Pathogen-Specific Effects of Probiotics in Children with Acute Gastroenteritis Seeking Emergency Care: A Randomized Trial

2021 ◽  
Author(s):  
Stephen B Freedman ◽  
Yaron Finkelstein ◽  
Xiao-Li Pang ◽  
Linda Chui ◽  
Phillip I Tarr ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Severe Disease ◽  
Lactobacillus Rhamnosus ◽  
Pediatric Emergency ◽  
Post Intervention ◽  
Treatment Allocation ◽  
Treatment Groups ◽  
Specific Effects ◽  
Level Data ◽  
Probiotic Product

Abstract Background It is unknown if probiotics exert pathogen-specific effects in children with diarrhea secondary to acute gastroenteritis. Methods Analysis of patient-level data from two multi-center randomized, placebo controlled, trials conducted in pediatric emergency departments in Canada and the U.S.. Participants were 3-48 months with >3 diarrheal episodes in the preceding 24 hours, and were symptomatic for <72 hours and <7 days in the Canadian and U.S. studies, respectively. Participants received either placebo or probiotic preparation (Canada-Lactobacillus rhamnosus R0011/L. helveticus R0052; U.S.-L. rhamnosus GG). The primary outcome was post-intervention moderate-to-severe disease [i.e. ≥9 on the Modified Vesikari Scale (MVS)]. Results Pathogens were identified in specimens from 59.3% (928/1565) children. No pathogen groups were less likely to experience an MVS ≥9 based on treatment allocation (test for interaction=0.35). No differences between groups were identified for adenovirus (aRR: 1.42; 95%CI: 0.62, 3.23), norovirus (aRR: 0.98; 95%CI: 0.56, 1.74), rotavirus (aRR: 0.86; 95%CI: 0.43, 1.71) or bacteria (aRR: 1.19; 95%CI: 0.41, 3.43). At pathogen-group and among individual pathogens there were no differences in diarrhea duration or the total number of diarrheal stools between treatment groups, regardless of intervention allocation or among probiotic sub-groups. Among adenovirus-infected children, those administered the Lactobacillus rhamnosus R0011/L. helveticus R0052 product experienced fewer diarrheal episodes (aRR: 0.65; 95%CI: 0.47 to 0.90). Conclusions Neither probiotic product resulted in less severe disease compared to placebo across a range of the most common etiologic pathogens. Clarifying the etiology of diarrhea among those without pathogens identified is warranted.

scholarly journals Randomised controlled trial ofLactobacillus rhamnosus(LGG) versus placebo in children presenting to the emergency department with acute gastroenteritis: the PECARN probiotic study protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e018115 ◽  
Author(s):  
David Schnadower ◽  
Phillip I Tarr ◽  
T Charles Casper ◽  
Marc H Gorelick ◽  
Michael J Dean ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Statistical Power ◽  
Controlled Trial ◽  
Severe Disease ◽  
Lactobacillus Rhamnosus ◽  
Research Network ◽  
Controlled Study ◽  
Double Blind ◽  
Data Set ◽  
Public Data

IntroductionAcute gastroenteritis (AGE) is a common and burdensome condition that affects millions of children worldwide each year. Currently available strategies are limited to symptomatic management, treatment and prevention of dehydration and infection control; no disease-modifying interventions exist. Probiotics, defined as live microorganisms beneficial to the host, have shown promise in improving AGE outcomes, but existing studies have sufficient limitations such that the use of probiotics cannot currently be recommended with confidence. Here we present the methods of a large, rigorous, randomised, double-blind placebo-controlled study to assess the effectiveness and side effect profile ofLactobacillus rhamnosusGG (LGG) (ATCC 53103) in children with AGE.Methods and analysisThe study is being conducted in 10 US paediatric emergency departments (EDs) within the federally funded Pediatric Emergency Care Applied Research Network, in accordance with current SPIRIT and CONSORT statement recommendations. We will randomise 970 children presenting to participating EDs with AGE to either 5 days of treatment with LGG (1010colony-forming unit twice a day) or placebo between July 2014 to December 2017. The main outcome is the occurrence of moderate-to-severe disease over time, as defined by the Modified Vesikari Scale. We also record adverse events and side effects related to the intervention. We will conduct intention-to-treat analyses and use an enrichment design to restore the statistical power in case the presence of a subpopulation with a substantially low treatment effect is identified.Ethics and disseminationInstitutional review board approval has been obtained at all sites, and data and material use agreements have been established between the participating sites. The results of the trial will be published in peer-reviewed journals. A deidentified public data set will be made available after the completion of all study procedures.Trial registration numberNCT01773967.

