The role of continuous renal replacement therapy (CRRT) has been expanding beyond support for acute kidney injury (AKI) in recent years. Children with malignancy are particularly at risk of ...developing conditions that may require CRRT. We reported three children with malignancy who received CRRT for non-AKI indications. Patient 1 was a 17-year-old teenage girl who developed refractory type B lactic acidosis due to relapse of acute lymphoblastic leukemia (ALL). Her peak lactate level was 18 mmol/L, and the lowest pH and bicarbonate level was 7.13 and 6.0 mmol/L, respectively. She received three sessions of high-volume hemodiafiltration to bring down the lactate level. Patient 2 was a 15-year-old male with T-cell ALL who developed cytokine storm requiring mechanical ventilatory and high-dose inotropic support due to necrotizing enterocolitis complicated by pneumoperitoneum and Klebsiella pneumoniae septicemia. He received two sessions of hemoperfusion using a specific filter capable of endotoxin absorption and cytokine removal and was successfully weaned off all inotropes after the treatment. Patient 3 was an 8-year-old boy who received bone marrow transplantation and developed worsening hyperbilirubinemia and deteriorating liver function. He received a session of single-pass albumin dialysis for bilirubin removal prior to liver biopsy. Except for mild electrolyte disturbances, no major CRRT complication was encountered. Our report demonstrated that CRRT is an effective and safe procedure for a wide spectrum of nonrenal conditions among children with oncological diagnoses in the pediatric intensive care unit. However, the optimal dose, regime, timing of initiation, and monitoring target for these indications remain to be determined.
We evaluated the acceptability of an additional ad hoc influenza vaccination among the health care professionals following seasons with significant antigenic drift.Self-administered, anonymous ...surveys were performed by hard copy questionnaires in public hospitals, and by an on-line platform available to all healthcare professionals, from April 1st to May 31st, 2015. A total of 1290 healthcare professionals completed the questionnaires, including doctors, nurses, and allied health professionals working in both the public and private systems.Only 31.8% of participating respondents expressed an intention to receive the additional vaccine, despite that the majority of them agreed or strongly agreed that it would bring benefit to the community (88.9%), save lives (86.7%), reduce medical expenses (76.3%), satisfy public expectation (82.8%), and increase awareness of vaccination (86.1%). However, a significant proportion expressed concern that the vaccine could disturb the normal immunization schedule (45.5%); felt uncertain what to do in the next vaccination round (66.0%); perceived that the summer peak might not occur (48.2%); and believed that the summer peak might not be of the same virus (83.5%). Furthermore, 27.8% of all respondents expected that the additional vaccination could weaken the efficacy of previous vaccinations; 51.3% was concerned about side effects; and 61.3% estimated that there would be a low uptake rate. If the supply of vaccine was limited, higher priority groups were considered to include the elderly aged ≥65 years with chronic medical conditions (89.2%), the elderly living in residential care homes (87.4%), and long-stay residents of institutions for the disabled (80.7%). The strongest factors associated with accepting the additional vaccine included immunization with influenza vaccines in the past 3 years, higher perceived risk of contracting influenza, and higher perceived severity of the disease impact.The acceptability to an additional ad hoc influenza vaccination was low among healthcare professionals. This could have a negative impact on such additional vaccination campaigns since healthcare professionals are a key driver for vaccine acceptance. The discordance in perceived risk and acceptance of vaccination regarding self versus public deserves further evaluation.
Background
Influenza imposes substantial healthcare burden in children, which can be prevented by vaccination. Influenza vaccination coverage varies widely among childhood populations worldwide, ...which has significant impact on herd immunity and usefulness of influenza vaccine. However, there are limited real‐life data on influenza vaccine effectiveness (VE) in children.
Objective
This prospective study aimed to investigate clinical spectrum of childhood influenza and VE in preventing influenza in Hong Kong children.
Methods
A total of 623 children were recruited from 15 kindergartens and primary schools. Parents completed a questionnaire on subjects’ health and influenza vaccination history. Flocked nasopharyngeal swabs (FNPSs) were collected in biweekly school visits during 2014‐2015 influenza seasons. Influenza A and B viruses were detected and typed by molecular assays.
Results
A total of 2633 FNPS samples were collected, with two or more samples being obtained from 607 (97.4%) of subjects. Thirty‐six (11.2%) subjects had influenza A or B in 2014, whereas all 19 (6.3%) subjects identified in 2015 had influenza A. Ninety‐nine subjects reported influenza‐like illness (ILI), and nine illness visits were arranged. Influenza vaccination was protective against ILI but not mild laboratory‐confirmed influenza by surveillance. Moderate overall influenza VE of 42%‐52% was observed for ILI, and subgroup analyses showed much higher VE for both ILI (70.9% vs 34.6%) and mild laboratory‐confirmed influenza (44.0% vs −6.2%) in school‐age children than preschoolers who were vaccinated within 12 months.
Conclusions
Mild laboratory‐confirmed influenza infection is common in children during influenza seasons. Influenza vaccination is effective against ILI but not mild infection identified by surveillance.
ABSTRACT
Importance
Pediatric palliative care (PPC) has gained great attention in western countries, however data on Hong Kong children receiving PPC are limited. There are gaps in knowledge about ...the PPC needs in local children with cancer.
Objective
To assess the current situation of PPC service of Hong Kong children with cancer.
Methods
We performed a 10‐year retrospective review in a tertiary pediatric oncology unit and studied the referral pattern, clinical characteristics and services provided.
