19 results on '"Smolka V"'
Search Results
2. The Sclerosing Cholangitis Outcomes in Pediatrics (SCOPE) Index: A Prognostic Tool for Children
- Author
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Deneau, M.R. Mack, C. Perito, E.R. Ricciuto, A. Valentino, P.L. Amin, M. Amir, A.Z. Aumar, M. Auth, M. Broderick, A. DiGuglielmo, M. Draijer, L.G. Tavares Fagundes, E.D. El-Matary, W. Ferrari, F. Furuya, K.N. Gupta, N. Hochberg, J.T. Homan, M. Horslen, S. Iorio, R. Jensen, M.K. Jonas, M.M. Kamath, B.M. Kerkar, N. Kim, K.M. Kolho, K.-L. Koot, B.G.P. Laborda, T.J. Lee, C.K. Loomes, K.M. Martinez, M. Miethke, A. Miloh, T. Mogul, D. Mohammad, S. Mohan, P. Moroz, S. Ovchinsky, N. Palle, S. Papadopoulou, A. Rao, G. Rodrigues Ferreira, A. Sathya, P. Schwarz, K.B. Shah, U. Shteyer, E. Singh, R. Smolka, V. Soufi, N. Tanaka, A. Varier, R. Vitola, B. Woynarowski, M. Zerofsky, M. Zizzo, A. Guthery, S.L.
- Abstract
Background and Aims: Disease progression in children with primary sclerosing cholangitis (PSC) is variable. Prognostic and risk-stratification tools exist for adult-onset PSC, but not for children. We aimed to create a tool that accounts for the biochemical and phenotypic features and early disease stage of pediatric PSC. Approach and Results: We used retrospective data from the Pediatric PSC Consortium. The training cohort contained 1,012 patients from 40 centers. We generated a multivariate risk index (Sclerosing Cholangitis Outcomes in Pediatrics [SCOPE] index) that contained total bilirubin, albumin, platelet count, gamma glutamyltransferase, and cholangiography to predict a primary outcome of liver transplantation or death (TD) and a broader secondary outcome that included portal hypertensive, biliary, and cancer complications termed hepatobiliary complications (HBCs). The model stratified patients as low, medium, or high risk based on progression to TD at rates of
- Published
- 2021
3. Ursodeoxycholic Acid Therapy in Pediatric Primary Sclerosing Cholangitis: Predictors of Gamma Glutamyltransferase Normalization and Favorable Clinical Course
- Author
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Deneau, M. Perito, E. Ricciuto, A. Gupta, N. Kamath, B.M. Palle, S. Vitola, B. Smolka, V. Ferrari, F. Amir, A.Z. Miloh, T. Papadopoulou, A. Mohan, P. Mack, C. Kolho, K.-L. Iorio, R. El-Matary, W. Venkat, V. Chan, A. Saubermann, L. Valentino, P.L. Shah, U. Miethke, A. Lin, H. Jensen, M.K.
- Abstract
Objective: To investigate patient factors predictive of gamma glutamyltransferase (GGT) normalization following ursodeoxycholic acid (UDCA) therapy in children with primary sclerosing cholangitis. Study design: We retrospectively reviewed patient records at 46 centers. We included patients with a baseline serum GGT level ≥50 IU/L at diagnosis of primary sclerosing cholangitis who initiated UDCA therapy within 1 month and continued therapy for at least 1 year. We defined “normalization” as a GGT level
- Published
- 2019
4. Gamma Glutamyltransferase Reduction Is Associated With Favorable Outcomes in Pediatric Primary Sclerosing Cholangitis
- Author
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Deneau, M.R. Mack, C. Abdou, R. Amin, M. Amir, A. Auth, M. Bazerbachi, F. Marie Broderick, A. Chan, A. DiGuglielmo, M. El-Matary, W. El-Youssef, M. Ferrari, F. Furuya, K.N. Gottrand, F. Gupta, N. Homan, M. Jensen, M.K. Kamath, B.M. Mo Kim, K. Kolho, K.-L. Konidari, A. Koot, B. Iorio, R. Martinez, M. Mohan, P. Palle, S. Papadopoulou, A. Ricciuto, A. Saubermann, L. Sathya, P. Shteyer, E. Smolka, V. Tanaka, A. Valentino, P.L. Varier, R. Venkat, V. Vitola, B. Vos, M.B. Woynarowski, M. Yap, J. Miloh, T.
- Subjects
digestive system ,digestive system diseases - Abstract
Adverse clinical events in primary sclerosing cholangitis (PSC) happen too slowly to capture during clinical trials. Surrogate endpoints are needed, but no such validated endpoints exist for children with PSC. We evaluated the association between gamma glutamyltransferase (GGT) reduction and long-term outcomes in pediatric PSC patients. We evaluated GGT normalization (< 50 IU/L) at 1 year among a multicenter cohort of children with PSC who did or did not receive treatment with ursodeoxycholic acid (UDCA). We compared rates of event-free survival (no portal hypertensive or biliary complications, cholangiocarcinoma, liver transplantation, or liver-related death) at 5 years. Of the 287 children, mean age of 11.4 years old, UDCA was used in 81% at a mean dose of 17 mg/kg/day. Treated and untreated groups had similar GGT at diagnosis (314 versus 300, P= not significant [NS]). The mean GGT was reduced at 1 year in both groups, with lower values seen in treated (versus untreated) patients (99 versus 175, P= 0.002), but 5-year event-free survival was similar (74% versus 77%, P= NS). In patients with GGT normalization (versus no normalization) by 1 year, regardless of UDCA treatment status, 5-year event-free survival was better (91% versus 67%, P< 0.001). Similarly, larger reduction in GGT over 1 year (> 75% versus < 25% reduction) was also associated with improved outcome (5-year event-free survival 88% versus 61%, P= 0.005). Conclusion:A GGT < 50 and/or GGT reduction of > 75% by 1 year after PSC diagnosis predicts favorable 5-year outcomes in children. GGT has promise as a potential surrogate endpoint in future clinical trials for pediatric PSC. © 2018 The Authors. Hepatology Communications published by Wiley Periodicals, Inc., on behalf of the American Association for the Study of Liver Diseases.
