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Constipation implicated as an indicator of Helicobacter pylori infection
SAN FRANCISCO – Infants refractory constipation and chronic abdominal pain should be tested for the presence of Helicobacter pylori infection. Just relying on the detection of antigen to H. pylori in stool may not be a definitive indicator of the bacterial infection; endoscopic biopsy is a more specific test, according to study findings presented at the Pediatric Academic Societies meeting.
“Our study highlights that constipation seems to be prevalent among children who test positive for H. pylori in stool. No other predominant symptom was found to be related to H. pylori infection,” said Ayesha Baig, MD, a third-year resident at Brookdale University Hospital and Medical Center in Brooklyn, N.Y.
Gastritis that results from H. pylori infection in the mucous membrane lining the stomach is extremely common in children and adolescents. Yet, diagnosis remains challenging, with disagreement about the hallmark symptoms to look for in making the diagnosis.
The researchers retrospectively examined the medical records of patients aged 2-18 years who had been treated for chronic abdominal pain at the hospital’s gastrointestinal clinic between late 2013 and mid-2016. One aim was to see if there was a predominant symptom in patients in whom H. pylori infection had been proven by the detection of antibody to the bacteria in stool and/or in an endoscopic biopsy. Other aims were to identify a relationship between symptoms and the two methods of detecting H. pylori, and to see if symptoms varied with age. Other gastrointestinal disorders were not considered.
The majority (60%) of the 91 patients were male. Most were African American. Their mean age was 10-12 years.
The presence of nausea, vomiting, diarrhea, constipation, blood in stool, and prior history of use of proton pump inhibitors were compared in those testing positive and negative for H. pylori.
Of the patients who were constipated, 72% tested positive for H. pylori in stool and 28% of tested positive for H. pylori in endoscopic biopsy. In patients testing positive for H. pylori based on the presence of antigen in the stool, about 40% tested negative using endoscopic biopsy.
Age was irrelevant concerning biopsy results and symptoms.
“A proportion of patients who tested positive for H. pylori stool antigen tested negative for H. pylori using endoscopic biopsy, which is a higher-specificity method. Our study indicated that stool antigen alone is not a definitive indicator for treating H. pylori,” said Dr. Baig.
The influence of empiric treatment is still an open question that needs examination.
Dr. Baig reported having no relevant financial disclosures.
*This article was updated on 5/24/2017.
SAN FRANCISCO – Infants refractory constipation and chronic abdominal pain should be tested for the presence of Helicobacter pylori infection. Just relying on the detection of antigen to H. pylori in stool may not be a definitive indicator of the bacterial infection; endoscopic biopsy is a more specific test, according to study findings presented at the Pediatric Academic Societies meeting.
“Our study highlights that constipation seems to be prevalent among children who test positive for H. pylori in stool. No other predominant symptom was found to be related to H. pylori infection,” said Ayesha Baig, MD, a third-year resident at Brookdale University Hospital and Medical Center in Brooklyn, N.Y.
Gastritis that results from H. pylori infection in the mucous membrane lining the stomach is extremely common in children and adolescents. Yet, diagnosis remains challenging, with disagreement about the hallmark symptoms to look for in making the diagnosis.
The researchers retrospectively examined the medical records of patients aged 2-18 years who had been treated for chronic abdominal pain at the hospital’s gastrointestinal clinic between late 2013 and mid-2016. One aim was to see if there was a predominant symptom in patients in whom H. pylori infection had been proven by the detection of antibody to the bacteria in stool and/or in an endoscopic biopsy. Other aims were to identify a relationship between symptoms and the two methods of detecting H. pylori, and to see if symptoms varied with age. Other gastrointestinal disorders were not considered.
The majority (60%) of the 91 patients were male. Most were African American. Their mean age was 10-12 years.
The presence of nausea, vomiting, diarrhea, constipation, blood in stool, and prior history of use of proton pump inhibitors were compared in those testing positive and negative for H. pylori.
Of the patients who were constipated, 72% tested positive for H. pylori in stool and 28% of tested positive for H. pylori in endoscopic biopsy. In patients testing positive for H. pylori based on the presence of antigen in the stool, about 40% tested negative using endoscopic biopsy.
Age was irrelevant concerning biopsy results and symptoms.
“A proportion of patients who tested positive for H. pylori stool antigen tested negative for H. pylori using endoscopic biopsy, which is a higher-specificity method. Our study indicated that stool antigen alone is not a definitive indicator for treating H. pylori,” said Dr. Baig.
The influence of empiric treatment is still an open question that needs examination.
Dr. Baig reported having no relevant financial disclosures.
*This article was updated on 5/24/2017.
SAN FRANCISCO – Infants refractory constipation and chronic abdominal pain should be tested for the presence of Helicobacter pylori infection. Just relying on the detection of antigen to H. pylori in stool may not be a definitive indicator of the bacterial infection; endoscopic biopsy is a more specific test, according to study findings presented at the Pediatric Academic Societies meeting.
“Our study highlights that constipation seems to be prevalent among children who test positive for H. pylori in stool. No other predominant symptom was found to be related to H. pylori infection,” said Ayesha Baig, MD, a third-year resident at Brookdale University Hospital and Medical Center in Brooklyn, N.Y.
Gastritis that results from H. pylori infection in the mucous membrane lining the stomach is extremely common in children and adolescents. Yet, diagnosis remains challenging, with disagreement about the hallmark symptoms to look for in making the diagnosis.
The researchers retrospectively examined the medical records of patients aged 2-18 years who had been treated for chronic abdominal pain at the hospital’s gastrointestinal clinic between late 2013 and mid-2016. One aim was to see if there was a predominant symptom in patients in whom H. pylori infection had been proven by the detection of antibody to the bacteria in stool and/or in an endoscopic biopsy. Other aims were to identify a relationship between symptoms and the two methods of detecting H. pylori, and to see if symptoms varied with age. Other gastrointestinal disorders were not considered.
The majority (60%) of the 91 patients were male. Most were African American. Their mean age was 10-12 years.
The presence of nausea, vomiting, diarrhea, constipation, blood in stool, and prior history of use of proton pump inhibitors were compared in those testing positive and negative for H. pylori.
Of the patients who were constipated, 72% tested positive for H. pylori in stool and 28% of tested positive for H. pylori in endoscopic biopsy. In patients testing positive for H. pylori based on the presence of antigen in the stool, about 40% tested negative using endoscopic biopsy.
Age was irrelevant concerning biopsy results and symptoms.
“A proportion of patients who tested positive for H. pylori stool antigen tested negative for H. pylori using endoscopic biopsy, which is a higher-specificity method. Our study indicated that stool antigen alone is not a definitive indicator for treating H. pylori,” said Dr. Baig.
The influence of empiric treatment is still an open question that needs examination.
Dr. Baig reported having no relevant financial disclosures.
*This article was updated on 5/24/2017.
AT PAS 17
Key clinical point:
Major finding: Seventy-two percent and 28% of patients who were constipated tested positive for H. pylori in stool and in endoscopic biopsy, respectively.
Data source: Retrospective case-control study from a single medical center.
Disclosures: Dr. Baig reported having no relevant financial disclosures.
HMGB1 might be new biomarker of celiac disease in children
, said Sara Manti, MD, of the unit of pediatric genetics and immunology at the University of Messina, Italy, and her associates.
