76 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. VÝSLEDKY KAROTICKÉHO STENTOVÁNÍ PŘI RUTINNÍM TESTOVÁNÍ ÚČINNOSTI PROTIDESTIČKOVÉ LÉČBY.
- Author
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Vigláš, P., Smolka, V., Raupach, J., Hejčl, A., Černík, D., and Cihlář, F.
- Abstract
Cíl: Cílem práce je analýza výsledků karotického stentování u našeho souboru pacientů rutinně testovaných na účinnost protidestičkové terapie. Srovnáváme výsledky s daty z rando-mizovaných kontrolovaných studií. Metodika: Retrospektivní analýza výsledku elektivního stentování karotické tepny na Radiologické klinice Masarykovy nemocnice v Ústí nad Labem v letech 2014-2022. Stentování karotické tepny podstoupilo 241 pacientů, kteří nebyli vhodní pro chirurgické ošetření. Soubor konsekutivních pacientů je specifický nastavením účinné protidestičkové léčby před výkonem. Sledované obdobíje do 30 dnů od výkonu. Výsledky: Bylo ošetřeno 179 mužů (74,2 %) a 62 žen (25,8 %). Pět pacientů (2,0 %) ve sledovaném období utrpělo cévní mozkovou příhodu (CMP) v souvislosti s výkonem, dva (0,8 %) zemřeli na komplikaci přímo spojenou s výkonem. Tři pacienti zemřeli na příčinu nesouvisející s intervencí (1,2 %). Nesetkali jsme se s infarktem myokardu. V celém souboru bylo riziko smrti nebo vzniku cévní mozkové příhody související s výkonem statisticky významně nižší ve srovnání s výsledky studie CREST (2,0 % vs. 4,8 %, p = 0,0243). V souboru sym-ptomatických pacientů bylo riziko smrti nebo cévní mozkové příhody související s výkonem významně nižší ve srovnání se studií ICSS (2,9 % vs. 7,4 %, p = 0,0243). Závěr: V našem souboru pacientů nevhodných k chirurgickému ošetření karotické stenózy jsme hodnotili vliv účinné protidestičkové terapie na výsledek léčby karotickým stentem. Riziko periprocedurální smrti či CMP bylo statisticky signifikantně nižší než ve studiích CREST a ICSS. Výsledky prokazují, že rutinní testování protidestičkové léčby je bezpečné a může snižovat riziko vzniku CMP a periprocedurální smrti. [ABSTRACT FROM AUTHOR]
- Published
- 2024
4. Ursodeoxycholic Acid Therapy in Pediatric Primary Sclerosing Cholangitis: Predictors of Gamma Glutamyltransferase Normalization and Favorable Clinical Course
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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
5. Gamma Glutamyltransferase Reduction Is Associated With Favorable Outcomes in Pediatric Primary Sclerosing Cholangitis
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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.
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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
6. 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
7. EFFICACY AND SAFETY OF SEBELIPASE ALFA IN CHILDREN AND ADULTS WITH LYSOSOMAL ACID LIPASE DEFICIENCY: RESULTS OF A PHASE 3 TRIAL
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Deegan, P., Murphy, E., Rahman, Y., Ezgu, FATİH SÜHEYL, Coker, M., Camarena Grande, C., Valayannopoulos, V., Rojas-Caro, S., Smolka, V., Quinn, A., Yang, Y., Schwab, K. O., Scarpa, M., Taybert, J., Pastor Rosado, J., Mengel, E., Malinova, V., Feillet, F., DiRocco, M., and Baric, I.
- Published
- 2015
8. Muscular dystrophies and myopathies: the spectrum of mutated genes in the Czech Republic
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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
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- 2016
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9. Efficacy and safety of sebelipase alfa in children and adults with Lysosomal Acid Lipase Deficiency: results of a phase 3 trial
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Rojas-Caro, S., primary, Balwani, M., additional, Bialer, M., additional, Grande, C. Camarena, additional, Sanchez, A. Consuelo, additional, Ezgu, F.Suheyl, additional, Kostyleva, M., additional, Laukaitis, C., additional, Malinová, V., additional, Neilan, E., additional, Peters, H., additional, Rahman, Y., additional, Scarpa, M., additional, Smolka, V., additional, Taybert, J., additional, Valayannopoulos, V., additional, Zenia, M., additional, Yang, Y., additional, Eckert, S., additional, and Quinn, A., additional
- Published
- 2015
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10. P1211 : Efficacy and safety of sebelipase alfa in children and adults with lysosomal acid lipase deficiency: Results of a phase 3 trial
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Rojas-Caro, S., primary, Baric, I., additional, Camarena Grande, C., additional, Coker, M., additional, Deegan, P., additional, DiRocco, M., additional, Ezgu, F.S., additional, Feillet, F., additional, Malinova, V., additional, Mengel, E., additional, Murphy, E., additional, Pastor Rosado, J., additional, Rahman, Y., additional, Scarpa, M., additional, Schwab, K.O., additional, Smolka, V., additional, Taybert, J., additional, Valayannopoulos, V., additional, Yang, Y., additional, and Quinn, A., additional
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- 2015
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11. Efficacy and safety of sebelipase alfa in children and adults with Lysosomal Acid Lipase Deficiency: results of a phase 3 trial
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EZGÜ, FATİH SÜHEYL, Consuelo Sanchez, A., Rojas-Caro, S., Quinn, A., Kostyleva, M., Balwani, M., Camarena Grande, C., Laukaitis, C., Malinova, V., Neilan, E., Peters, H., Rahman, Y., Scarpa, M., Valayannopoulos, V., Smolka, V., Eckert, S., Taybert, J., Yang, Y., Zenia, M., and Bialer, M.