Results
Totally 117 children were referred to PPC Team which constituted 65% deceased children within the study period. The commonest diagnoses were central nervous system tumour (32.5%), leukaemia (25.6%) and neuroblastoma (9.4%). Ninety‐one percent of children were referred after the last relapse or stopping curative treatment. The median time of referral to death was 77 days interquartile range (IQR): 35, 182. The median number of hospital admission after referral was 2 (IQR: 1, 5), with a median of 27 days total hospital stay (IQR: 10, 60). The reasons for admission were palliative chemotherapy (16.1%), pain control (12.1%) and platelet transfusion (11.2%). For the death episode, the median duration of hospital stay was 15 days (IQR: 2, 46). Most patients received oxygen (82.0%), intravenous fluid (81.2%) and intravenous analgesic (52.1%). A total of 111 (94.9%) children died in hospital, 15 had been admitted into intensive care unit (ICU) but only 5 (4.5%) died in ICU.
Interpretation
Pain control and platelet transfusion were common reasons of readmission. Death in ICU and at home was uncommon in Hong Kong situation.
Introduction: Compared with young children who have acute lymphoblastic leukaemia (ALL), adolescents with ALL have unfavourable disease profiles and worse survival. However, limited data are ...available regarding the characteristics and outcomes of adolescents with ALL who underwent treatment in clinical trials. The aim of this study was to investigate the causes of treatment failure in adolescents with ALL. Methods: We retrospectively analysed the outcomes of 711 children with ALL, aged 1-18 years, who were enrolled in five clinical trials of paediatric ALL treatment between 1993 and 2015. Results: Among the 711 children with ALL, 530 were young children (1-9 years at diagnosis) and 181 were adolescents (including 136 younger adolescents 10-14 years and 45 older adolescents 15-18 years). Compared with young children who had ALL, adolescents with ALL were less likely to have favourable genetic features and more likely to demonstrate poor early response to treatment. The 10-year overall survival and event-fr
Importance
131I‐metaiodobenzylguanidine (131I‐mIBG) has a significant targeted antitumor effect for neuroblastoma. However, currently there is a paucity of data for the use of 131I‐mIBG as a ...“front‐line” therapeutic agent in those patients with newly diagnosed high‐risk neuroblastoma as part of the conditioning regimen for myeloablative chemotherapy (MAC).
Objective
To evaluate the feasibility of upfront consolidation treatment with 131I‐mIBG plus MAC and hematopoietic stem cell transplantation (HSCT) in high‐risk neuroblastoma patients.
Methods
A retrospective, single‐center study was conducted from 2003–2019 on newly diagnosed high‐risk neuroblastoma patients without progressive disease (PD) after the completion of induction therapy. They received 131I‐mIBG infusion and MAC followed by HSCT.
Results
A total of 24 high‐risk neuroblastoma patients were enrolled with a median age of 3.0 years at diagnosis. After receiving this sequential consolidation treatment, 3 of 13 patients who were in partial response (PR) before 131I‐mIBG treatment achieved either complete response (CR) (n = 1) or very good partial response (VGPR) (n = 2) after HSCT. With a median follow‐up duration of 13.0 months after 131I‐mIBG therapy, the 5‐year event‐free survival and overall survival rates estimated were 29% and 38% for the entire cohort, and 53% and 67% for the patients who were in CR/VGPR at the time of 131I‐mIBG treatment.
Interpretation
Upfront consolidation treatment with 131I‐mIBG plus MAC and HSCT is feasible and tolerable in high‐risk neuroblastoma patients, however the survival benefit of this 131I‐mIBG regimen is only observed in the patients who were in CR/VGPR at the time of 131I‐mIBG treatment.
Upfront consolidation treatment with 131I‐mIBG plus myeloablative chemotherapy (MAC) and hematopoietic stem cell transplantation (HSCT) is feasible in high‐risk neuroblastoma patients, and the better survival benefit of this 131I‐mIBG regimen is observed in the patients who were in complete response (CR)/very good partial response (VGPR) at the time of 131I‐mIBG treatment.
Malignant pigmented clear cell epithelioid cell tumor of the kidney is a rare variant of perivascular epithelioid cells tumors (PEComa) or epithelioid angiomyolipoma (AML). PEComa is ...characteristically composed purely of epitheloid cells. The fat cells and the blood vessels that are typical of classic AML are absent. Most epithelioid AML cases are benign; however, malignant epithelioid AML of the kidney has been occasionally reported in adults in association with tuberous sclerosis. We report the radiological-pathological features of a malignant pigmented clear cell epithelioid renal tumor in a 15-year-old boy presenting with extensive metastases but without clinical evidence of tuberous sclerosis.
Background
Primitive neuroectodermal tumours (PNETs) constitute a family of neoplasms of presumed neuroectodermal origin that predominantly present as bone or soft-tissue masses in adolescents and ...young adults. PNET arising in the kidney is rare.
Objective
To describe the radiological features in three patients with primary renal PNET.
Materials and methods
The radiological features of primary renal PNET in three adolescent patients (age 10, 14 and 16 years) are described.
Results
Tumour thrombus extending into the renal vein and inferior vena cava was noted in all three patients. In addition, further tumour extension into the atrium was seen in two patients with extension into a pulmonary artery in one patient. Neural foraminal and intraspinal extension close to the origin of the tumour was identified in two patients. Liver, bone and lung metastases were identified.
Conclusion
While rare, one should consider the diagnosis of PNET when encountering a renal mass with aggressive features such as inferior vena cava tumour thrombus, direct intraspinal invasion and distant metastasis.
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