A Case Series of SARS-CoV-2 RT-PCR-Positive Hospitalized Infants 60 Days of Age or Younger From 2 New York City Pediatric Emergency Departments

2021 ◽  
Vol 60 (4-5) ◽  
pp. 247-251
Author(s):  
Ameer Hassoun ◽  
Nessy Dahan ◽  
Christopher Kelly
Keyword(s):  
New York ◽  
Case Reports ◽  
Severe Disease ◽  
Case Series ◽  
Pediatric Emergency ◽  
Rt Pcr ◽  
Vulnerable Group ◽  
Mild Disease ◽  
Young Infants ◽  
Novel Coronavirus

The emergence of novel coronavirus disease-2019 poses an unprecedented challenge to pediatricians. While the majority of children experience mild disease, initial case reports on young infants are conflicting. We present a case series of 8 hospitalized infants 60 days of age or younger with coronavirus disease-2019. A quarter of these patients had coinfections (viral or bacterial). None of these infants had severe disease. Continued vigilance in testing this vulnerable group of infants is warranted.

scholarly journals Predicting severe pneumonia in the emergency department: a global study of the Pediatric Emergency Research Networks (PERN)—study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041093
Author(s):  
Todd Adam Florin ◽  
Daniel Joseph Tancredi ◽  
Lilliam Ambroggio ◽  
Franz E Babl ◽  
Stuart R Dalziel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Prediction Model ◽  
Severe Disease ◽  
Pediatric Emergency ◽  
Global Network ◽  
Clinical Prediction ◽  
Emergency Research ◽  
Research Networks ◽  
Clinical Prediction Model ◽  
Severity Scores

IntroductionPneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs.Methods and analysisThis study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to <14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7–14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models.Ethics and disseminationThis study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children’s Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation.

scholarly journals 526. Clinical Presenting Characteristics of Pediatric COVID-19 Infection in a Tertiary Care Children’s Hospital in Detroit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S330-S330
Author(s):  
Jocelyn Y Ang ◽  
Nirupama Kannikeswaran ◽  
Basim Asmar
Keyword(s):  
Mechanical Ventilation ◽  
Severe Disease ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Pediatric Emergency ◽  
Study Cohort ◽  
Mild Disease ◽  
Presenting Symptoms ◽  
Patient Disposition

Abstract Background There is limited data regarding the presenting clinical characteristics of COVID-19 in children. Our objective is to describe the clinical presentations and outcomes of COVID-19 infection early in the pandemic at our institution. Methods We performed a retrospective chart review of children up to 18 years who underwent testing for SARS CoV-2 from March 1st to May 10th 2020 at our pediatric emergency department. We abstracted patient’s demographics, clinical presentation, diagnostic studies and patient disposition. We classified the severity of clinical illness based on published criteria. We excluded patients diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. Results SARS CoV-2 testing was performed on 481 patients of whom 43 (8.9%) tested positive. Of these, 4 were diagnosed with MIS-C. Data of 39 patients were analyzed. Patients’ demographics, co-morbidities, presenting signs and symptoms and disposition are shown in Table 1. Age range was 47 days – 18 years. Infants representing one third (14/39; 35.9%) of our study cohort. There was equal sex distribution. Asthma or obesity was present in 17 (44%). The most common presenting symptoms included fever, cough, shortness of breath and diarrhea. Chest radiograph showed pneumonia in 12 (30.8%) patients. Two thirds (27/39; 69.2%) were asymptomatic or had mild disease; six patients (15.4%) had severe or critical illness (Figure 1). Nineteen (48%) patients were admitted to the general pediatric service. Eleven (28%) were admitted to the Intensive Care Units (ICU). The characteristics, presenting symptoms and interventions performed in the PICU cohort are shown in Table 2. Half of these patients required mechanical ventilation. There was one death in a 3 month old infant unrelated to SARS CoV-2. Majority of the infants required hospitalization (12/14; 85.7%), including 4 to the PICU (one each for non accidental trauma, ingestion, seizure and pneumonia). Table 1. Patient demographics, signs and symptoms of COVID-19 infection in Children Table 2: PICU patients: Characteristics, Interventions and pharmacotherapy Figure 1: Severity of Ill ness in the study cohort Conclusion Majority (17; 43%) of our children with COVID-19 had a mild disease. Eleven (28%) including 4 infants required critical care; 5 required mechanical ventilation. There was no COVID-19 related mortality. Larger studies are needed to further define the spectrum of COVID- 19 and risk factors associated with severe disease in children. Disclosures All Authors: No reported disclosures