- Published
- 2018
5. The natural history of primary sclerosing cholangitis in 781 children: A multicenter, international collaboration
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Deneau, M.R. El-Matary, W. Valentino, P.L. Abdou, R. Alqoaer, K. Amin, M. Amir, A.Z. Auth, M. Bazerbachi, F. Broderick, A. Chan, A. Cotter, J. Doan, S. El-Youssef, M. Ferrari, F. Furuya, K.N. Gottrand, M. Gottrand, F. Gupta, N. Homan, M. Kamath, B.M. Kim, K.M. Kolho, K.-L. Konidari, A. Koot, B. Iorio, R. Ledder, O. Mack, C. Martinez, M. Miloh, T. Mohan, P. O'Cathain, N. Papadopoulou, A. Ricciuto, A. Saubermann, L. Sathya, P. Shteyer, E. Smolka, V. Tanaka, A. Varier, R. Venkat, V. Vitola, B. Vos, M.B. Woynarowski, M. Yap, J. Jensen, M.K.
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digestive system diseases - Abstract
There are limited data on the natural history of primary sclerosing cholangitis (PSC) in children. We aimed to describe the disease characteristics and long-term outcomes of pediatric PSC. We retrospectively collected all pediatric PSC cases from 36 participating institutions and conducted a survival analysis from the date of PSC diagnosis to dates of diagnosis of portal hypertensive or biliary complications, cholangiocarcinoma, liver transplantation, or death. We analyzed patients grouped by disease phenotype and laboratory studies at diagnosis to identify objective predictors of long-term outcome. We identified 781 patients, median age 12 years, with 4,277 person-years of follow-up; 33% with autoimmune hepatitis, 76% with inflammatory bowel disease, and 13% with small duct PSC. Portal hypertensive and biliary complications developed in 38% and 25%, respectively, after 10 years of disease. Once these complications developed, median survival with native liver was 2.8 and 3.5 years, respectively. Cholangiocarcinoma occurred in 1%. Overall event-free survival was 70% at 5 years and 53% at 10 years. Patient groups with the most elevated total bilirubin, gamma-glutamyltransferase, and aspartate aminotransferase-to-platelet ratio index at diagnosis had the worst outcomes. In multivariate analysis PSC–inflammatory bowel disease and small duct phenotypes were associated with favorable prognosis (hazard ratios 0.6, 95% confidence interval 0.5-0.9, and 0.7, 95% confidence interval 0.5-0.96, respectively). Age, gender, and autoimmune hepatitis overlap did not impact long-term outcome. Conclusion: PSC has a chronic, progressive course in children, and nearly half of patients develop an adverse liver outcome after 10 years of disease; elevations in bilirubin, gamma-glutamyltransferase, and aspartate aminotransferase-to-platelet ratio index at diagnosis can identify patients at highest risk; small duct PSC and PSC–inflammatory bowel disease are more favorable disease phenotypes. (Hepatology 2017;66:518–527). © 2017 by the American Association for the Study of Liver Diseases.
- Published
- 2017
6. Muscular dystrophies and myopathies: the spectrum of mutated genes in the Czech Republic
- Author
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Stehlíková, K., primary, Skálová, D., additional, Zídková, J., additional, Haberlová, J., additional, Voháňka, S., additional, Mazanec, R., additional, Mrázová, L., additional, Vondráček, P., additional, Ošlejšková, H., additional, Zámečník, J., additional, Honzík, T., additional, Zeman, J., additional, Magner, M., additional, Šišková, D., additional, Langová, M., additional, Gregor, V., additional, Godava, M., additional, Smolka, V., additional, and Fajkusová, L., additional
- Published
- 2016
- Full Text
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7. Two patients with clinically distinct manifestation of pyruvate dehydrogenase deficiency due to mutations in PDHA1 gene
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Martin Magner, Vinšová, K., Tesařová, M., Hájková, Z., Hansíková, H., Wenchich, L., Ješina, P., Smolka, V., Adam, T., Vaněčková, M., Zeman, J., and Honzík, T.
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Male ,Adolescent ,Blotting, Western ,Mutation ,Humans ,Pyruvate Dehydrogenase (Lipoamide) ,Sequence Analysis, DNA ,Child ,Pyruvate Dehydrogenase Complex Deficiency Disease - Abstract
The most common cause of pyruvate dehydrogenase complex (PDHc) deficiency is the deficit of the E1α-subunit. The aim of this study was to describe distinct course of the disease in two boys with mutations in PDHA1 gene and illustrate the possible obstacles in measurement of PDHc activity. Clinical data and metabolic profiles were collected and evaluated. PDHc and E1α-subunit activities were measured using radiometric assay. Subunits of PDHc were detected by Western blot. PDHA1 gene was analysed by direct sequencing. In patient 1, the initial hypotonia with psychomotor retardation was observed since early infancy. The child gradually showed symptoms of spasticity and arrest of psychomotor development. In patient 2, the disease manifested by seizures and hyporeflexia in the toddler age. The diagnosis was confirmed at the age of seven years after attacks of dystonia and clinical manifestation of myopathy with normal mental development. Brain MRI of both patients revealed lesions typical of Leigh syndrome. Enzymatic analyses revealed PDHc deficiency in isolated lymphocytes in the first but not in the second patient. The direct measurement of PDH E1-subunit revealed deficiency in this individual. In patient 1, a novel hemizigous mutation c.857CT (Pro250Leu) was detected in the X-linked PDHA1 gene. Mutation c.367CT (Arg88Cys) was found in patient 2. We present first two patients with PDHc deficit due to mutations in PDHA1 gene in the Czech Republic. We document the broad variability of clinical symptoms of this disease. We proved that normal PDHc activity may not exclude the disease.