Serum HMGB1 levels were significantly higher in 49 children with celiac disease, compared with 44 healthy children in the control group (16.4 ng/mL vs. 6.23 ng/mL; P less than .001). Children with typical form celiac disease had significantly higher serum HMGB1 levels (22.03 ng/mL) than both children with atypical form (14.83 ng/mL) and silent form celiac disease (12.3 ng/mL). There was no statistically significant difference in serum HMGB1 levels between children with atypical form and silent form celiac disease.
Higher serum HMGB1 levels were correlated with severity of Marsh-Oberhüber classification.
These data, which need to be confirmed in further studies, suggest that HMGB1 is upregulated and linked to the severity of histologic damage in celiac disease. If other studies confirm these findings, it could be hypothesized that “asymptomatic children only with positive familial history and abnormal serum anti–tTG-IgA levels as well as normal serum HMGB1 levels need not be subjected to endoscopy to rule out the CD diagnosis,” the investigators said.
Perhaps, “neutralizing HMGB1 activity might be identified as a potential therapeutic target,” Dr. Manti and her associates noted.
Read more in the journal Nutrition (2017 May;37:18-21).
, said Sara Manti, MD, of the unit of pediatric genetics and immunology at the University of Messina, Italy, and her associates.
Serum HMGB1 levels were significantly higher in 49 children with celiac disease, compared with 44 healthy children in the control group (16.4 ng/mL vs. 6.23 ng/mL; P less than .001). Children with typical form celiac disease had significantly higher serum HMGB1 levels (22.03 ng/mL) than both children with atypical form (14.83 ng/mL) and silent form celiac disease (12.3 ng/mL). There was no statistically significant difference in serum HMGB1 levels between children with atypical form and silent form celiac disease.
Higher serum HMGB1 levels were correlated with severity of Marsh-Oberhüber classification.
These data, which need to be confirmed in further studies, suggest that HMGB1 is upregulated and linked to the severity of histologic damage in celiac disease. If other studies confirm these findings, it could be hypothesized that “asymptomatic children only with positive familial history and abnormal serum anti–tTG-IgA levels as well as normal serum HMGB1 levels need not be subjected to endoscopy to rule out the CD diagnosis,” the investigators said.
Perhaps, “neutralizing HMGB1 activity might be identified as a potential therapeutic target,” Dr. Manti and her associates noted.
Read more in the journal Nutrition (2017 May;37:18-21).
, said Sara Manti, MD, of the unit of pediatric genetics and immunology at the University of Messina, Italy, and her associates.
Serum HMGB1 levels were significantly higher in 49 children with celiac disease, compared with 44 healthy children in the control group (16.4 ng/mL vs. 6.23 ng/mL; P less than .001). Children with typical form celiac disease had significantly higher serum HMGB1 levels (22.03 ng/mL) than both children with atypical form (14.83 ng/mL) and silent form celiac disease (12.3 ng/mL). There was no statistically significant difference in serum HMGB1 levels between children with atypical form and silent form celiac disease.
Higher serum HMGB1 levels were correlated with severity of Marsh-Oberhüber classification.
These data, which need to be confirmed in further studies, suggest that HMGB1 is upregulated and linked to the severity of histologic damage in celiac disease. If other studies confirm these findings, it could be hypothesized that “asymptomatic children only with positive familial history and abnormal serum anti–tTG-IgA levels as well as normal serum HMGB1 levels need not be subjected to endoscopy to rule out the CD diagnosis,” the investigators said.
Perhaps, “neutralizing HMGB1 activity might be identified as a potential therapeutic target,” Dr. Manti and her associates noted.
Read more in the journal Nutrition (2017 May;37:18-21).
FROM NUTRITION
Breast milk bacteria seed infant gut microbiome
Beneficial bacteria in the mother’s breast milk and on the breast skin seed the infant gut microbiome and maintain it even after solid foods are introduced, according to a report published in JAMA Pediatrics.
Noting that little is known about the vertical transfer of breast milk microbes from mother to infant, researchers examined bacteria in samples from breast milk, areolar skin swabs, and infant stools in 107 healthy mother-infant pairs. The samples were obtained during a 5-year period from mothers and infants living in the community in Los Angeles and St. Petersburg, Fla., said Pia S. Pannaraj, MD, of the division of infectious diseases, Children’s Hospital Los Angeles, and her associates.
The transferred bacteria are known to “have prominent carbohydrate, amino acid, and energy metabolism functions.” In addition, “The amount of daily breastfeeding as a proportion of total milk intake continued to influence the infant stool microbiome diversity and membership even after solid foods were introduced,” Dr. Pannaraj and her associates said.
These findings highlight “the importance of breastfeeding in the assembly of the infant gut microbiome.” They also support current World Health Organization and American Academy of Pediatrics recommendations “for exclusive breastfeeding during the first 6 months, with continued breastfeeding until at least 12 months,” the investigators added.
Beneficial bacteria in the mother’s breast milk and on the breast skin seed the infant gut microbiome and maintain it even after solid foods are introduced, according to a report published in JAMA Pediatrics.
Noting that little is known about the vertical transfer of breast milk microbes from mother to infant, researchers examined bacteria in samples from breast milk, areolar skin swabs, and infant stools in 107 healthy mother-infant pairs. The samples were obtained during a 5-year period from mothers and infants living in the community in Los Angeles and St. Petersburg, Fla., said Pia S. Pannaraj, MD, of the division of infectious diseases, Children’s Hospital Los Angeles, and her associates.
The transferred bacteria are known to “have prominent carbohydrate, amino acid, and energy metabolism functions.” In addition, “The amount of daily breastfeeding as a proportion of total milk intake continued to influence the infant stool microbiome diversity and membership even after solid foods were introduced,” Dr. Pannaraj and her associates said.
These findings highlight “the importance of breastfeeding in the assembly of the infant gut microbiome.” They also support current World Health Organization and American Academy of Pediatrics recommendations “for exclusive breastfeeding during the first 6 months, with continued breastfeeding until at least 12 months,” the investigators added.
Beneficial bacteria in the mother’s breast milk and on the breast skin seed the infant gut microbiome and maintain it even after solid foods are introduced, according to a report published in JAMA Pediatrics.
Noting that little is known about the vertical transfer of breast milk microbes from mother to infant, researchers examined bacteria in samples from breast milk, areolar skin swabs, and infant stools in 107 healthy mother-infant pairs. The samples were obtained during a 5-year period from mothers and infants living in the community in Los Angeles and St. Petersburg, Fla., said Pia S. Pannaraj, MD, of the division of infectious diseases, Children’s Hospital Los Angeles, and her associates.
The transferred bacteria are known to “have prominent carbohydrate, amino acid, and energy metabolism functions.” In addition, “The amount of daily breastfeeding as a proportion of total milk intake continued to influence the infant stool microbiome diversity and membership even after solid foods were introduced,” Dr. Pannaraj and her associates said.
These findings highlight “the importance of breastfeeding in the assembly of the infant gut microbiome.” They also support current World Health Organization and American Academy of Pediatrics recommendations “for exclusive breastfeeding during the first 6 months, with continued breastfeeding until at least 12 months,” the investigators added.
FROM JAMA PEDIATRICS
Key clinical point: Beneficial bacteria in the mother’s breast milk and on the areola seed and maintain the infant gut microbiome.
Major finding: During their first 30 days of life, breastfed infants obtained a mean of 28% of their gut bacteria from breast milk and 10% from the mothers’ areolar skin.
Data source: A prospective longitudinal study involving 107 healthy mother-infant pairs.