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Cardiology and Cardiovascular Medicine - Published
- 2015
12. P-088: Posterior reversible encephalopathy syndrome (PRES) as a side effect of biological treatment of IBD in children
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Karaskova, E., primary, Vydra, D., additional, Véghová-Velgánová, M., additional, Smolka, V., additional, Klásková, E., additional, and Michálková, K., additional
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- 2014
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13. [Molecular analysis of Wilson disease]
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Vrábelová S, Vánová P, Kopecková L, Trunecka P, Smolka V, Procházková D, Vejvalková S, Suláková A, Kupcová V, Bzdúch V, and Kozák L
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Adenosine Triphosphatases ,Adult ,Male ,Polymorphism, Genetic ,Adolescent ,Gene Frequency ,Hepatolenticular Degeneration ,Copper-Transporting ATPases ,Sequence Analysis, Protein ,Child, Preschool ,Humans ,Point Mutation ,Female ,Child ,Cation Transport Proteins ,Copper - Abstract
Wilson disease is an autosomal recessive disorder, characterized by cooper accumulation and intoxication of the organism. Molecular basis of the disease represent mutations in the gene for the copper-transporting ATPase (ATP7B).The submitted paper deals with results of molecular-genetic examination in 130 unrelated families in which Wilson disease was diagnosed. By denaturing gradient gel electrophoresis (DGGE), the exons with abnormal sequences were detected. Followed by sequencing, 17 causal mutations and 9 silent polymorphism were found. Five novel mutations were detected. After analysis of 260 mutant alleles, 214 (82.3%) were identified. The most frequent mutation, H1069Q, occurred in our population with the frequency of 65.8%. Incidence of other mutations, however, did not exceed 5%.DNA analysis of the Wilson disease offers prompt and reliable results in affected families. It can help to identify asymptomatic and heterozygote siblings at genetic counselling.
- Published
- 2003
14. [Metabolic complications and neurologic manifestations of vitamin B12 deficiency in children of vegetarian mothers]
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Smolka V, Bekárek V, Hlídková E, Bucil J, Mayerová D, Skopková Z, Adam T, Hrubá E, Kozich V, Buriánková L, Saligová J, Buncová M, and Jiri Zeman
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Male ,Anemia, Megaloblastic ,Developmental Disabilities ,Diet, Vegetarian ,Brain ,Infant ,Mothers ,Vitamin B 12 Deficiency ,Magnetic Resonance Imaging ,Failure to Thrive ,Breast Feeding ,Humans ,Muscle Hypotonia ,Female ,Infant Nutritional Physiological Phenomena ,Methylmalonic Acid - Abstract
Serious hematological, metabolic and neurological complications owing to the nutritional deficiency of vitamin B12 may occur in infants of mothers on a strict vegetarian diet.The mother of the first child was a strict vegetarian. She had an elevated urinary methylmalonic acid level and a low concentration of serum vitamin B12. Her 13-month-old daughter was exclusively breast-fed until the age of 9 month and then she was fed only vegetables. Physical examination revealed psychomotoric retardation, apathy, muscular hypotonia, abnormal movements and failure to thrive. Laboratory analysis showed a megaloblastic anaemia, a low level of vitamin B12 and methylmalonic aciduria. MRI of the brain revealed diffuse frontotemporoparietal atrophy and retardation of myelination. After treatment with vitamin B12 supplements, abnormal movements disappeared and development improved, but a mild generalised hypotonia continued. A cranial MRI 9 months after treatment still showed signs of retardation of myelination. The second patient, an 8 month-old male, son of a strict vegetarian mother too, was referred for investigation of psychomotoric retardation, hypotonia, dyskinesia, failure to thrive and microcephaly. He was breast-fed and from 6 month of age he had also received fruit juices. Laboratory analysis revealed megaloblastic anaemia, high methylmalonic aciduria and homocystinuria. The patient's and his mother's serum level of vitamin B12 were low. After treatment with vitamin B12 supplements, biochemical and metabolic markers of disease were normal but there continued a generalised hypotonia, microcephaly and language delay.Our observations emphasize the health complications of nutritional cobalamine deficiency and a requirement of clinical, biochemical and metabolic monitoring in infants within strict vegetarian families.