8. Assessing the Validity of Adult-derived Prognostic Models for Primary Sclerosing Cholangitis Outcomes in Children
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Mansi Amin, Parvathi Mohan, Federica Ferrari, Achiya Z. Amir, Eyal Shteyer, Frédéric Gottrand, Matthew DiGuglielmo, Raghu Varier, Nitika A. Gupta, Kaija-Leena Kolho, Stephen L. Guthery, Veena Venkat, Pamela L. Valentino, Amanda Ricciuto, Mark Deneau, Cara L. Mack, Marek Woynarowski, Binita M. Kamath, Lawrence J. Saubermann, Bart G. P. Koot, Madeleine Aumar, Kyung Mo Kim, M.K. Jensen, Matjaz Homan, Bernadette Vitola, Wael El-Matary, Annemarie Broderick, Marcus Auth, Sirish Palle, Alexandra Papadopoulou, Mercedes Martinez, Vratislav Smolka, Raffaele Iorio, Tamir Miloh, Katryn N. Furuya, Laura G. Draijer, Atsushi Tanaka, Khaled Alqoaer, Pushpa Sathya, University of Helsinki, Children's Hospital, HUS Children and Adolescents, Graduate School, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, Amsterdam Reproduction & Development (AR&D), Paediatric Gastroenterology, Deneau, M. R., Valentino, P. L., Mack, C., Alqoaer, K., Amin, M., Amir, A. Z., Aumar, M., Auth, M., Broderick, A., Diguglielmo, M., Draijer, L. G., El-Matary, W., Ferrari, F., Furuya, K. N., Gottrand, F., Gupta, N., Homan, M., Jensen, M. K., Kamath, B. M., Kim, K. M., Kolho, K. -L., Koot, B., Iorio, R., Martinez, M., Miloh, T., Mohan, P., Palle, S., Papadopoulou, A., Ricciuto, A., Saubermann, L., Sathya, P., Shteyer, E., Smolka, V., Tanaka, A., Varier, R., Venkat, V., Vitola, B., Woynarowski, M., and Guthery, S.
- Subjects
Male ,risk stratification ,Autoimmune hepatitis ,Kaplan-Meier Estimate ,Pediatrics ,0302 clinical medicine ,Liver Function Tests ,3123 Gynaecology and paediatrics ,FIBROSIS ,Child ,RISK ,High prevalence ,Gastroenterology ,primary sclerosing cholangitis ,Prognosis ,3. Good health ,Natural history ,Hepatitis, Autoimmune ,natural history ,030220 oncology & carcinogenesis ,Predictive value of tests ,primary sclerosing cholangiti ,030211 gastroenterology & hepatology ,Female ,prognosi ,medicine.medical_specialty ,Cholangitis, Sclerosing ,MEDLINE ,Risk Assessment ,VALIDATION ,Primary sclerosing cholangitis ,CHOLANGIOCARCINOMA ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Prognostic models ,Hepatitis ,Models, Statistical ,business.industry ,Reproducibility of Results ,NATURAL-HISTORY ,medicine.disease ,PLATELET RATIO INDEX ,pediatric ,TRANSPLANT-FREE SURVIVAL ,AUTOIMMUNE HEPATITIS ,Pediatrics, Perinatology and Child Health ,business - Abstract
Background: Natural history models for primary sclerosing cholangitis (PSC) are derived from adult patient data, but have never been validated in children. It is unclear how accurate such models are for children with PSC. Methods: We utilized the pediatric PSC consortium database to assess the Revised Mayo Clinic, Amsterdam-Oxford, and Boberg models. We calculated the risk stratum and predicted survival for each patient within each model using patient data at PSC diagnosis, and compared it with observed survival. We evaluated model fit using the c-statistic. Results: Model fit was good at 1 year (c-statistics 0.93, 0.87, 0.82) and fair at 10 years (0.78, 0.75, 0.69) in the Mayo, Boberg, and Amsterdam-Oxford models, respectively. The Mayo model correctly classified most children as low risk, whereas the Amsterdam-Oxford model incorrectly classified most as high risk. All of the models underestimated survival of patients classified as high risk. Albumin, bilirubin, AST, and platelets were most associated with outcomes. Autoimmune hepatitis was more prevalent in higher risk groups, and over-weighting of AST in these patients accounted for the observed versus predicted survival discrepancy. Conclusions: All 3 models offered good short-term discrimination of outcomes but only fair long-term discrimination. None of the models account for the high prevalence of features of autoimmune hepatitis overlap in children and the associated elevated aminotransferases. A pediatric-specific model is needed. AST, bilirubin, albumin, and platelets will be important predictors, but must be weighted to account for the unique features of PSC in children.