Disclosures: This study was supported by the National Institutes of Health and the University of Pennsylvania Center for AIDS Research. Dr. Pannaraj reported ties to AstraZeneca and Pfizer.
Parenting style linked to toddler sensory adaptation, behavior
SAN FRANCISCO – Children of parents who have a permissive parenting style were more likely to have atypical sensory adaptation at age 1 year and increased behavior difficulties at 2 years, compared to children exposed to other parenting styles, in a new, unpublished study.
Toddlers with permissive parents had more than double the risk of internalizing behaviors and triple the risk of externalizing behaviors compared to peers whose parents used an authoritative or authoritarian parenting style, reported Mary Lauren Neel, MD, a fellow in pediatrics at Vanderbilt University, Nashville, Tenn. This association appeared stronger among preterm infants, but without a statistically significant increased effect.
Dr. Neel’s study tested whether children’s sensory adaptation differed according to parenting styles, as defined by the validated Baumrind’s framework of authoritative, authoritarian, and permissive parenting (Genet Psychol Monogr. 1967 Feb;75[1]:43-88). These styles are based on parents’ demandingness (whether they have developmentally appropriate expectations of their child) and responsivity (how sensitively parents perceive and respond to children’s needs), Dr. Neel explained. The majority of the children’s parents (61%) had an authoritative style, while 18% had an authoritarian style, and 11% had a permissive style.
Previous research has identified a link between abnormal sensory interactions with the environment and early behavioral problems, and preterm infants are already more likely to experience both behavioral difficulties and atypical sensory adaption than are children born at term. Dr. Neel’s research, therefore, compared 52 term infants and 51 preterm infants. The median gestational age at birth was 35 weeks, and 29% of the cohort were very preterm, born at 32 weeks or earlier. Almost all (97%) of the mothers had at least a high school education.
The researchers assessed the infants at 12 months with the Infant/Toddler Sensory Profile and at 24 months with the Child Behavior Checklist. At 12 months, after adjustment for gestational age at birth, infants of authoritative parents had greater oral sensation seeking (P = .01) and decreased sensory sensitivity (P = .02), those of authoritarian parents had increased sensation seeking (P = .04), and those of permissive parents had decreased attention to children’s visual surroundings (P = .03).
One in five (21%) of the children had an atypical neurologic threshold at 1 year, but no statistically significant association was seen between an atypical threshold and authoritarian and authoritative parenting. Neither parenting style was associated with externalizing or internalizing behaviors.
Permissive parents’ children, however, were 2.6 times more likely to have atypical sensory adaptation. Further, at 2 years, these children were 2.2 times more likely to have internalizing behaviors and 3 times more likely to have externalizing behaviors, Dr. Neel reported.
“The association between permissive parenting and abnormal sensory neurological threshold in the home environment may explain the increased risk for behavior problems in children of permissive parents at 2 years,” she said. The results were consistent among term and preterm infants with a trend toward increasing significance preterm infants.
“It’s possible that prematurity augments these dynamics, but we would need a larger sample size,” she said, adding that the potential underlying mechanisms for that association are something that future research would need to tease out.
After an audience member asked about the possibility that children’s sensory capabilities might be driving parenting style, Dr. Neel acknowledged the bidirectional relationship between parent and child but noted that most psychology research suggest parenting style has more to do with the parents than with their children.
Limitations of the study include its small size and lack of data on other potential confounding factors, such as parental mental health.
The study was funded by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development as well as a private grant. Dr. Neel reported having no disclosures.
SAN FRANCISCO – Children of parents who have a permissive parenting style were more likely to have atypical sensory adaptation at age 1 year and increased behavior difficulties at 2 years, compared to children exposed to other parenting styles, in a new, unpublished study.
Toddlers with permissive parents had more than double the risk of internalizing behaviors and triple the risk of externalizing behaviors compared to peers whose parents used an authoritative or authoritarian parenting style, reported Mary Lauren Neel, MD, a fellow in pediatrics at Vanderbilt University, Nashville, Tenn. This association appeared stronger among preterm infants, but without a statistically significant increased effect.
Dr. Neel’s study tested whether children’s sensory adaptation differed according to parenting styles, as defined by the validated Baumrind’s framework of authoritative, authoritarian, and permissive parenting (Genet Psychol Monogr. 1967 Feb;75[1]:43-88). These styles are based on parents’ demandingness (whether they have developmentally appropriate expectations of their child) and responsivity (how sensitively parents perceive and respond to children’s needs), Dr. Neel explained. The majority of the children’s parents (61%) had an authoritative style, while 18% had an authoritarian style, and 11% had a permissive style.
Previous research has identified a link between abnormal sensory interactions with the environment and early behavioral problems, and preterm infants are already more likely to experience both behavioral difficulties and atypical sensory adaption than are children born at term. Dr. Neel’s research, therefore, compared 52 term infants and 51 preterm infants. The median gestational age at birth was 35 weeks, and 29% of the cohort were very preterm, born at 32 weeks or earlier. Almost all (97%) of the mothers had at least a high school education.
The researchers assessed the infants at 12 months with the Infant/Toddler Sensory Profile and at 24 months with the Child Behavior Checklist. At 12 months, after adjustment for gestational age at birth, infants of authoritative parents had greater oral sensation seeking (P = .01) and decreased sensory sensitivity (P = .02), those of authoritarian parents had increased sensation seeking (P = .04), and those of permissive parents had decreased attention to children’s visual surroundings (P = .03).
One in five (21%) of the children had an atypical neurologic threshold at 1 year, but no statistically significant association was seen between an atypical threshold and authoritarian and authoritative parenting. Neither parenting style was associated with externalizing or internalizing behaviors.
Permissive parents’ children, however, were 2.6 times more likely to have atypical sensory adaptation. Further, at 2 years, these children were 2.2 times more likely to have internalizing behaviors and 3 times more likely to have externalizing behaviors, Dr. Neel reported.
“The association between permissive parenting and abnormal sensory neurological threshold in the home environment may explain the increased risk for behavior problems in children of permissive parents at 2 years,” she said. The results were consistent among term and preterm infants with a trend toward increasing significance preterm infants.
“It’s possible that prematurity augments these dynamics, but we would need a larger sample size,” she said, adding that the potential underlying mechanisms for that association are something that future research would need to tease out.
After an audience member asked about the possibility that children’s sensory capabilities might be driving parenting style, Dr. Neel acknowledged the bidirectional relationship between parent and child but noted that most psychology research suggest parenting style has more to do with the parents than with their children.
Limitations of the study include its small size and lack of data on other potential confounding factors, such as parental mental health.
The study was funded by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development as well as a private grant. Dr. Neel reported having no disclosures.
SAN FRANCISCO – Children of parents who have a permissive parenting style were more likely to have atypical sensory adaptation at age 1 year and increased behavior difficulties at 2 years, compared to children exposed to other parenting styles, in a new, unpublished study.
Toddlers with permissive parents had more than double the risk of internalizing behaviors and triple the risk of externalizing behaviors compared to peers whose parents used an authoritative or authoritarian parenting style, reported Mary Lauren Neel, MD, a fellow in pediatrics at Vanderbilt University, Nashville, Tenn. This association appeared stronger among preterm infants, but without a statistically significant increased effect.