scholarly journals Effect of a Synbiotic Mix on Lymphoid Organs of Broilers Infected with Salmonella typhimurium and Clostridium perfringens

Animals ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 886 ◽  
Author(s):  
Zuamí Villagrán-de la Mora ◽  
Olga Vázquez-Paulino ◽  
Hugo Avalos ◽  
Felipe Ascencio ◽  
Karla Nuño ◽  
...  
Keyword(s):  
Salmonella Typhimurium ◽  
Clostridium Perfringens ◽  
Lactobacillus Rhamnosus ◽  
Lymphoid Organs ◽  
Control Group ◽  
Agave Tequilana ◽  
Gallus Gallus Domesticus ◽  
Salmonella Infection ◽  
Treatment Groups ◽  
Growth Promoting

Synbiotic consumption can modulate immune response. This work involves studying the effect of a synbiotic on lymphoid organs and IgA of broilers infected with Salmonella typhimurium and Clostridium perfringens. A total of 258 one-day-old male broilers (Gallus gallus domesticus), line COBBAvian48 (free of growth-promoting antibiotics), were distributed into eight treatment groups. A symbiotic mix comprising Lactobacillus rhamnosus HN001 and Pediococcus acidilactici MA18/5 M as probiotics and 4.5% (0.045 g g−1) of Agave tequilana fructans as prebiotic per dose (one milliliter) was administered through drinking water the first day of life. Bursa, spleen and thymus were analyzed. Broilers treated with the synbiotic, whether or not infected with pathogens, had bigger bursa follicles than the non-treated (p < 0.05), and the ones from the synbiotic group had more lymphocytes than the control group (p < 0.05). Thymus follicles of the synbiotic group were bigger than the control group (p < 0.05). Lesions associated with Salmonella infection were found in the bursa, however, in the broilers treated with the synbiotic, the lesions were less intense and were not present after 32 days of life. The synbiotic mix can stimulate the bursa, increasing the size of their follicles and promoting the ability to resist infections caused by S. typhimurium in broilers.

scholarly journals A randomized trial evaluating virus-specific effects of a combination probiotic in children with acute gastroenteritis

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Stephen B. Freedman ◽  
◽  
Jianling Xie ◽  
Alberto Nettel-Aguirre ◽  
Xiao-Li Pang ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Acute Gastroenteritis ◽  
Specific Effects

Aspirin Treatment of Migraine Attacks: Plasma Drug Level Data

Cephalalgia ◽  
1982 ◽  
Vol 2 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Lesley Ross-Lee ◽  
Vernon Heazlewood ◽  
John H. Tyrer ◽  
Mervyn J. Eadie
Keyword(s):  
Pain Relief ◽  
Intramuscular Injection ◽  
Drug Level ◽  
The Other ◽  
Plasma Drug Level ◽  
Plasma Drug ◽  
Treatment Groups ◽  
Level Data ◽  
Oral Aspirin

Plasma aspirin and salicylate levels were measured at intervals over a two hour period during migraine attacks in 10 subjects given 900 mg oral aspirin alone, in 10 subjects given 900 mg oral aspirin plus 10 mg oral metoclopramide, and in 10 subjects given 900 mg oral aspirin plus an intramuscular injection of 10 mg metoclopramide. Higher peak aspirin and salicylate levels occurred in patients given aspirin with metoclopramide. Aspirin tended to appear in plasma earlier in patients given aspirin with oral metoclopramide than in patients given aspirin alone, or aspirin with intramuscular metoclopramide. Patients given aspirin with oral metoclopramide tended to obtain better early pain relief than the other two treatment groups, though by one hour from dosage use of injected metoclopramide was also associated with better pain relief.

scholarly journals Rapid Adoption of Lactobacillus rhamnosus GG for Acute Gastroenteritis