- Published
- 2019
9. Ursodeoxycholic acid therapy in pediatric primary sclerosing cholangitis: predictors of gamma glutamyltransferase normalization and favorable clinical course
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Wael El-Matary, Lawrence J. Saubermann, Kaija-Leena Kolho, Federica Ferrari, Uzma Shah, Alexander Miethke, Raffaele Iorio, Cara L. Mack, Parvathi Mohan, Albert Chan, Binita M. Kamath, Amanda Ricciuto, Bernadette Vitola, Sirish Palle, Henry C. Lin, Emily R. Perito, Nitika A. Gupta, Veena Venkat, Achiya Z. Amir, Alexandra Papadopoulou, Vratislav Smolka, Tamir Miloh, Pamela L. Valentino, Mark Deneau, M. K. Jensen, Deneau, M., Perito, E., Ricciuto, A., Gupta, N., Kamath, B. M., Palle, S., Vitola, B., Smolka, V., Ferrari, F., Amir, A. Z., Miloh, T., Papadopoulou, A., Mohan, P., Mack, C., Kolho, K. -L., Iorio, R., El-Matary, W., Venkat, V., Chan, A., Saubermann, L., Valentino, P. L., Shah, U., Miethke, A., Lin, H., Jensen, M. K., Children's Hospital, Clinicum, Lastentautien yksikkö, and HUS Children and Adolescents
- Subjects
Male ,Time Factors ,MULTICENTER ,CHILDREN ,Disease ,Gastroenterology ,Severity of Illness Index ,Cohort Studies ,0302 clinical medicine ,Liver Function Tests ,3123 Gynaecology and paediatrics ,Fibrosis ,030212 general & internal medicine ,Treatment Failure ,Gamma-glutamyltransferase ,Child ,biology ,treatment ,Ursodeoxycholic Acid ,gamma-Glutamyltransferase ,cholestasi ,Ursodeoxycholic acid ,3. Good health ,Treatment Outcome ,Female ,medicine.drug ,Normalization (statistics) ,medicine.medical_specialty ,Adolescent ,Cholangitis, Sclerosing ,autoimmune ,cholestasis ,juvenile ,surrogate endpoint ,Article ,Primary sclerosing cholangitis ,03 medical and health sciences ,Cholestasis ,Predictive Value of Tests ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Analysis of Variance ,business.industry ,Surrogate endpoint ,NATURAL-HISTORY ,medicine.disease ,digestive system diseases ,ALKALINE-PHOSPHATASE ,Pediatrics, Perinatology and Child Health ,biology.protein ,business ,Biomarkers ,Follow-Up Studies - Abstract
OBJECTIVE: To investigate patient factors predictive of gamma glutamyltransferase (GGT) normalization following ursodeoxycholic acid (UDCA) therapy in children with primary sclerosing cholangitis. STUDY DESIGN: We retrospectively reviewed patient records at 46 centers. We included patients with a baseline serum GGT level ≥50 IU/L at diagnosis of primary sclerosing cholangitis who initiated UDCA therapy within 1 month and continued therapy for at least 1 year. We defined "normalization" as a GGT level
- Published
- 2019
10. Development and validation of a new drug-focused predictive risk score for postoperative delirium in orthopaedic and trauma surgery patients.
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Geßele C, Saller T, Smolka V, Dimitriadis K, Amann U, and Strobach D
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Acute Care Surgery, Medication Reconciliation methods, Retrospective Studies, Risk Assessment methods, Risk Factors, Wounds and Injuries surgery, Orthopedic Procedures adverse effects, Orthopedic Procedures methods, Emergence Delirium diagnosis, Emergence Delirium prevention & control
- Abstract
Background: Postoperative delirium (POD) is the most common complication following surgery in elderly patients. During pharmacist-led medication reconciliation (PhMR), a predictive risk score considering delirium risk-increasing drugs and other available risk factors could help to identify risk patients., Methods: Orthopaedic and trauma surgery patients aged ≥ 18 years with PhMR were included in a retrospective observational single-centre study 03/2022-10/2022. The study cohort was randomly split into a development and a validation cohort (6:4 ratio). POD was assessed through the 4 A's test (4AT), delirium diagnosis, and chart review. Potential risk factors available at PhMR were tested via univariable analysis. Significant variables were added to a multivariable logistic regression model. Based on the regression coefficients, a risk score for POD including delirium risk-increasing drugs (DRD score) was established., Results: POD occurred in 42/328 (12.8%) and 30/218 (13.8%) patients in the development and validation cohorts, respectively. Of the seven evaluated risk factors, four were ultimately tested in a multivariable logistic regression model. The final DRD score included age (66-75 years, 2 points; > 75 years, 3 points), renal impairment (eGFR < 60 ml/min/1.73m
2 , 1 point), anticholinergic burden (ACB-score ≥ 3, 1 point), and delirium risk-increasing drugs (n ≥ 2; 2 points). Patients with ≥ 4 points were classified as having a high risk for POD. The areas under the receiver operating characteristic curve of the risk score model were 0.89 and 0.81 for the development and the validation cohorts, respectively., Conclusion: The DRD score is a predictive risk score assessable during PhMR and can identify patients at risk for POD. Specific preventive measures concerning drug therapy safety and non-pharmacological actions should be implemented for identified risk patients., (© 2024. The Author(s).)- Published
- 2024
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11. Etiology and classification of acute pancreatitis in children admitted to ICU using the Pediatric Sequential Organ Failure Assessment (pSOFA) score.