Dr. Neel’s study tested whether children’s sensory adaptation differed according to parenting styles, as defined by the validated Baumrind’s framework of authoritative, authoritarian, and permissive parenting (Genet Psychol Monogr. 1967 Feb;75[1]:43-88). These styles are based on parents’ demandingness (whether they have developmentally appropriate expectations of their child) and responsivity (how sensitively parents perceive and respond to children’s needs), Dr. Neel explained. The majority of the children’s parents (61%) had an authoritative style, while 18% had an authoritarian style, and 11% had a permissive style.
Previous research has identified a link between abnormal sensory interactions with the environment and early behavioral problems, and preterm infants are already more likely to experience both behavioral difficulties and atypical sensory adaption than are children born at term. Dr. Neel’s research, therefore, compared 52 term infants and 51 preterm infants. The median gestational age at birth was 35 weeks, and 29% of the cohort were very preterm, born at 32 weeks or earlier. Almost all (97%) of the mothers had at least a high school education.
The researchers assessed the infants at 12 months with the Infant/Toddler Sensory Profile and at 24 months with the Child Behavior Checklist. At 12 months, after adjustment for gestational age at birth, infants of authoritative parents had greater oral sensation seeking (P = .01) and decreased sensory sensitivity (P = .02), those of authoritarian parents had increased sensation seeking (P = .04), and those of permissive parents had decreased attention to children’s visual surroundings (P = .03).
One in five (21%) of the children had an atypical neurologic threshold at 1 year, but no statistically significant association was seen between an atypical threshold and authoritarian and authoritative parenting. Neither parenting style was associated with externalizing or internalizing behaviors.
Permissive parents’ children, however, were 2.6 times more likely to have atypical sensory adaptation. Further, at 2 years, these children were 2.2 times more likely to have internalizing behaviors and 3 times more likely to have externalizing behaviors, Dr. Neel reported.
“The association between permissive parenting and abnormal sensory neurological threshold in the home environment may explain the increased risk for behavior problems in children of permissive parents at 2 years,” she said. The results were consistent among term and preterm infants with a trend toward increasing significance preterm infants.
“It’s possible that prematurity augments these dynamics, but we would need a larger sample size,” she said, adding that the potential underlying mechanisms for that association are something that future research would need to tease out.
After an audience member asked about the possibility that children’s sensory capabilities might be driving parenting style, Dr. Neel acknowledged the bidirectional relationship between parent and child but noted that most psychology research suggest parenting style has more to do with the parents than with their children.
Limitations of the study include its small size and lack of data on other potential confounding factors, such as parental mental health.
The study was funded by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development as well as a private grant. Dr. Neel reported having no disclosures.
AT PAS 17
Key clinical point: A permissive parenting style is associated with greater behavioral problems in children at age 2 years.
Major finding: Children of permissive parents had 2.2 times greater likelihood of internalizing behaviors and 3 times greater risk of externalizing behaviors at age 2, compared to children of parents with other styles.
Data source: A prospective observational study of 103 infants assessed at 12 and 24 months.
Disclosures: The study was funded by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development as well as a private grant. Dr. Neel reported having no disclosures.
Periconception smoking found to affect birth defect risk
SAN DIEGO – Smoking during the period of fetal organogenesis, during the first trimester of pregnancy, is associated with increased risk of some birth defects, results from a large retrospective analysis demonstrated.
Ms. Perry, a second-year medical student at the University of Cincinnati and her associates conducted a population-based retrospective cohort analysis of 1,436,036 live births in Ohio during 2006-2015. They compared the rates of major defects between births to nonsmoking mothers and those who smoked only during the 3-month preconception period and not in the first trimester; and in the preconception period plus throughout the first trimester. They used multivariate logistic regression to quantify the relationship between smoking and birth defects after adjustment for maternal race, age, pregestational diabetes, and socioeconomic factors.
The researchers observed that 23.3% of women smoked during pregnancy; 6.0% during preconception only and 17.3% smoked through the first trimester, as well. Smoking during the preconception period only, even without first trimester exposure, was associated with a 40% increased risk of gastroschisis (adjusted risk ratio, 1.4), but no other individual birth defects. However, smoking through the first trimester was associated with a modest but significantly increased risk of several defects, including gastroschisis (adjusted RR, 1.9), limb reduction (adjusted RR, 1.6), congenital diaphragmatic hernia (adjusted RR, 1.4), and cleft palate (adjusted RR, 1.2), even after adjustment for coexisting factors.
“It was surprising to see that, even when women stop smoking when they find out they are pregnant, and therefore are not smoking during the period of fetal organogenesis, there is still an increased risk of some congenital birth defects to the fetus,” Ms. Perry said. “My hope is that this study serves as a launching point for future research and public health efforts. It’s important to encourage smoking cessation in women of reproductive age, whether pregnant or not. Furthermore, it’s valuable to be able to explain to patients that along with adverse effects to their own health, smoking even before conception poses a risk to the fetus.”
She acknowledged certain limitations of the study, including its observational design. “There could exist unmeasurable influences that we were unable to adjust for,” Ms. Perry said. She reported having no financial disclosures.
SAN DIEGO – Smoking during the period of fetal organogenesis, during the first trimester of pregnancy, is associated with increased risk of some birth defects, results from a large retrospective analysis demonstrated.
Ms. Perry, a second-year medical student at the University of Cincinnati and her associates conducted a population-based retrospective cohort analysis of 1,436,036 live births in Ohio during 2006-2015. They compared the rates of major defects between births to nonsmoking mothers and those who smoked only during the 3-month preconception period and not in the first trimester; and in the preconception period plus throughout the first trimester. They used multivariate logistic regression to quantify the relationship between smoking and birth defects after adjustment for maternal race, age, pregestational diabetes, and socioeconomic factors.
The researchers observed that 23.3% of women smoked during pregnancy; 6.0% during preconception only and 17.3% smoked through the first trimester, as well. Smoking during the preconception period only, even without first trimester exposure, was associated with a 40% increased risk of gastroschisis (adjusted risk ratio, 1.4), but no other individual birth defects. However, smoking through the first trimester was associated with a modest but significantly increased risk of several defects, including gastroschisis (adjusted RR, 1.9), limb reduction (adjusted RR, 1.6), congenital diaphragmatic hernia (adjusted RR, 1.4), and cleft palate (adjusted RR, 1.2), even after adjustment for coexisting factors.
“It was surprising to see that, even when women stop smoking when they find out they are pregnant, and therefore are not smoking during the period of fetal organogenesis, there is still an increased risk of some congenital birth defects to the fetus,” Ms. Perry said. “My hope is that this study serves as a launching point for future research and public health efforts. It’s important to encourage smoking cessation in women of reproductive age, whether pregnant or not. Furthermore, it’s valuable to be able to explain to patients that along with adverse effects to their own health, smoking even before conception poses a risk to the fetus.”
She acknowledged certain limitations of the study, including its observational design. “There could exist unmeasurable influences that we were unable to adjust for,” Ms. Perry said. She reported having no financial disclosures.
SAN DIEGO – Smoking during the period of fetal organogenesis, during the first trimester of pregnancy, is associated with increased risk of some birth defects, results from a large retrospective analysis demonstrated.
Ms. Perry, a second-year medical student at the University of Cincinnati and her associates conducted a population-based retrospective cohort analysis of 1,436,036 live births in Ohio during 2006-2015. They compared the rates of major defects between births to nonsmoking mothers and those who smoked only during the 3-month preconception period and not in the first trimester; and in the preconception period plus throughout the first trimester. They used multivariate logistic regression to quantify the relationship between smoking and birth defects after adjustment for maternal race, age, pregestational diabetes, and socioeconomic factors.