PEDIATRICS ◽  
2013 ◽  
Vol 131 (Supplement 1) ◽  
pp. S96-S102 ◽  
Author(s):  
Michelle W. Parker ◽  
Joshua K. Schaffzin ◽  
Andrea Lo Vecchio ◽  
Connie Yau ◽  
Karen Vonderhaar ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Lactobacillus Rhamnosus ◽  
Lactobacillus Rhamnosus Gg

scholarly journals Risk of COVID-19 is associated with long-term exposure to air pollution

2020 ◽  
Author(s):  
Huaiyu Tian ◽  
Yonghong Liu ◽  
Hongbin Song ◽  
Chieh-Hsi Wu ◽  
Bingying Li ◽  
...  
Keyword(s):  
Severe Disease ◽  
Mainland China ◽  
Severe Infection ◽  
Chronic Obstructive ◽  
Quality Improvements ◽  
Obstructive Pulmonary Disease ◽  
Individual Level ◽  
Human Movements ◽  
Level Data

Introductory paragraphHigh risk of severe disease of COVID-19 has been associated with patients with chronic obstructive pulmonary disease, cardiovascular disease or hypertension1, and long-term exposure to PM2.5 has been associated with COVID-19 mortality 2. We collate individual level data of confirmed COVID-19 cases during the first wave of the epidemic in mainland China by March 6, 2020. We pair these data with a mobile phone dataset, covering human movements from Wuhan before the travel ban and inner-city movements during the time of emergency response from 324 cities in China. Adjusting for socio-economic factors, an increase of 10 μg/m3 in NO2 or PM2.5 was found to be associated with a 22.41% (95%CI: 7.28%-39.89%) or 15.35% (95%CI: 5.60%-25.98%) increase in the number of COVID-19 cases, and a 19.20% (95%CI: 4.03%-36.59%) or 9.61% (95%CI: 0.12%-20.01%) increase in severe infection, respectively. Our results highlight the importance of air quality improvements to health benefits.

scholarly journals Healthcare trajectory of children with rare bone disease attending pediatric emergency departments

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
David Dawei Yang ◽  
Geneviève Baujat ◽  
Antoine Neuraz ◽  
Nicolas Garcelon ◽  
Claude Messiaen ◽  
...  
Keyword(s):  
Severe Disease ◽  
Pediatric Emergency ◽  
Bone Diseases ◽  
University Hospital ◽  
Emergency Situations ◽  
Multiple Issues ◽  
Independent Variable ◽  
Healthcare Trajectory ◽  
Rare Bone Diseases ◽  
Healthcare Visit

Abstract Background Children with rare bone diseases (RBDs), whether medically complex or not, raise multiple issues in emergency situations. The healthcare burden of children with RBD in emergency structures remains unknown. The objective of this study was to describe the place of the pediatric emergency department (PED) in the healthcare of children with RBD. Methods We performed a retrospective single-center cohort study at a French university hospital. We included all children under the age of 18 years with RBD who visited the PED in 2017. By cross-checking data from the hospital clinical data warehouse, we were able to trace the healthcare trajectories of the patients. The main outcome of interest was the incidence (IR) of a second healthcare visit (HCV) within 30 days of the index visit to the PED. The secondary outcomes were the IR of planned and unplanned second HCVs and the proportion of patients classified as having chronic medically complex (CMC) disease at the PED visit. Results The 141 visits to the PED were followed by 84 s HCVs, giving an IR of 0.60 [95% CI: 0.48–0.74]. These second HCVs were planned in 60 cases (IR = 0.43 [95% CI: 0.33–0.55]) and unplanned in 24 (IR = 0.17 [95% CI: 0.11–0.25]). Patients with CMC diseases accounted for 59 index visits (42%) and 43 s HCVs (51%). Multivariate analysis including CMC status as an independent variable, with adjustment for age, yielded an incidence rate ratio (IRR) of second HCVs of 1.51 [95% CI: 0.98–2.32]. The IRR of planned second HCVs was 1.20 [95% CI: 0.76–1.90] and that of unplanned second HCVs was 2.81 [95% CI: 1.20–6.58]. Conclusion An index PED visit is often associated with further HCVs in patients with RBD. The IRR of unplanned second HCVs was high, highlighting the major burden of HCVs for patients with chronic and severe disease.

Sign in / Sign up

Export Citation Format

Share Document