- Published
- 2002
15. Single-shot Paravertebral blockade for postoperative analgesia after urologic surgery in children
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Berta, E., primary, Spanhel, J., additional, Gabrhelik, T., additional, Smakal, O., additional, and Smolka, V., additional
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- 2007
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16. Hyperbarická oxygenoterapie u pediatrických pacientů v Centru hyperbarické medicíny Ostrava v letech 2007-2011.
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Hájek, M., Slaný, J., Maršálková, J., Tichavská, J., Němcová, P., Lutzová, M., Neuwirtová, I., Spilková, Z., Ručková, M., Nogolová, A., Bártová, T., Duda, J., Smolka, V., Klásková, E., Hladík, M., Trávníček, B., Chmelař, D., Beran, V., Štěrba, J., and Kepák, T.
- Abstract
Copyright of Czecho-Slovak Pediatrics / Česko-Slovenská Pediatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2015
17. Kontrollierte Beatmung auf pädiatrischen Intensivstationen in der Tschechischen Republik
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Fedora, M., primary, Kroupová, L., additional, Košut, P., additional, Fanta, I., additional, Hrdlička, R., additional, Kobr, J., additional, Prchlík, M., additional, Smolka, V., additional, Vobruba, V., additional, Dominik, P., additional, Klimovič, M., additional, Šeda, M., additional, Marek, L., additional, and Doleček, M., additional
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- 2005
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18. Primary sclerosing cholangitis with features of autoimmune hepatitis in children and adolescents
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Smolka, V, primary
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- 2001
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19. Refeeding syndrom v dětském věku.
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Karásková, E., Vydra, D., Smolka, V., Véghová-Velgáňová, M., Tkachyk, O., Ťoukálková, L., and Mihál, V.
- Abstract
Copyright of Czecho-Slovak Pediatrics / Česko-Slovenská Pediatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2014
20. Nemoc ze střádání esterů cholesterolu (CESD): klinická, laboratorní a histologická charakteristika šesti pacientů.
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Mazurová, S., Poupětová, H., Hůlková, H., Ťoukálková, L., Urbanová, Z., Zeman, J., Smolka, V., Malinová, V., and Honzík, T.
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WOLMAN disease ,CHOLESTERYL ester transfer protein ,TRIGLYCERIDES ,LYSOSOMES ,HEPATIC fibrosis - Abstract
Copyright of Czecho-Slovak Pediatrics / Česko-Slovenská Pediatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2014
21. Akutní diseminovaná encefalomyelitida.
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Rohanová, M., Smolka, V., Klásková, E., Wiedermann, J., Saitz, J., Neklanová, M., and Michálková, K.
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POSTVACCINAL encephalitis , *MYCOPLASMA pneumoniae , *CENTRAL nervous system diseases , *PATHOLOGICAL physiology , *NERVOUS system , *MAGNETIC resonance imaging - Abstract
The article presents a case report of a boy with an acute disseminated encephalomyelitis following an infection induced by Mycoplasma pneumoniae. It is a demyelinating inflammatory disease of the central nervous system caused by the malfunction of the regulation of the immunity reaction of an organism to an infection or a vaccination. The occurrence of the disease is very rare and the diagnosis is determined by exclusion based on anamnesis data, clinical picture and examination finding of the nervous system by magnetic resonance. [ABSTRACT FROM AUTHOR]
- Published
- 2012
22. Hypothalamo-hypofyzární dysfunkce u dětí a dospívajících po mozkovém úrazu - prospektivní sledování.
- Author
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Aleksijevič, D., Klásková, E., Mihál, V., Wiedermann, J., Venháčová, P., Krahulík, D., Zapletalová, J., and Smolka, V.