The researchers observed that 23.3% of women smoked during pregnancy; 6.0% during preconception only and 17.3% smoked through the first trimester, as well. Smoking during the preconception period only, even without first trimester exposure, was associated with a 40% increased risk of gastroschisis (adjusted risk ratio, 1.4), but no other individual birth defects. However, smoking through the first trimester was associated with a modest but significantly increased risk of several defects, including gastroschisis (adjusted RR, 1.9), limb reduction (adjusted RR, 1.6), congenital diaphragmatic hernia (adjusted RR, 1.4), and cleft palate (adjusted RR, 1.2), even after adjustment for coexisting factors.
“It was surprising to see that, even when women stop smoking when they find out they are pregnant, and therefore are not smoking during the period of fetal organogenesis, there is still an increased risk of some congenital birth defects to the fetus,” Ms. Perry said. “My hope is that this study serves as a launching point for future research and public health efforts. It’s important to encourage smoking cessation in women of reproductive age, whether pregnant or not. Furthermore, it’s valuable to be able to explain to patients that along with adverse effects to their own health, smoking even before conception poses a risk to the fetus.”
She acknowledged certain limitations of the study, including its observational design. “There could exist unmeasurable influences that we were unable to adjust for,” Ms. Perry said. She reported having no financial disclosures.
AT ACOG 2017
Key clinical point:
Major finding: Smoking during only the preconception period was associated with a 40% increased risk of gastroschisis (adjusted RR, 1.4), while smoking during the first trimester of pregnancy was associated with a significantly increased risk of gastroschisis (adjusted RR, 1.9) and several other birth defects.
Data source: A retrospective cohort analysis of 1,436,036 live births in Ohio during 2006-2015.
Disclosures: Ms. Perry reported having no financial disclosures.
Cushing’s appears to begin its cardiovascular effects during childhood
ORLANDO – Cushing’s disease may begin to exert its harmful cardiovascular effects quite early, a small pediatric study has found.
Children as young as 6 years old with the disorder already may show signs of cardiovascular remodeling, with stiffer aortas and higher aortic pulse-wave velocity than do age-matched controls, Hailey Blain and Maya Lodish, MD, said at the annual meeting of the Endocrine Society.
Cushing’s diseases has long been linked with increased cardiovascular risk in adults, but the study by Dr. Lodish and Ms. Blain is one of the first to examine the link in children. Their findings suggest that early cardiovascular risk factor management should be a routine part of these patients’ care, Dr. Lodish said in an interview.
“It’s very important to make sure that there is recognition of the cardiovascular risk factors that go along with this disease. Elevated levels of cholesterol, hypertension, and other risk factors that are in these individuals should be ameliorated as soon as possible from an early age and, most importantly, physicians should be diagnosing and treating children early, once they are identified as having Cushing’s disease. And, given that we are not sure whether these changes are reversible, we need to make sure these children are followed very closely.”
Indeed, Dr. Lodish has reason to believe that the changes may be long lasting or even permanent.
“We are looking at these children longitudinally and have 3-year data on some patients already. We want to see if they return to normal pulse wave velocity after surgical cure, or whether this is permanent remodeling. There is an implication already that it may be in a subset of individuals,” she said, citing her own 2009 study on hypertension in pediatric Cushing’s patients. “We looked at blood pressure at presentation, after surgical cure, and 1 year later. A significant portion of the kids still had hypertension at 1 year. This leads us to wonder if they will continue to be at risk for cardiovascular morbidity as adults.”
The patients had a mean 2.5-year history of Cushing’s disease Their mean midnight cortisol level was 18.8 mcg/dL and mean plasma adrenocorticotropic hormone level, 77.3 pg/mL. Five patients were taking antihypertensive medications. Low- and high-density lipoprotein levels were acceptable in all patients.
The cardiovascular measures were compared to an age-matched historical control group. In this comparison, patients had significantly higher pulse wave velocity compared with controls (mean 4 vs. 3.4 m/s). Pulse wave velocity positively correlated with both midnight plasma cortisol and 24-hour urinary free cortisol collections. In the three patients with long-term follow-up after surgical cure of Cushing’s, the pulse wave velocity did not improve, either at 6 months or 1 year after surgery. This finding echoes those of Dr. Lodish’s 2009 paper, suggesting that once cardiovascular remodeling sets in, the changes may be long lasting.
“The link between Cushing’s and cardiovascular remodeling is related to the other things that go along with the disease,” Dr. Lodish said. “The hypertension, the adiposity, and the high cholesterol all may contribute to arterial rigidity. It’s also thought to be due to an increase in connective tissue. The bioelastic function of the aorta may be affected by having Cushing’s.”
That connection also suggests that certain antihypertensives may be more beneficial to patients with Cushing’s disease, she added. “It might have an implication in what blood pressure drug you use. Angiotensin-converting enzyme inhibitors increase vascular distensibility and inhibit collagen formation and fibrosis. It is a pilot study and needs longitudinal follow up and additional patient accrual, however, finding signs of cardiovascular remodeling in young children with Cushing’s is intriguing and deserves further study.”
Neither Ms. Blain nor Dr. Lodish had any financial disclosures.
ORLANDO – Cushing’s disease may begin to exert its harmful cardiovascular effects quite early, a small pediatric study has found.
Children as young as 6 years old with the disorder already may show signs of cardiovascular remodeling, with stiffer aortas and higher aortic pulse-wave velocity than do age-matched controls, Hailey Blain and Maya Lodish, MD, said at the annual meeting of the Endocrine Society.
Cushing’s diseases has long been linked with increased cardiovascular risk in adults, but the study by Dr. Lodish and Ms. Blain is one of the first to examine the link in children. Their findings suggest that early cardiovascular risk factor management should be a routine part of these patients’ care, Dr. Lodish said in an interview.
“It’s very important to make sure that there is recognition of the cardiovascular risk factors that go along with this disease. Elevated levels of cholesterol, hypertension, and other risk factors that are in these individuals should be ameliorated as soon as possible from an early age and, most importantly, physicians should be diagnosing and treating children early, once they are identified as having Cushing’s disease. And, given that we are not sure whether these changes are reversible, we need to make sure these children are followed very closely.”
Indeed, Dr. Lodish has reason to believe that the changes may be long lasting or even permanent.
“We are looking at these children longitudinally and have 3-year data on some patients already. We want to see if they return to normal pulse wave velocity after surgical cure, or whether this is permanent remodeling. There is an implication already that it may be in a subset of individuals,” she said, citing her own 2009 study on hypertension in pediatric Cushing’s patients. “We looked at blood pressure at presentation, after surgical cure, and 1 year later. A significant portion of the kids still had hypertension at 1 year. This leads us to wonder if they will continue to be at risk for cardiovascular morbidity as adults.”
The patients had a mean 2.5-year history of Cushing’s disease Their mean midnight cortisol level was 18.8 mcg/dL and mean plasma adrenocorticotropic hormone level, 77.3 pg/mL. Five patients were taking antihypertensive medications. Low- and high-density lipoprotein levels were acceptable in all patients.
The cardiovascular measures were compared to an age-matched historical control group. In this comparison, patients had significantly higher pulse wave velocity compared with controls (mean 4 vs. 3.4 m/s). Pulse wave velocity positively correlated with both midnight plasma cortisol and 24-hour urinary free cortisol collections. In the three patients with long-term follow-up after surgical cure of Cushing’s, the pulse wave velocity did not improve, either at 6 months or 1 year after surgery. This finding echoes those of Dr. Lodish’s 2009 paper, suggesting that once cardiovascular remodeling sets in, the changes may be long lasting.