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Smolka V, Rohanova M, Seda M, Karaskova E, Tkachyk O, Zapalka M, and Volejnikova J
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- Humans, Child, Organ Dysfunction Scores, Retrospective Studies, Acute Disease, Severity of Illness Index, Neoplasm Recurrence, Local, Prognosis, Intensive Care Units, Pancreatitis diagnostic imaging, Pancreatitis etiology
- Abstract
Background: Pediatric acute pancreatitis (AP) is rare but increasing. Severe AP is associated with higher morbidity and mortality. However, there are no universally accepted prognostic criteria for AP., Methods: This retrospective study included children with AP admitted to an intensive care unit (ICU) of our tertiary pediatric center between January 2009 and December 2018. The severity of organ dysfunction in AP was assessed according to the modified Atlanta criteria using the Pediatric Sequential Organ Failure Assessment (pSOFA) and Computed Tomography Severity Index (CTSI)., Results: Seventy acute episodes of AP were evaluated in 55 children with primary pancreatitis. In addition, secondary AP was diagnosed in 15 patients originally admitted to ICU for different indications. Mild AP [no organ dysfunction, normal computed tomography (CT) finding] was the most prevalent (64/85 episodes in 49 children), followed by moderate AP (15 children; pSOFA 2-9 points, CTSI 3-4 points on admission). Severe AP (pSOFA 4-17 points, CTSI 6-10 points) was diagnosed in 6 children with traumatic or secondary AP. The most frequent etiologies of primary AP episodes were idiopathic (39%) and biliary (31%). Children with idiopathic AP had frequent relapses and comorbidities. Hereditary AP was typically mild, but presented with high pancreatic enzyme levels and recurrence rates. Admission at ICU and an interval without enteral nutrition (EN) were relatively short in drug-induced AP and relatively long in secondary and traumatic AP. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 13 patients with biliary AP and in 4 patients with traumatic AP. No AP-related death was observed., Conclusion: pSOFA score accurately reflects the severity and prognosis of AP in children., (Copyright © 2022. Published by Elsevier B.V.)
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- 2023
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12. The Influence of Adherence to Orthosis and Physiotherapy Protocol on Functional Outcome after Proximal Humeral Fracture in the Elderly.
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Fleischhacker E, Gleich J, Smolka V, Neuerburg C, Böcker W, and Helfen T
- Abstract
In the treatment of proximal humeral fractures (PHF), patients are often recommended to wear a sling or orthosis and to perform physiotherapy. However, some patients, especially elderly ones, struggle to comply with these rehabilitation regimens. Therefore, the aim of the study was to evaluate whether these incompliant patients have a worse functional outcome than those who adhere to the rehabilitation protocol. After receiving a diagnosis of a PHF, patients were divided into four groups according to fracture morphology: conservative with sling, operative with sling, conservative with abduction orthosis, and operative with abduction orthosis. At the 6-week follow-up, compliance regarding brace use and physiotherapy performance were assessed, as well as the constant score (CS) and complications or revision surgeries. The CS as well as the complications and revision surgeries were also surveyed after one year. In 149 participants, with a mean age of 73.9 ± 7.2 years, only 37% terminated orthosis and only 49% underwent physiotherapy as recommended. The statistical analysis showed no significant difference in the CS, complications, and revision surgeries between the groups.
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- 2023
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13. Impact of Newborn Screening and Early Dietary Management on Clinical Outcome of Patients with Long Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency and Medium Chain Acyl-CoA Dehydrogenase Deficiency-A Retrospective Nationwide Study.
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Rücklová K, Hrubá E, Pavlíková M, Hanák P, Farolfi M, Chrastina P, Vlášková H, Kousal B, Smolka V, Foltenová H, Adam T, Friedecký D, Ješina P, Zeman J, Kožich V, and Honzík T
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- 3-Hydroxyacyl CoA Dehydrogenases deficiency, Cardiomyopathies epidemiology, Carnitine analogs & derivatives, Carnitine blood, Child, Child, Preschool, Czech Republic epidemiology, Female, Humans, Incidence, Infant, Infant, Newborn, Lipid Metabolism, Inborn Errors epidemiology, Male, Metabolism, Inborn Errors diagnosis, Mitochondrial Myopathies epidemiology, Nervous System Diseases epidemiology, Outcome Assessment, Health Care, Retrospective Studies, Rhabdomyolysis epidemiology, Severity of Illness Index, Acyl-CoA Dehydrogenase deficiency, Cardiomyopathies diagnosis, Cardiomyopathies diet therapy, Lipid Metabolism, Inborn Errors diagnosis, Lipid Metabolism, Inborn Errors diet therapy, Mitochondrial Myopathies diagnosis, Mitochondrial Myopathies diet therapy, Mitochondrial Trifunctional Protein deficiency, Neonatal Screening methods, Nervous System Diseases diagnosis, Nervous System Diseases diet therapy, Rhabdomyolysis diagnosis, Rhabdomyolysis diet therapy
- Abstract
Long chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD/MTPD) and medium chain acyl-CoA dehydrogenase deficiency (MCADD) were included in the expanded neonatal screening program (ENBS) in Czechia in 2009, allowing for the presymptomatic diagnosis and nutritional management of these patients. The aim of our study was to assess the nationwide impact of ENBS on clinical outcome. This retrospective study analysed acute events and chronic complications and their severity in pre-ENBS and post-ENBS cohorts. In total, 28 children (12 before, 16 after ENBS) were diagnosed with LCHADD/MTPD (incidence 0.8/100,000 before and 1.2/100,000 after ENBS). In the subgroup detected by ENBS, a significantly longer interval from birth to first acute encephalopathy was observed. In addition, improvement in neuropathy and cardiomyopathy (although statistically non-significant) was demonstrated in the post-ENBS subgroup. In the MCADD cohort, we included 69 patients (15 before, 54 after ENBS). The estimated incidence rose from 0.7/100,000 before to 4.3/100,000 after ENBS. We confirmed a significant decrease in the number of episodes of acute encephalopathy and lower proportion of intellectual disability after ENBS ( p < 0.0001). The genotype-phenotype correlations suggest a new association between homozygosity for the c.1528C > G variant and more severe heart involvement in LCHADD patients.