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BRAIN injuries ,TRAUMATOLOGY ,HYPOTHALAMUS ,HYPOTHALAMIC hormones ,HYPOGONADISM - Abstract
Copyright of Czecho-Slovak Pediatrics / Česko-Slovenská Pediatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2012
23. Hyperbaric oxygen therapy in pediatric patients at the Centre of Hyperbaric Medicine Ostrava in the years 2007-2011,Hyperbarická oxygenoterapie u pediatrických pacientu v Centru hyperbarické medicíny Ostrava v letech 2007-2011
- Author
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Hájek, M., Slaný, J., Maršálková, J., Tichavská, J., Němcová, P., Lutzová, M., Neuwirtová, I., Spilková, Z., Ručková, M., Nogolová, A., Bártová, T., Duda, J., Smolka, V., Eva Klásková, Hladík, M., Trávníček, B., Chmelař, D., Beran, V., Štěrba, J., Kepák, T., Fedora, M., Šeda, M., Žurek, J., and Novomeský, F.
24. Metabolic complications and neurologic manifestations of vitamin B12 deficiency in children of vegetarian mothers,Metabolické komplikace a neurologické projevy pri deficitu vitaminu B12 u detí vegetariánských matek
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Smolka, V., Bekárek, V., Hlídková, E., Bucil, J., Mayerová, D., Skopková, Z., Tomas Adam, Hrubá, E., Kozich, V., Buriánková, L., Saligová, J., Buncová, M., and Zeman, J.
25. Cholesteryl Ester Storage Disease (CESD): Clinical, laboratory and histological characteristics in 6 patients | Nemoc ze střádání esteru cholesterolu (CESD): klinická, laboratorní a histologická charakteristika šesti pacientů
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Mazurová, S., Poupětová, H., Helena Hůlková, ͖oukálková, L., Urbanová, Z., Zeman, J., Smolka, V., Malinová, V., and Honzík, T.
26. Hepatic failure after valproic acid administration in an infant with cytochrome C oxidase,Jaterní selhání po podání kyseliny valproové u kojence s deficitem cytochrom C oxidázy
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Smolka, V., Reitinger, J., Bekárek, V., Hansíková, H., Neklanová, M., Kameníčková, J., Tomas Adam, Tesařová, M., Čapková, M., and Zeman, J.
27. 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.
- Subjects
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.
28. Assessing the Validity of Adult-derived Prognostic Models for Primary Sclerosing Cholangitis Outcomes in Children
- Author
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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
29. Ursodeoxycholic acid therapy in pediatric primary sclerosing cholangitis: predictors of gamma glutamyltransferase normalization and favorable clinical course
- Author
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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
30. Teachers’ pay: consistently low and unattractive
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Münich, Daniel, Perignáthová, M., Zapletalová, Lucie, and Smolka, V.
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teachers’ pay ,Czech Republic ,pay differences - Abstract
The level and structure of teachers’ salaries significantly affect overall interest in the teaching profession and play a part in determining the structure of those interested in the profession. The quality of new recruits to the teaching profession in turn determines the long term quality of education and educational results in the given country. Salaries for teachers at Czech public primary schools, in a relative comparison with salaries for highly qualified employees, have long been among the lowest in the world’s thirty most developed countries. As far as teachers’ general skills are concerned, these are still relatively good in the Czech Republic compared to many other countries. This is however undoubtedly determined to a large extent on the high numbers of older teachers in the profession, who began their careers decades ago. Interest in the teaching profession among talented younger Czechs is currently very low.
- Published
- 2015
31. 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
- Subjects
- 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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32. [The old person in road traffic].
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Smolka V
- Subjects
- Humans, Aged, Cognition, Accidents, Traffic prevention & control, Geriatrics
- Abstract
Due to the demographic change and the rising mobility of older adults in comparison with former generations, the number of old persons involved in road traffic has been continuously growing. The safety of all participating parties in road traffic necessitates a successful interaction of each individual's visual, motor and cognitive functions. These might be negatively affected by age-related physiological changes with a large individual variation. In addition, old age is affected to varying degrees by multimorbidity and the resulting medication can further influence the ability to drive. There are, however, several options to compensate for potential functional losses in road traffic. Maintaining the mobility of old people for as long as possible and at the same time maintaining traffic safety for all participants represents a challenge for society and medicine when dealing with older adults. This article discusses the old person in road traffic from a geriatrics point of view., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2023
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33. 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
- Subjects
- 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.)
- Published
- 2023
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34. 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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35. Benefit of medication reviews by renal pharmacists in the setting of a computerized physician order entry system with clinical decision support.
