métodos de cribado que identifiquen los individuos de ...riesgo. En la actualidad no existe consenso acerca de la herramienta de cribado nutricional más apropiada para aplicar en población pediátrica. Objetivo: Validar en España la herramienta de cribado nutricional pediátrico STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics). Métodos: Estudio descriptivo transversal en pacientes ingresados en un hospital pediátrico de tercer nivel con diferentes especialidades médicas y quirúrgicas. En las primeras 24 horas de ingreso se aplicó el método de cribado nutricional STAMP. Para la validación de sus resultados se llevó a cabo una valoración del estado nutricional que incluyó datos clínicos, antropométricos y de composición corporal realizada por personal especializado en nutrición. Resultados: Fueron estudiados 250 niños. La valoración nutricional detectó 64 pacientes (25,6%) considerados de riesgo, de los cuales 40 (16%) estaban ya malnutridos. STAMP clasificó un 48,4% de la muestra como de riesgo nutricional elevado. Dicho método mostró una sensibilidad del 75% y una especificidad del 60,8% para identificar los pacientes considerados de riesgo en la valoración nutricional, y una sensibilidad del 90% y especificidad del 59,5% para detectar los malnutridos. Comentarios: La frecuencia de malnutrición fue algo inferior a la de otros países de nuestro entorno, aunque el método diagnóstico fue diferente. El método STAMP es una herramienta sencilla y útil para el cribado nutricional, que evitaría la necesidad de valorar a todos los pacientes al ingreso para detectar los sujetos de riesgo.Background: Malnutrition among hospitalized patients has clinical implications, and interest has arisen to find screening tools able to identify subjects under risk. At present, there is no consensus about the most suitable nutrition screening tool for pediatric patients. Aim: To validate STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics) pediatric screening tool in Spain. Methods: Descriptive cross-sectional study of patients admitted to a 3rd level children's hospital with both medical and surgical specialities. During the first 24 hours of admission, STAMP screening tool was applied. For its validation, results were compared with those obtained from a nutritional assessment performed by specialist staff, which included clinical, anthropometric and body composition data. Results: A sample of 250 children was studied. Nutritional assessment identified 64 patients (25.6%) under risk, 40 of whom were malnourished (16%). STAMP classified 48.4% of the patients as being under nutritional risk. This tool showed 75% sensitivity and 60.8% specificity when identifying patients under risk according to nutritional assessment. It showed 90% sensitivity and 59.5% specificity when identifying malnourished patients. Comments: Malnutrition was less frequent than that reported in other European countries, although diagnosis technique was different. STAMP is a simple and useful tool for nutritional screening, avoiding the need to assess all patients on admission in order to identify those under nutritional risk.
Aim: To evaluate the effect of supplementing a hypocaloric diet with mandarin juice, a food with a high content of antioxidants (vitamin C, flavonoids and carotenoids), on biomarkers of ...oxidant/antioxidant status of severe obese children.
Methods: Forty obese children were randomized into two groups pair‐wise in a 4‐week controlled intervention study. Both groups followed a hypocaloric diet. One group received additionally a supplementation of 500 mL of 100% mandarin juice daily. Clinical data, anthropometry, dietary intake and fasting blood samples were collected at baseline and after the intervention. Lipid peroxidation was assessed by circulating levels of malondialdehyde, and protein oxidation was determined by the concentration of plasma carbonyl groups. The antioxidant defence was evaluated by red cell‐reduced glutathione and plasma levels of α‐tocopherol and vitamin C.
Results: The supplemented group experienced a decrease in the levels of malondialdehyde (−9.6%, p = 0.014) and carbonyl groups (−36.1%, p = 0.006) and an increase in antioxidants (α‐tocopherol +16.1%, p = 0.006, glutathione +36.1%, p < 0.0001, and vitamin C + 94.6%, p < 0.0001).
Conclusion: The mandarin juice consumption with a reduced calorie diet positively affects the antioxidant defence and produces a decrease in biomarkers of oxidative stress in obese children.