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- 2021
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14. Acute onset of autoimmune hepatitis in children and adolescents.
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Smolka V, Tkachyk O, Ehrmann J, Karaskova E, Zapalka M, and Volejnikova J
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- Acute Disease, Adolescent, Child, Child, Preschool, Female, Hepatitis, Autoimmune complications, Hepatitis, Autoimmune diagnosis, Humans, Immunosuppressive Agents therapeutic use, Liver Failure, Acute etiology, Male, Hepatitis, Autoimmune drug therapy
- Abstract
Background: Autoimmune hepatitis (AIH) is a rare progressive liver disease, which manifests as acute hepatitis in 40%-50% of pediatric cases. This refers predominantly to spontaneous exacerbations of previously unrecognized subclinical AIH with laboratory and histological signs of chronic hepatitis, or to acute exacerbations of known chronic disease. Only a few of these patients fulfill criteria for acute liver failure (ALF)., Methods: Forty children diagnosed with AIH in our center between 2000 and 2018 were included in this study. All of them fulfilled revised diagnostic criteria of the International Autoimmune Hepatitis Group (IAIHG) for probable or confirmed AIH, and other etiologies of liver diseases were excluded. Patients were divided into two groups: acute AIH (A-AIH) or chronic AIH (C-AIH)., Results: Acute onset of AIH occurred in 19/40 children (48%). Six of them fulfilled the criteria of ALF with coagulopathy and encephalopathy. Five of 6 children with ALF suffered from exacerbation of previously undiagnosed chronic AIH, among which 4 children were histologically confirmed as micronodular cirrhosis. The remaining one patient had fulminant AIH with centrilobular necrosis, but no histological signs of previous chronic liver damage. We observed significantly lower levels of albumin, higher levels of aminotransferases, bilirubin, INR, IgG, higher IAIHG score and more severe histological findings in A-AIH than in C-AIH. No differences in patient age and presence of autoantibodies were observed between A-AIH and C-AIH. All children, including those with ALF and cirrhosis, were treated with corticosteroids, and are alive and achieved AIH remission. Liver transplant was not indicated in any patient., Conclusion: Rapid and accurate diagnosis of A-AIH may be difficult. However, timely start of immunosuppressive therapy improves prognosis and decreases number of indicated liver transplantations in children with AIH., (Copyright © 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.)
- Published
- 2020
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15. Assessing the Validity of Adult-derived Prognostic Models for Primary Sclerosing Cholangitis Outcomes in Children.
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Deneau MR, Valentino PL, Mack C, Alqoaer K, Amin M, Amir AZ, Aumar M, Auth M, Broderick A, DiGuglielmo M, Draijer LG, El-Matary W, Ferrari F, Furuya KN, Gottrand F, Gupta N, Homan M, Jensen MK, Kamath BM, Kim KM, Kolho KL, Koot B, Iorio R, Martinez M, Miloh T, Mohan P, Palle S, Papadopoulou A, Ricciuto A, Saubermann L, Sathya P, Shteyer E, Smolka V, Tanaka A, Varier R, Venkat V, Vitola B, Woynarowski M, and Guthery S
- Subjects
- Child, Cholangitis, Sclerosing complications, Female, Hepatitis, Autoimmune complications, Hepatitis, Autoimmune mortality, Humans, Kaplan-Meier Estimate, Liver Function Tests methods, Male, Predictive Value of Tests, Prognosis, Reproducibility of Results, Cholangitis, Sclerosing mortality, Gastroenterology methods, Models, Statistical, Pediatrics methods, Risk Assessment methods
- Abstract
Background: Natural history models for primary sclerosing cholangitis (PSC) are derived from adult patient data, but have never been validated in children. It is unclear how accurate such models are for children with PSC., Methods: We utilized the pediatric PSC consortium database to assess the Revised Mayo Clinic, Amsterdam-Oxford, and Boberg models. We calculated the risk stratum and predicted survival for each patient within each model using patient data at PSC diagnosis, and compared it with observed survival. We evaluated model fit using the c-statistic., Results: Model fit was good at 1 year (c-statistics 0.93, 0.87, 0.82) and fair at 10 years (0.78, 0.75, 0.69) in the Mayo, Boberg, and Amsterdam-Oxford models, respectively. The Mayo model correctly classified most children as low risk, whereas the Amsterdam-Oxford model incorrectly classified most as high risk. All of the models underestimated survival of patients classified as high risk. Albumin, bilirubin, AST, and platelets were most associated with outcomes. Autoimmune hepatitis was more prevalent in higher risk groups, and over-weighting of AST in these patients accounted for the observed versus predicted survival discrepancy., Conclusions: All 3 models offered good short-term discrimination of outcomes but only fair long-term discrimination. None of the models account for the high prevalence of features of autoimmune hepatitis overlap in children and the associated elevated aminotransferases. A pediatric-specific model is needed. AST, bilirubin, albumin, and platelets will be important predictors, but must be weighted to account for the unique features of PSC in children.