“The link between Cushing’s and cardiovascular remodeling is related to the other things that go along with the disease,” Dr. Lodish said. “The hypertension, the adiposity, and the high cholesterol all may contribute to arterial rigidity. It’s also thought to be due to an increase in connective tissue. The bioelastic function of the aorta may be affected by having Cushing’s.”
That connection also suggests that certain antihypertensives may be more beneficial to patients with Cushing’s disease, she added. “It might have an implication in what blood pressure drug you use. Angiotensin-converting enzyme inhibitors increase vascular distensibility and inhibit collagen formation and fibrosis. It is a pilot study and needs longitudinal follow up and additional patient accrual, however, finding signs of cardiovascular remodeling in young children with Cushing’s is intriguing and deserves further study.”
Neither Ms. Blain nor Dr. Lodish had any financial disclosures.
ORLANDO – Cushing’s disease may begin to exert its harmful cardiovascular effects quite early, a small pediatric study has found.
Children as young as 6 years old with the disorder already may show signs of cardiovascular remodeling, with stiffer aortas and higher aortic pulse-wave velocity than do age-matched controls, Hailey Blain and Maya Lodish, MD, said at the annual meeting of the Endocrine Society.
Cushing’s diseases has long been linked with increased cardiovascular risk in adults, but the study by Dr. Lodish and Ms. Blain is one of the first to examine the link in children. Their findings suggest that early cardiovascular risk factor management should be a routine part of these patients’ care, Dr. Lodish said in an interview.
“It’s very important to make sure that there is recognition of the cardiovascular risk factors that go along with this disease. Elevated levels of cholesterol, hypertension, and other risk factors that are in these individuals should be ameliorated as soon as possible from an early age and, most importantly, physicians should be diagnosing and treating children early, once they are identified as having Cushing’s disease. And, given that we are not sure whether these changes are reversible, we need to make sure these children are followed very closely.”
Indeed, Dr. Lodish has reason to believe that the changes may be long lasting or even permanent.
“We are looking at these children longitudinally and have 3-year data on some patients already. We want to see if they return to normal pulse wave velocity after surgical cure, or whether this is permanent remodeling. There is an implication already that it may be in a subset of individuals,” she said, citing her own 2009 study on hypertension in pediatric Cushing’s patients. “We looked at blood pressure at presentation, after surgical cure, and 1 year later. A significant portion of the kids still had hypertension at 1 year. This leads us to wonder if they will continue to be at risk for cardiovascular morbidity as adults.”
The patients had a mean 2.5-year history of Cushing’s disease Their mean midnight cortisol level was 18.8 mcg/dL and mean plasma adrenocorticotropic hormone level, 77.3 pg/mL. Five patients were taking antihypertensive medications. Low- and high-density lipoprotein levels were acceptable in all patients.
The cardiovascular measures were compared to an age-matched historical control group. In this comparison, patients had significantly higher pulse wave velocity compared with controls (mean 4 vs. 3.4 m/s). Pulse wave velocity positively correlated with both midnight plasma cortisol and 24-hour urinary free cortisol collections. In the three patients with long-term follow-up after surgical cure of Cushing’s, the pulse wave velocity did not improve, either at 6 months or 1 year after surgery. This finding echoes those of Dr. Lodish’s 2009 paper, suggesting that once cardiovascular remodeling sets in, the changes may be long lasting.
“The link between Cushing’s and cardiovascular remodeling is related to the other things that go along with the disease,” Dr. Lodish said. “The hypertension, the adiposity, and the high cholesterol all may contribute to arterial rigidity. It’s also thought to be due to an increase in connective tissue. The bioelastic function of the aorta may be affected by having Cushing’s.”
That connection also suggests that certain antihypertensives may be more beneficial to patients with Cushing’s disease, she added. “It might have an implication in what blood pressure drug you use. Angiotensin-converting enzyme inhibitors increase vascular distensibility and inhibit collagen formation and fibrosis. It is a pilot study and needs longitudinal follow up and additional patient accrual, however, finding signs of cardiovascular remodeling in young children with Cushing’s is intriguing and deserves further study.”
Neither Ms. Blain nor Dr. Lodish had any financial disclosures.
AT ENDO 2017
Key clinical point:
Major finding: Patients had significantly higher pulse wave velocity, compared with controls (mean 4 vs. 3.4 m/s).
Data source: The small cohort study comprises 10 patients and a series of age-matched historical controls.
Disclosures: Neither Dr. Lodish nor Ms. Blain have any financial disclosures.
Each added day of pediatric MRSA bacteremia upped complication risk 50%
Every additional day of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in hospitalized children was associated with a 50% increased risk of developing a complication, reported Rana F. Hamdy, MD, of Children’s National Health System, Washington, and her associates.
That was one of the findings of a study performed to determine the epidemiology, clinical outcomes, and risk factors for treatment failure in pediatric MRSA bacteremia. It took place in three hospitals, one each in Philadelphia, Baltimore, and Salt Lake City.
“This finding is in contrast to the epidemiology of MRSA bacteremia in adults, in whom bacteremia is more frequently attributed to catheter-related infections (31%-36%), endovascular infections (13%-15%), or an unknown source (15%-20%), and the durations of MRSA bacteremia are typically more prolonged (median duration of bacteremia is 8-9 days),” Dr. Hamdy and her associates wrote.
“Differences in the epidemiology of MRSA bacteremia between children and adults emphasize the need for dedicated pediatric studies to better understand the clinical characteristics and outcomes specific to children,” the researchers noted.
Musculoskeletal infections and endovascular infections were linked with treatment failure, possibly reflecting “the relatively higher burden of bacteria and/or decreased drug penetration into bone and endovascular infection sites,” the investigators said. Catheter-related infections were tied to reduced odds of treatment failure, “these episodes being localized to the catheter and therefore potentially less-invasive S. aureus infections.”
Mortality among these children with MRSA bacteremia was low, at 2%, but “nearly one-quarter of all patients experienced complications,” the study authors said (Pediatrics. 2017 May 5. doi: 10.1542/peds.2017-0183).
There was progression of infection in 7% of cases, and hematogenous complications or sequelae occurred in 23%. Twenty percent of children developed septic emboli or another metastatic focus of infection.
“This association between the duration of bacteremia and the development of complications has been previously reported among adults with S. aureus bacteremia,” Dr. Hamdy noted, “and provides important epidemiologic data that could inform decisions relating to the timing of additional imaging, such as echocardiograms, to identify metastatic foci.”
The children were treated with vancomycin, and some received additional anti-MRSA antibiotics. “Vancomycin trough concentrations or [minimum inhibitory concentrations] were not associated with treatment failure,” the investigators said. “Future studies to determine the appropriate vancomycin dose, duration, and approach to therapeutic drug monitoring are warranted to optimize patient outcomes.”
The National Institutes of Health funded the study. Dr. Hamdy and her associates disclosed they have no relevant financial relationships.
Every additional day of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in hospitalized children was associated with a 50% increased risk of developing a complication, reported Rana F. Hamdy, MD, of Children’s National Health System, Washington, and her associates.
That was one of the findings of a study performed to determine the epidemiology, clinical outcomes, and risk factors for treatment failure in pediatric MRSA bacteremia. It took place in three hospitals, one each in Philadelphia, Baltimore, and Salt Lake City.