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Seiberth S, Mannell H, Birkenmaier C, Neuerburg C, Smolka V, Andraschko M, and Strobach D
- Subjects
- Humans, Medication Review, Pharmacists, Retrospective Studies, Decision Support Systems, Clinical, Medical Order Entry Systems
- Abstract
What Is Known and Objective: A 'renal pharmacist consultant service' (RPCS) reviewing patients' charts with renal impairment (RI) for drug-related problems (DRP) can foster patient safety. However, the benefit of this service in the new setting of a computerized physician order entry (CPOE)-system with a clinical decision support (CDS)-system is unknown. The aim of our study was to evaluate the general need for an RPCS on wards with a CPOE-CDS-system already in use and its effectiveness on prescription changes to ensure in-hospital patient safety., Methods: Over a period of 3 months (02-04/2021), elective orthopaedic and trauma patients with eGFR
absolute /CrCl <60 ml/min at a German University Hospital received a medication review by a renal pharmacist for all medication entered into the CPOE-system (Meona®) by the treating physicians. Written consultations explaining identified DRP and recommending interventions to solve them, for example, dose or drug adaptation, were shared with the physicians directly in the drug chart tab of Meona®. In complex cases, DRP were additionally discussed via phone. The prescription changes were evaluated retrospectively., Results and Discussion: During 53 working days, 712 (30.5%) of 2331 screened patients were included with an eGFRnon-indexed /CrCl <60 ml/min and a pharmacist-led medication review was performed for all medication presented in the CPOE-system (Meona®). In 79 of 712 (11.1%) patients, one or more DRP were detected (median 1 DRP (1-3) per patient) and written recommendations concerning 106 of 1090 (9.7%) drugs were shared via Meona®. In total, 104 DRP were identified, mostly caused by 'dosage too high' (n = 55, 52.9%), 'dosage regime wrong' (n = 13, 12.5%), and 'contraindication' (n = 9, 8.7%). Acceptance rate of recommendations was 74.0% (n = 77/104). In nine cases (8.7%), despite of specific recommendations, no adjustment of drugs was made because of lack of alternatives. In 11 (10.6%) cases, prescription remained unchanged for unknown reasons and in seven (6.7%) cases, the result was unknown due to discharge., What Is New and Conclusion: In the setting of prescribing in a CPOE-CDS-system, that provides physicians with advice for drug or dose adaption, the pharmacist-led medication reviews still identified DRP in orthopaedic and trauma patients with RI. A RPCS forwarding recommendations to solve DRP via the electronic medical record increased appropriate prescribing by physicians and, thus, may further improve patient safety., (© 2022 The Authors. Journal of Clinical Pharmacy and Therapeutics published by John Wiley & Sons Ltd.)- Published
- 2022
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36. Recurrence of Primary Sclerosing Cholangitis After Liver Transplant in Children: An International Observational Study.
- Author
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Martinez M, Perito ER, Valentino P, Mack CL, Aumar M, Broderick A, Draijer LG, Fagundes EDT, Furuya KN, Gupta N, Horslen S, Jonas MM, Kamath BM, Kerkar N, Kim KM, Kolho KL, Koot BGP, Laborda TJ, Lee CK, Loomes KM, Miloh T, Mogul D, Mohammed S, Ovchinsky N, Rao G, Ricciuto A, Rodrigues Ferreira A, Schwarz KB, Smolka V, Tanaka A, Tessier MEM, Venkat VL, Vitola BE, Woynarowski M, Zerofsky M, and Deneau MR
- Subjects
- Adolescent, Age Factors, Alanine Transaminase blood, Aspartate Aminotransferases blood, Child, Cholangitis, Sclerosing blood, Cholangitis, Sclerosing epidemiology, Disease Progression, Drug Resistance, Female, Glucocorticoids therapeutic use, Graft Rejection drug therapy, Graft Rejection pathology, Graft Survival, Humans, Hypertension, Portal physiopathology, Inflammatory Bowel Diseases epidemiology, Internationality, Male, Recurrence, Registries, Risk Factors, Time Factors, gamma-Glutamyltransferase blood, Cholangitis, Sclerosing surgery, Graft Rejection epidemiology, Hypertension, Portal epidemiology, Liver Transplantation
- Abstract
Background and Aims: Recurrent primary sclerosing cholangitis (rPSC) following liver transplant (LT) has a negative impact on graft and patient survival; little is known about risk factors for rPSC or disease course in children., Approach and Results: We retrospectively evaluated risk factors for rPSC in 140 children from the Pediatric PSC Consortium, a multicenter international registry. Recipients underwent LT for PSC and had >90 days of follow-up. The primary outcome, rPSC, was defined using Graziadei criteria. Median follow-up after LT was 3 years (interquartile range 1.1-6.1). rPSC occurred in 36 children, representing 10% and 27% of the subjects at 2 years and 5 years following LT, respectively. Subjects with rPSC were younger at LT (12.9 vs. 16.2 years), had faster progression from PSC diagnosis to LT (2.5 vs. 4.1 years), and had higher alanine aminotransferase (112 vs. 66 IU/L) at LT (all P < 0.01). Inflammatory bowel disease was more prevalent in the rPSC group (86% vs. 66%; P = 0.025). After LT, rPSC subjects had more episodes of biopsy-proved acute rejection (mean 3 vs. 1; P < 0.001), and higher prevalence of steroid-refractory rejection (41% vs. 20%; P = 0.04). In those with rPSC, 43% developed complications of portal hypertension, were relisted for LT, or died within 2 years of the diagnosis. Mortality was higher in the rPSC group (11.1% vs. 2.9%; P = 0.05)., Conclusions: The incidence of rPSC in this cohort was higher than previously reported, and was associated with increased morbidity and mortality. Patients with rPSC appeared to have a more aggressive, immune-reactive phenotype. These findings underscore the need to understand the immune mechanisms of rPSC, to lay the foundation for developing new therapies and improve outcomes in this challenging population., (© 2021 by the American Association for the Study of Liver Diseases.)