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- 2020
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16. Gamma Glutamyltransferase Reduction Is Associated With Favorable Outcomes in Pediatric Primary Sclerosing Cholangitis.
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Deneau MR, Mack C, Abdou R, Amin M, Amir A, Auth M, Bazerbachi F, Marie Broderick A, Chan A, DiGuglielmo M, El-Matary W, El-Youssef M, Ferrari F, Furuya KN, Gottrand F, Gupta N, Homan M, Jensen MK, Kamath BM, Mo Kim K, Kolho KL, Konidari A, Koot B, Iorio R, Martinez M, Mohan P, Palle S, Papadopoulou A, Ricciuto A, Saubermann L, Sathya P, Shteyer E, Smolka V, Tanaka A, Valentino PL, Varier R, Venkat V, Vitola B, Vos MB, Woynarowski M, Yap J, and Miloh T
- Abstract
Adverse clinical events in primary sclerosing cholangitis (PSC) happen too slowly to capture during clinical trials. Surrogate endpoints are needed, but no such validated endpoints exist for children with PSC. We evaluated the association between gamma glutamyltransferase (GGT) reduction and long-term outcomes in pediatric PSC patients. We evaluated GGT normalization (< 50 IU/L) at 1 year among a multicenter cohort of children with PSC who did or did not receive treatment with ursodeoxycholic acid (UDCA). We compared rates of event-free survival (no portal hypertensive or biliary complications, cholangiocarcinoma, liver transplantation, or liver-related death) at 5 years. Of the 287 children, mean age of 11.4 years old, UDCA was used in 81% at a mean dose of 17 mg/kg/day. Treated and untreated groups had similar GGT at diagnosis (314 versus 300, P = not significant [NS]). The mean GGT was reduced at 1 year in both groups, with lower values seen in treated (versus untreated) patients (99 versus 175, P = 0.002), but 5-year event-free survival was similar (74% versus 77%, P = NS). In patients with GGT normalization (versus no normalization) by 1 year, regardless of UDCA treatment status, 5-year event-free survival was better (91% versus 67%, P < 0.001). Similarly, larger reduction in GGT over 1 year (> 75% versus < 25% reduction) was also associated with improved outcome (5-year event-free survival 88% versus 61%, P = 0.005). Conclusion: A GGT < 50 and/or GGT reduction of > 75% by 1 year after PSC diagnosis predicts favorable 5-year outcomes in children. GGT has promise as a potential surrogate endpoint in future clinical trials for pediatric PSC.
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- 2018
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17. Prospective study of hypothalamo-hypophyseal dysfunction in children and adolescents following traumatic brain injury.
- Author
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Krahulik D, Aleksijevic D, Smolka V, Klaskova E, Venhacova P, Vaverka M, Mihal V, and Zapletalova J
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- Adolescent, Brain Injuries, Traumatic physiopathology, Child, Child, Preschool, Diabetes Insipidus etiology, Diabetes Insipidus physiopathology, Female, Human Growth Hormone deficiency, Humans, Hypogonadism etiology, Hypogonadism physiopathology, Hypopituitarism etiology, Hypopituitarism physiopathology, Hypothalamic Diseases physiopathology, Hypothalamic Hormones metabolism, Hypothyroidism etiology, Hypothyroidism physiopathology, Inappropriate ADH Syndrome etiology, Inappropriate ADH Syndrome physiopathology, Magnetic Resonance Imaging, Male, Prospective Studies, Puberty, Precocious etiology, Puberty, Precocious physiopathology, Risk Factors, Time Factors, Brain Injuries, Traumatic complications, Hypothalamic Diseases etiology, Hypothalamo-Hypophyseal System physiology
- Abstract
Background and Aims: Retrospective studies of TBI have found a neuroendocrine dysfunction following traumatic brain injury in 23 to 60% of adults and 15 to 21% of children. Our aims were to determine the prevalence of hypothalamo-hypophyseal dysfunction in children following brain injury, assess its relationship to the type of injury and the course of the acute post-traumatic phase., Patients and Methods: Body development (growth, pubertal development, and skeletal maturity) were evaluated in 58 patients (21 girls) after a brain injury rated 3 to 12 on the Glasgow Coma Scale (GCS). The patients underwent standard endocrine tests - TSH, fT4, IGF-1, PRL, morning cortisol, FSH, LH, and testosterone in boys and estradiol in girls - in the early post-traumatic period (2 to 14 days; T0) and at 3, 6, and 12 months after the injury (T3, T6, and T12). Dynamic tests were carried out in patients with abnormalities in their clinical examination and/or laboratory results. An MRI was performed on all patients at T12., Results: The median age at the time of injury was 11.3 (0.5 to 18.7) years. Of the 58 patients, 23 had GCS < 8, corresponding to severe brain injury. At T0, diabetes insipidus (DI) was diagnosed in 12 patients, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was found in 4 patients. Frequent hormonal changes simulated central hypothyroidism (in 45% of patients) and hypogonadotropic hypogonadism (in 25% of adolescents who were already pubertal at the time of injury > Tanner II). Examination at T3 (n = 58) confirmed a combined pituitary hormone deficiency in two boys and DI in another one. At T6 (n = 49), hormonal dysfunctions were diagnosed in two boys (precocious puberty and growth hormone deficiency). At T12 (n = 39), a new endocrine dysfunction was diagnosed in five patients (growth hormone deficiency in two, hypogonadotropic hypogonadism in two, and in one patient, already diagnosed with a growth hormone deficiency, central hypothyroidism, as well). Brain MRI revealed an empty sella in two patients with growth hormone deficiency. Patients with GCS < 8 had more symptoms of SIADH or DI in the early post-traumatic period 11/23 vs. patients with GCS of 8 to 13 (4/35), and more frequent hormonal disorder (6/23) than individuals with moderate trauma (3/35), P = 0.0135. The incidence of endocrine dysfunction at T0 significantly correlated with the severity of injury (P = 0.05), but it was not an indicator for the development of a late hormonal disorder., Conclusion: Within a year after injury, a hormonal disorder was found in 17.6% of the patients. Neuroendocrine dysfunction as a late consequence of craniocerebral trauma in children and adolescents was less frequent than in adults. Risk factors for its development are the gravity of the injury, brain scan pathology, and possibly the development of DI, SIADH, or CSWS in the acute post-traumatic phase.