“This finding is in contrast to the epidemiology of MRSA bacteremia in adults, in whom bacteremia is more frequently attributed to catheter-related infections (31%-36%), endovascular infections (13%-15%), or an unknown source (15%-20%), and the durations of MRSA bacteremia are typically more prolonged (median duration of bacteremia is 8-9 days),” Dr. Hamdy and her associates wrote.
“Differences in the epidemiology of MRSA bacteremia between children and adults emphasize the need for dedicated pediatric studies to better understand the clinical characteristics and outcomes specific to children,” the researchers noted.
Musculoskeletal infections and endovascular infections were linked with treatment failure, possibly reflecting “the relatively higher burden of bacteria and/or decreased drug penetration into bone and endovascular infection sites,” the investigators said. Catheter-related infections were tied to reduced odds of treatment failure, “these episodes being localized to the catheter and therefore potentially less-invasive S. aureus infections.”
Mortality among these children with MRSA bacteremia was low, at 2%, but “nearly one-quarter of all patients experienced complications,” the study authors said (Pediatrics. 2017 May 5. doi: 10.1542/peds.2017-0183).
There was progression of infection in 7% of cases, and hematogenous complications or sequelae occurred in 23%. Twenty percent of children developed septic emboli or another metastatic focus of infection.
“This association between the duration of bacteremia and the development of complications has been previously reported among adults with S. aureus bacteremia,” Dr. Hamdy noted, “and provides important epidemiologic data that could inform decisions relating to the timing of additional imaging, such as echocardiograms, to identify metastatic foci.”
The children were treated with vancomycin, and some received additional anti-MRSA antibiotics. “Vancomycin trough concentrations or [minimum inhibitory concentrations] were not associated with treatment failure,” the investigators said. “Future studies to determine the appropriate vancomycin dose, duration, and approach to therapeutic drug monitoring are warranted to optimize patient outcomes.”
The National Institutes of Health funded the study. Dr. Hamdy and her associates disclosed they have no relevant financial relationships.
Every additional day of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in hospitalized children was associated with a 50% increased risk of developing a complication, reported Rana F. Hamdy, MD, of Children’s National Health System, Washington, and her associates.
That was one of the findings of a study performed to determine the epidemiology, clinical outcomes, and risk factors for treatment failure in pediatric MRSA bacteremia. It took place in three hospitals, one each in Philadelphia, Baltimore, and Salt Lake City.
“This finding is in contrast to the epidemiology of MRSA bacteremia in adults, in whom bacteremia is more frequently attributed to catheter-related infections (31%-36%), endovascular infections (13%-15%), or an unknown source (15%-20%), and the durations of MRSA bacteremia are typically more prolonged (median duration of bacteremia is 8-9 days),” Dr. Hamdy and her associates wrote.
“Differences in the epidemiology of MRSA bacteremia between children and adults emphasize the need for dedicated pediatric studies to better understand the clinical characteristics and outcomes specific to children,” the researchers noted.
Musculoskeletal infections and endovascular infections were linked with treatment failure, possibly reflecting “the relatively higher burden of bacteria and/or decreased drug penetration into bone and endovascular infection sites,” the investigators said. Catheter-related infections were tied to reduced odds of treatment failure, “these episodes being localized to the catheter and therefore potentially less-invasive S. aureus infections.”
Mortality among these children with MRSA bacteremia was low, at 2%, but “nearly one-quarter of all patients experienced complications,” the study authors said (Pediatrics. 2017 May 5. doi: 10.1542/peds.2017-0183).
There was progression of infection in 7% of cases, and hematogenous complications or sequelae occurred in 23%. Twenty percent of children developed septic emboli or another metastatic focus of infection.
“This association between the duration of bacteremia and the development of complications has been previously reported among adults with S. aureus bacteremia,” Dr. Hamdy noted, “and provides important epidemiologic data that could inform decisions relating to the timing of additional imaging, such as echocardiograms, to identify metastatic foci.”
The children were treated with vancomycin, and some received additional anti-MRSA antibiotics. “Vancomycin trough concentrations or [minimum inhibitory concentrations] were not associated with treatment failure,” the investigators said. “Future studies to determine the appropriate vancomycin dose, duration, and approach to therapeutic drug monitoring are warranted to optimize patient outcomes.”
The National Institutes of Health funded the study. Dr. Hamdy and her associates disclosed they have no relevant financial relationships.
FROM PEDIATRICS
Key clinical point:
Major finding: The primary sources of infection were osteomyelitis (31%), catheter-related bloodstream infections (22%), and skin and soft tissue infections (16%); endocarditis occurred in only 2% – a different epidemiology than in adults.
Data source: A study of 174 hospitalized children (younger than 19 years) with MRSA bacteremia at three hospitals in different states.
Disclosures: The National Institutes of Health funded the study. Dr. Hamdy and her associates disclosed they have no relevant financial relationships.
Two doses HPV vaccine are as good as three against genital warts
Receiving two doses of human papillomavirus (HPV) vaccine at 5-month intervals or longer appears to provide similar protection against genital warts as three doses among girls initiating the series before age 15 years, reported Rebecca B. Perkins, MD, of Boston University, and her associates.
Of 387,906 adolescent females, 8% received 1 dose of HPV vaccine, 9% received 2 doses, 31% received 3 doses, and 52% remained unvaccinated. The mean age of the girls in the study was 15 years, and average length of follow-up was 6 years. The girls were aged 9-18 years on Jan.1, 2007, and the exposure period began at that time for unvaccinated girls or on the date of the last HPV vaccine injection for those receiving the vaccine. Among girls receiving more than 1 dose, 60% received their second dose within 3 months of their first dose (on time), and 47% received their third dose within 5 months of their second dose.
“Although reductions in genital warts are an important early marker of vaccine effectiveness, reductions in cervical dysplasia and cancers are far more important vaccine-related outcomes,” Dr. Perkins and her associates said. “Human papillomavirus vaccine protection must last many years to provide adequate cancer protection, therefore ongoing studies are paramount,” they noted.
The study used data from the Truven Health Analytics MarketScan Commercial Claims Database, covering enrollees and dependents from about half of provider-sponsored U.S. health insurance plans.
Read more at (Sex Transm Dis. 2017 Jun. doi: 10.1097/OLQ.0000000000000615).
Receiving two doses of human papillomavirus (HPV) vaccine at 5-month intervals or longer appears to provide similar protection against genital warts as three doses among girls initiating the series before age 15 years, reported Rebecca B. Perkins, MD, of Boston University, and her associates.
Of 387,906 adolescent females, 8% received 1 dose of HPV vaccine, 9% received 2 doses, 31% received 3 doses, and 52% remained unvaccinated. The mean age of the girls in the study was 15 years, and average length of follow-up was 6 years. The girls were aged 9-18 years on Jan.1, 2007, and the exposure period began at that time for unvaccinated girls or on the date of the last HPV vaccine injection for those receiving the vaccine. Among girls receiving more than 1 dose, 60% received their second dose within 3 months of their first dose (on time), and 47% received their third dose within 5 months of their second dose.
“Although reductions in genital warts are an important early marker of vaccine effectiveness, reductions in cervical dysplasia and cancers are far more important vaccine-related outcomes,” Dr. Perkins and her associates said. “Human papillomavirus vaccine protection must last many years to provide adequate cancer protection, therefore ongoing studies are paramount,” they noted.