- Published
- 2021
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37. 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.
- Author
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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
- Subjects
- 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.
- Published
- 2021
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38. The Sclerosing Cholangitis Outcomes in Pediatrics (SCOPE) Index: A Prognostic Tool for Children.
- Author
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Deneau MR, Mack C, Perito ER, Ricciuto A, Valentino PL, Amin M, Amir AZ, Aumar M, Auth M, Broderick A, DiGuglielmo M, Draijer LG, Tavares Fagundes ED, El-Matary W, Ferrari F, Furuya KN, Gupta N, Hochberg JT, Homan M, Horslen S, Iorio R, Jensen MK, Jonas MM, Kamath BM, Kerkar N, Kim KM, Kolho KL, Koot BGP, Laborda TJ, Lee CK, Loomes KM, 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 KB, Shah U, Shteyer E, Singh R, Smolka V, Soufi N, Tanaka A, Varier R, Vitola B, Woynarowski M, Zerofsky M, Zizzo A, and Guthery SL
- Subjects
- Adolescent, Bilirubin blood, Biopsy, Child, Cholangiography, Cholangitis, Sclerosing mortality, Cholangitis, Sclerosing pathology, Cholangitis, Sclerosing surgery, Disease Progression, Female, Humans, Liver Transplantation, Male, Platelet Count, Prognosis, Retrospective Studies, Risk Factors, Serum Albumin analysis, gamma-Glutamyltransferase blood, Cholangitis, Sclerosing diagnosis
- 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 <1%, 3%, and 9% annually and to HBCs at rates of 2%, 6%, and 13% annually, respectively (P < 0.001). C-statistics to discriminate outcomes at 1 and 5 years were 0.95 and 0.82 for TD and 0.80 and 0.76 for HBCs, respectively. Baseline hepatic fibrosis stage was worse with increasing risk score, with extensive fibrosis in 8% of the lowest versus 100% with the highest risk index (P < 0.001). The model was validated in 240 children from 11 additional centers and performed well., Conclusions: The SCOPE index is a pediatric-specific prognostic tool for PSC. It uses routinely obtained, objective data to predict a complicated clinical course. It correlates strongly with biopsy-proven liver fibrosis. SCOPE can be used with families for shared decision making on clinical care based on a patient's individual risk, and to account for variable disease progression when designing future clinical trials., (© 2020 by the American Association for the Study of Liver Diseases.)
- Published
- 2021
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39. Severe linezolid-induced lactic acidosis in a child with acute lymphoblastic leukemia: A case report.
- Author
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Smolka V, Rohanova M, Ludikova B, Novak Z, Zapalka M, Pospisilova D, and Volejnikova J
- Subjects
- Anti-Bacterial Agents adverse effects, Bacteria, Child, Female, Humans, Linezolid adverse effects, Acidosis, Lactic chemically induced, Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy
- Abstract
Linezolid is an antibiotic increasingly used for treatment of resistant Gram-positive infections, which blocks bacterial proteosythesis through direct inhibition of mitochondrial ribosomes. The most common adverse effects of linezolid include gastrointestinal symtoms, peripheral neuropathy, bone marrow depression and lactic acidosis. Here we present a rare case of a 9-year-old female, a survivor of acute lymphoblastic leukemia (ALL) and a hematopoietic stem cell transplant (HSCT), who developed life-threatening lactic acidosis with vomiting, impaired consciousness and Kussmaul breathing after 51 days of intravenous linezolid administration due to mycobacterial infection. She fully recovered after drug discontinuation and normalization of the plasma levels. We conclude that plasma lactate concentrations should be monitored closely during any linezolid treatment, particularly in patients with hepatic or renal dysfunction., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2020
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40. Morphogenetic systems: Models and experiments.