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- 2017
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18. Significant phenotype variability of congenital central hypoventilation syndrome in a family with polyalanine expansion mutation of the PHOX2B gene.
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Klaskova E, Drabek J, Hobzova M, Smolka V, Seda M, Hyjanek J, Slavkovsky R, Stranska J, and Prochazka M
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- Child, Preschool, Female, Humans, Hypoventilation genetics, Respiratory Insufficiency genetics, Homeodomain Proteins genetics, Hypoventilation congenital, Mutation genetics, Peptides genetics, Sleep Apnea, Central genetics, Transcription Factors genetics
- Abstract
Background: Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder resulting from mutations in the PHOX2B gene located on chromosome 4p12.3, characterized by hypoventilation secondary to missing responses to both hypercapnia and hypoxia., Case Report: Proband. A girl, hospitalised 5 times for respiratory failure from 6 weeks old, presented at 4 years of age severe cyanosis related to pneumonia. Tracheostomy was done, and she was discharged home using a portable positive pressure ventilator during sleep. Proband's father: The father was retrospectively found out to suffer from severe headache and excessive daytime sleepiness. Molecular genetic evaluation of PHOX2B gene was performed and casual polyalanine repeat expansion mutation c.741_755dup15 in exon 3 was found both in proband and her father in heterozygous form. The proband's grandmother died of respiratory failure after administration of benzodiazepine at the age of fifty years. Considering the grandmother's history, she is highly suspected of having had CCHS as well., Conclusion: Repeated respiratory failure of girl was explained by PHOX2B mutation and Ondina curse. Proband´s father has incompletely penetrated PHOX2B heterozygous mutation as well and proband´s grandmother died probably from the consequences of drug interaction with PHOX2B mutated background as well. Both daughter and father currently require overnight mechanical ventilatory support. Although most PHOX2B mutations occur de novo, our case is a rare three generation family affected by autosomal dominant inheritance with incomplete penetrance manifested as the late-form of CCHS and proven PHOX2B mutation in two generations.
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- 2016
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19. Long-term follow-up of children and adolescents with primary sclerosing cholangitis and autoimmune sclerosing cholangitis.
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Smolka V, Karaskova E, Tkachyk O, Aiglova K, Ehrmann J, Michalkova K, Konecny M, and Volejnikova J
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- Adolescent, Age Factors, Biomarkers blood, Child, Cholangitis, Sclerosing diagnosis, Cholangitis, Sclerosing drug therapy, Cholangitis, Sclerosing mortality, Czech Republic epidemiology, Disease Progression, End Stage Liver Disease epidemiology, Female, Follow-Up Studies, Hepatitis, Autoimmune diagnosis, Hepatitis, Autoimmune drug therapy, Hepatitis, Autoimmune mortality, Humans, Hypertension, Portal epidemiology, Immunoglobulin G blood, Immunosuppressive Agents therapeutic use, Incidence, Jaundice, Obstructive epidemiology, Kaplan-Meier Estimate, Male, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Factors, Time Factors, Cholangitis, Sclerosing epidemiology, Hepatitis, Autoimmune epidemiology
- Abstract
Background: Sclerosing cholangitis (SC) is a chronic cholestatic hepatobiliary disease with uncertain long-term prognosis in pediatric patients. This study aimed to evaluate long-term results in children with SC according to the types of SC., Methods: We retrospectively followed up 25 children with SC over a period of 4-17 years (median 12). The diagnosis of SC was based on biochemical, histological and cholangiographic findings. Patients fulfilling diagnostic criteria for probable or definite autoimmune hepatitis at the time of diagnosis were defined as having autoimmune sclerosing cholangitis (ASC); other patients were included in a group of primary sclerosing cholangitis (PSC). The incidence of the following complications was studied: obstructive cholangitis, portal hypertension, advanced liver disease and death associated with the primary disease., Results: Fourteen (56%) patients had PSC and 11 (44%) had ASC. Patients with ASC were significantly younger at the time of diagnosis (12.3 vs 15.4 years, P=0.032) and had higher IgG levels (22.7 vs 17.2 g/L, P=0.003). The mentioned complications occurred in 4 (16%) patients with SC, exclusively in the PSC group: one patient died from colorectal cancer, one patient underwent liver transplantation and two patients, in whom severe bile duct stenosis was present at diagnosis, were endoscopically treated for acute cholangitis. Furthermore, two other children with ASC and 2 children with PSC had elevated aminotransferase levels. The 10-year overall survival was 95.8% in all patients, 100% in patients without complicated liver disease, and 75.0% in patients with complications., Conclusion: In children, ASC is a frequent type of SC, whose prognosis may be better than that in patients with PSC.
- Published
- 2016
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