BackgroundBelimumab (BLM) is a monoclonal antibody that inhibits B-lymphocyte stimulating factor (BlyS) approved as a specific treatment for systemic lupus erythematosus (SLE) in 2011. We present the ...experience with BLM in a Spanish cohort with more than 460 patients.ObjectivesTo describe demographic characteristics, efficacy and safety of BLM in patients with SLE in Spanish population since its approval.MethodsDescriptive, retrospective, multicenter study in patients diagnosed with SLE according to EULAR/ACR 2019, SLICC and/or ACR 1997 diagnostic criteria. Data regarding SLE patients treated with BLM were collected from medical records (2011-2022). Demographic features, efficacy, laboratory variables, SLEDAI, renal involvement, steroid dose, administration routes and safety were assessed. To see whether a trend in BLM prescription had changed or not over time, two periods of time were analyzed: 2011-2016 (period1) and 2017-2022 (period2).ResultsBaseline characteristics of patients are summarized in Table 1.A total of 462 patients (36 hospitals) were included, 50.9% were on intravenous (IV), 34% on subcutaneous (SC) and 15.1% switched from IV to SC route. The median number of pre-BLM csDMARD use was 2.0 (2.0-3.0), being hydroxychloroquine (HCQ) the most frequently used (94.5%). Fifty-two patients were treated with IV cyclophosphamide with a median of 6 bolus received. At the time of BLM start, 443 patients were on prednisone with a median dose of 6.2 mg (5.0-10.0). Significant decreases in prednisone dose, SLEDAI and anti-DNA antibodies were observed from baseline until the last visit, whereas complement C3 and C4 values raised (Figure 1). A total of 118 patients (27.4%) had renal involvement with a median proteinuria of 1.0 g/day (0.5-2.4). Renal biopsy was done in 102 out of 118 patients, being class IV (33%), class III (21%) and class V (16%) the most frequently reported. After BLM, 73.3% of these patients improved (median proteinuria of 0.2 g/day (0.1-0.7).In period1, 100 patients started BLM compared to 362 in period2. The median time from SLE diagnosis to BLM begin was 7.1 (4.0-13.7) and 6.2 (2.1 -14.4) years in period1 and period2, respectively (p=0.454). We found a trend to use more csDMARD before BLM treatment in period1: 2.5 (2-3) vs. 2 (2-3) (p=0.088).A total of 143 (30.5%) patients discontinued treatment mostly due to inefficacy (55.9%) and infections (11.9%). In fact, 116 patients developed infections, mostly mild; 2 patients died, 16 had COVID-19 and 4 patients developed tumors requiring discontinuation of the drug.ConclusionIn our cohort of SLE patients in a real-world setting, BLM has been effective, safe and seems to be a good choice to treat renal involvement.References1Navarra SV, Guzmán RM, Gallacher AE, et al. Lancet. 2011;377(9767):721-31.2Stohl W, Hiepe; rt al. Arthritis Rheum. 2012;64(7):2328-37.3Furie R, Rovin BH, Houssiau F, et al. N Engl J Med. 2020;383(12):1117-1128.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
Pertuzumab combined with trastuzumab and docetaxel is the standard first-line therapy for HER2-positive metastatic breast cancer, based on results from the phase III CLEOPATRA trial. PERUSE was ...designed to assess the safety and efficacy of investigator-selected taxane with pertuzumab and trastuzumab in this setting.
In the ongoing multicentre single-arm phase IIIb PERUSE study, patients with inoperable HER2-positive advanced breast cancer (locally recurrent/metastatic) (LR/MBC) and no prior systemic therapy for LR/MBC (except endocrine therapy) received docetaxel, paclitaxel or nab-paclitaxel with trastuzumab 8mg/kg loading dose, then 6mg/kg every 3weeks (q3w) and pertuzumab (840mg loading dose, then 420mg q3w) until disease progression or unacceptable toxicity. The primary end point was safety. Secondary end points included overall response rate (ORR) and progression-free survival (PFS).
Overall, 1436 patients received at least one treatment dose (initially docetaxel in 775 patients, paclitaxel in 589, nab-paclitaxel in 65; 7 discontinued before starting taxane). Median age was 54years; 29% had received prior trastuzumab. Median treatment duration was 16months for pertuzumab and trastuzumab and 4months for taxane. Compared with docetaxel-containing therapy, paclitaxel-containing therapy was associated with more neuropathy (all-grade peripheral neuropathy 31% versus 16%) but less febrile neutropenia (1% versus 11%) and mucositis (14% versus 25%). At this preliminary analysis (52 months’ median follow-up), median PFS was 20.6 95% confidence interval (CI) 18.9–22.7 months overall (19.6, 23.0 and 18.1months with docetaxel, paclitaxel and nab-paclitaxel, respectively). ORR was 80% (95% CI 78%–82%) overall (docetaxel 79%, paclitaxel 83%, nab-paclitaxel 77%).
Preliminary findings from PERUSE suggest that the safety and efficacy of first-line pertuzumab, trastuzumab and taxane for HER2-positive LR/MBC are consistent with results from CLEOPATRA. Paclitaxel appears to be a valid alternative taxane backbone to docetaxel, offering similar PFS and ORR with a predictable safety profile.
NCT01572038.
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