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Smolka V, Drastík J, Bradík J, Garzon M, and Sosík P
- Subjects
- Cell Division, Computer Simulation, Cytoskeleton metabolism, Eukaryotic Cells cytology, Eukaryotic Cells metabolism, Prokaryotic Cells cytology, Prokaryotic Cells metabolism, Algorithms, Computational Biology methods, Models, Theoretical, Morphogenesis, Software
- Abstract
M systems are mathematical models of morphogenesis developed to gain insights into its relations to phenomena such as self-assembly, self-controlled growth, homeostasis, self-healing and self-reproduction, in both natural and artificial systems. M systems rely on basic principles of membrane computing and self-assembly, as well as explicit emphasis on geometrical structures (location and shape) in 2D, 3D or higher dimensional Euclidean spaces. They can be used for principled studies of these phenomena, both theoretically and experimentally, at a computational level abstracted from their detailed implementation. In particular, they afford 2D and 3D models to explore biological morphogenetic processes. Theoretical studies have shown that M systems are powerful tools (e.g., computational universal, i.e. can become as complex as any computer program) and their parallelism allows for trading space for time in solving efficiently problems considered infeasible on conventional computers (NP-hard problems). In addition, they can also exhibit properties such as robustness to injuries and degrees of self-healing. This paper focuses on the experimental side of M systems. To this end, we have developed a high-level morphogenetic simulator, Cytos, to implement and visualize M systems in silico in order to verify theoretical results and facilitate research in M systems. We summarize the software package and make a brief comparison with some other simulators of membrane systems. The core of the article is a description of a range of experiments inspired by aspects of morphogenesis in both prokaryotic and eukaryotic cells. The experiments explore the regulatory role of the septum and of the cytoskeleton in cell fission, the robustness of cell models against injuries, and, finally, the impact of changing nutrient concentration on population growth., (Copyright © 2020. Published by Elsevier B.V.)
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- 2020
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41. 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.)
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- 2020
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42. 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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43. Ursodeoxycholic Acid Therapy in Pediatric Primary Sclerosing Cholangitis: Predictors of Gamma Glutamyltransferase Normalization and Favorable Clinical Course.
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Deneau M, Perito E, Ricciuto A, Gupta N, Kamath BM, Palle S, Vitola B, Smolka V, Ferrari F, Amir AZ, Miloh T, Papadopoulou A, Mohan P, Mack C, Kolho KL, Iorio R, El-Matary W, Venkat V, Chan A, Saubermann L, Valentino PL, Shah U, Miethke A, Lin H, and Jensen MK
- Subjects
- Adolescent, Analysis of Variance, Biomarkers blood, Child, Cohort Studies, Female, Follow-Up Studies, Humans, Liver Function Tests, Male, Predictive Value of Tests, Retrospective Studies, Severity of Illness Index, Time Factors, Treatment Failure, Treatment Outcome, Cholangitis, Sclerosing blood, Cholangitis, Sclerosing drug therapy, Ursodeoxycholic Acid therapeutic use, gamma-Glutamyltransferase blood
- 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 <50 IU/L without experiencing portal hypertensive or dominant stricture events, liver transplantation, or death during the first year., Results: We identified 263 patients, median age 12.1 years at diagnosis, treated with UDCA at a median dose of 15 mg/kg/d. Normalization occurred in 46%. Patients with normalization had a lower prevalence of Crohn's disease, lower total bilirubin level, lower aspartate aminotransferase to platelet ratio index, greater platelet count, and greater serum albumin level at diagnosis. The 5-year survival with native liver was 99% in those patients who achieved normalization vs 77% in those who did not., Conclusions: Less than one-half of the patients treated with UDCA have a complete GGT normalization in the first year after diagnosis, but this subset of patients has a favorable 5-year outcome. Normalization is less likely in patients with a Crohn's disease phenotype or a laboratory profile suggestive of more advanced hepatobiliary fibrosis. Patients who do not achieve normalization could reasonably stop UDCA, as they are likely not receiving clinical benefit. Alternative treatments with improved efficacy are needed, particularly for patients with already-advanced disease., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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44. 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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45. The natural history of primary sclerosing cholangitis in 781 children: A multicenter, international collaboration.
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Deneau MR, El-Matary W, Valentino PL, Abdou R, Alqoaer K, Amin M, Amir AZ, Auth M, Bazerbachi F, Broderick A, Chan A, Cotter J, Doan S, El-Youssef M, Ferrari F, Furuya KN, Gottrand M, Gottrand F, Gupta N, Homan M, Kamath BM, Kim KM, Kolho KL, 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 MB, Woynarowski M, Yap J, and Jensen MK
- Subjects
- Analysis of Variance, Biopsy, Needle, Child, Cholangitis, Sclerosing pathology, Cohort Studies, Disease Progression, Disease-Free Survival, Female, Follow-Up Studies, Humans, Immunohistochemistry, Internationality, Japan, Liver Function Tests, Liver Transplantation mortality, Male, Multivariate Analysis, Predictive Value of Tests, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Severity of Illness Index, Survival Analysis, Cholangitis, Sclerosing mortality, Cholangitis, Sclerosing surgery, Liver Transplantation methods
- 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
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46. Chemical angioplasty with spasmolytics for vasospasm after subarachnoid hemorrhage.
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Hejčl A, Cihlář F, Smolka V, Vachata P, Bartoš R, Procházka J, Cihlář J, and Sameš M
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- Adult, Angioplasty adverse effects, Female, Humans, Infusions, Intra-Arterial adverse effects, Male, Middle Aged, Nimodipine therapeutic use, Vasodilator Agents therapeutic use, Angioplasty methods, Nimodipine administration & dosage, Subarachnoid Hemorrhage drug therapy, Vasodilator Agents administration & dosage, Vasospasm, Intracranial drug therapy
- Abstract
Background: Clinically symptomatic vasospasm leading to delayed ischemic neurological deficits occurs in up to 30% of patients with subarachnoid hemorrhage (SAH). Vasospasm can result in a serious decline in clinical conditions of patients with SAH, yet the algorithm for vasospasm treatment and prevention remains unclear. Intra-arterial administration of vasodilators is one of the modalities used for vasospasm therapy., Methods: Over the last 7 years, we have treated 27 female and 7 male patients with vasospasm using intra-arterial administration of either nimodipine or milrinone; all had suffered aneurysm rupture. Of these patients, 28 were treated surgically (clip), and 6 patients had their aneurysm coiled. Spasmolytics were applied from day 2 to day 18 after rupture., Results: Of the 53 procedures, angiographic improvement was documented in 92% of cases with a mean flow velocity decrease of 65 cm/s. Brain metabolism changes were monitored after the procedure. The highest level of immediate clinical improvement was observed in conscious patients with a focal neurological deficit (aphasia, hemiparesis). Overall clinical outcomes (Glasgow outcome scale, GOS) were as follows: GOS 5 (12 patients), GOS 4 (5 patients), GOS 3 (5 patients), GOS 2 (6 patients), and GOS 1 (6 patients)., Conclusions: Intra-arterial administration of spasmolytics is a safe and potent method of vasospasm treatment. It is most effective when applied to conscious patients with a focal deficit. For unconscious patients, its therapeutic benefits are inconclusive. Patients in severe clinical states would further require use of other diagnostic tools such as multimodal brain monitoring to complement vasospasm therapy.
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- 2017
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47. 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
- Subjects
- 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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48. 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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49. Enantioseparation of d,l-2-hydroxyglutaric acid by capillary electrophoresis with tandem mass spectrometry-Fast and efficient tool for d- and l-2-hydroxyglutaracidurias diagnosis.
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Švidrnoch M, Přibylka A, Bekárek V, Ševčík J, Smolka V, and Maier V
- Subjects
- Adult, Amino Acid Metabolism, Inborn Errors urine, Child, Creatinine urine, Glutarates urine, Humans, Reproducibility of Results, Stereoisomerism, Amino Acid Metabolism, Inborn Errors diagnosis, Electrophoresis, Capillary, Glutarates isolation & purification, Mass Spectrometry, Tandem Mass Spectrometry
- Abstract
A novel capillary electrophoresis-tandem mass spectrometry method for the enantioseparation and identification of 2-hydroxyglutaric acid enantiomers without derivatization for clinical purposes was described. Vancomycin chloride was used as an efficient chiral selector for the discrimination of 2-hydroxyglutaric acid enantiomers by capillary electrophoresis employed complete capillary filling method. The obtained resolution was 2.05. Hyphenation of CE with tandem mass spectrometry allows a reliable identification of separated enantiomers as well as their quantification. The method was validated and applied for the separation, identification and determination of 2-hydroxyglutaric enantiomers in urine samples obtained from healthy patients and two urine samples obtained from child patients suffering from high urine excretion of 2-hydroxyglutaric acid. Abnormal excretion of d-hydroxyglutaric acid was found in both child urine samples (104.5±2.1 and 2200.0±12.6mmol/mol of creatinine, respectively). The limits of detection for d- and l-hydroxyglutaric acid were 31 and 38nmol/L, respectively., (Copyright © 2016 Elsevier B.V. All rights reserved.)
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- 2016
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50. 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
- Subjects
- 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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