The study used data from the Truven Health Analytics MarketScan Commercial Claims Database, covering enrollees and dependents from about half of provider-sponsored U.S. health insurance plans.
Read more at (Sex Transm Dis. 2017 Jun. doi: 10.1097/OLQ.0000000000000615).
Receiving two doses of human papillomavirus (HPV) vaccine at 5-month intervals or longer appears to provide similar protection against genital warts as three doses among girls initiating the series before age 15 years, reported Rebecca B. Perkins, MD, of Boston University, and her associates.
Of 387,906 adolescent females, 8% received 1 dose of HPV vaccine, 9% received 2 doses, 31% received 3 doses, and 52% remained unvaccinated. The mean age of the girls in the study was 15 years, and average length of follow-up was 6 years. The girls were aged 9-18 years on Jan.1, 2007, and the exposure period began at that time for unvaccinated girls or on the date of the last HPV vaccine injection for those receiving the vaccine. Among girls receiving more than 1 dose, 60% received their second dose within 3 months of their first dose (on time), and 47% received their third dose within 5 months of their second dose.
“Although reductions in genital warts are an important early marker of vaccine effectiveness, reductions in cervical dysplasia and cancers are far more important vaccine-related outcomes,” Dr. Perkins and her associates said. “Human papillomavirus vaccine protection must last many years to provide adequate cancer protection, therefore ongoing studies are paramount,” they noted.
The study used data from the Truven Health Analytics MarketScan Commercial Claims Database, covering enrollees and dependents from about half of provider-sponsored U.S. health insurance plans.
Read more at (Sex Transm Dis. 2017 Jun. doi: 10.1097/OLQ.0000000000000615).
FROM SEXUALLY TRANSMITTED DISEASES
Game over: VTE is a risk in obese, sedentary teens
MONTREAL – It’s well known that airplane passengers, condemned to sit for endless hours in the claustrophobic cabins of the unfriendly skies, are at increased risk for venous thromboembolic events (VTEs). Less well documented, however, is the VTE risk encountered by overweight or obese teens who while their hours away playing video games.
“This is becoming a sedentary-type risk factor,” said Mira A. Kohorst, MD, from the division of pediatric hematology-oncology at the Mayo Clinic in Rochester, Minn.
Dr. Kohorst and her colleagues reported on a small but troubling trend of VTE episodes that they observed in teen boys over the last few years. They refer to obesity, sedentary lifestyle, and gaming as “the new thrombophilia cocktail in adolescent males.”
The reported incidence of pediatric VTE ranges from 0.7 to 4.9 per 100,000 person years, considerably lower than the 1 in 1000 estimated incidences reported in adults. But, thanks to the growing incidence of obesity in children, which more than doubled from 1980 to 2012 and quadrupled in teens age 12-19 years from 5% to 21%, youngsters appear to be catching up in the VTE department, the investigators reported.
“Given the direct mortality rate of 2% [that is] associated with VTE and risk for postthrombotic syndrome of 26%, it is important to understand underlying modifiable risk factors,” they wrote.
To do this, they retrospectively reviewed records of children who presented with VTE in their center.
All play, no exercise
The authors described three cases, including that of an 18-year old boy with a body mass index (BMI) of 37 kg/m2, putting him squarely in the obese category. This lad, who spent 12 or more hours a day playing video games and was sedentary at other times as well, presented with bilateral pulmonary emboli and an associated right lower lobe infarction. Testing for thrombophilia showed that he was heterozygous for factor V Leiden but did not have other coagulation abnormalities. He was started on enoxaparin (Lovenox) and then transitioned to apixaban (Eliquis) for a total of 6 months of thromboprophylaxis. He was counseled about modifying his lifestyle and did not have a recurrence after 14 months of follow-up.
A similarly sedentary 17-year old male with an even higher BMI (39 kg/m2) presented with bilateral basilar pulmonary emboli and infarctions in association with a left femoral deep vein thrombosis. This patients also had factor V Leiden heterozygosity and the May-Thurner (iliac vein compression) syndrome. He was treated for a total of 6 months with warfarin followed by rivaroxaban (Xarelto) and was counseled about lifestyle changes but was unable to lose weight. Eight months after completing therapy, he had a second extensive deep vein thrombosis, this time in his right leg, and was restarted on rivaroxaban.
The third patient, a morbidly obese (BMI 56 kg/m2) 13-year-old boy, presented with left lower lobe pulmonary embolism following 3 weeks of immobility caused by the Guillain-Barré syndrome. As in the other cases, he confessed to a sedentary lifestyle and a predilection for gaming. His father had previously developed a line-associated thrombus. The family declined thrombophilia testing. The patient received 3 months of enoxaparin. He has not been followed since discontinuing therapy.
Move it, kid!
The risk of VTE in adolescent boys, especially obese and extreme gamers who spend most of their waking hours in a chair staring at a screen, is similar to that for adolescent girls who use oral contraceptives, Dr. Kohorst and her colleagues said.
“Many case reports link prolonged ‘gaming’ to thrombosis and fatal pulmonary emboli. Additionally, prolonged television viewing has become a documented risk factor for mortality from pulmonary emboli,” the investigators wrote.
They recommend that clinicians ask adolescents about their gaming and TV-watching habits and encourage them to become more active to lower their risk for VTE.
The study was internally supported. Dr. Kohorst and colleagues reported no relevant disclosures.
MONTREAL – It’s well known that airplane passengers, condemned to sit for endless hours in the claustrophobic cabins of the unfriendly skies, are at increased risk for venous thromboembolic events (VTEs). Less well documented, however, is the VTE risk encountered by overweight or obese teens who while their hours away playing video games.
“This is becoming a sedentary-type risk factor,” said Mira A. Kohorst, MD, from the division of pediatric hematology-oncology at the Mayo Clinic in Rochester, Minn.
Dr. Kohorst and her colleagues reported on a small but troubling trend of VTE episodes that they observed in teen boys over the last few years. They refer to obesity, sedentary lifestyle, and gaming as “the new thrombophilia cocktail in adolescent males.”
The reported incidence of pediatric VTE ranges from 0.7 to 4.9 per 100,000 person years, considerably lower than the 1 in 1000 estimated incidences reported in adults. But, thanks to the growing incidence of obesity in children, which more than doubled from 1980 to 2012 and quadrupled in teens age 12-19 years from 5% to 21%, youngsters appear to be catching up in the VTE department, the investigators reported.
“Given the direct mortality rate of 2% [that is] associated with VTE and risk for postthrombotic syndrome of 26%, it is important to understand underlying modifiable risk factors,” they wrote.
To do this, they retrospectively reviewed records of children who presented with VTE in their center.
All play, no exercise
The authors described three cases, including that of an 18-year old boy with a body mass index (BMI) of 37 kg/m2, putting him squarely in the obese category. This lad, who spent 12 or more hours a day playing video games and was sedentary at other times as well, presented with bilateral pulmonary emboli and an associated right lower lobe infarction. Testing for thrombophilia showed that he was heterozygous for factor V Leiden but did not have other coagulation abnormalities. He was started on enoxaparin (Lovenox) and then transitioned to apixaban (Eliquis) for a total of 6 months of thromboprophylaxis. He was counseled about modifying his lifestyle and did not have a recurrence after 14 months of follow-up.
A similarly sedentary 17-year old male with an even higher BMI (39 kg/m2) presented with bilateral basilar pulmonary emboli and infarctions in association with a left femoral deep vein thrombosis. This patients also had factor V Leiden heterozygosity and the May-Thurner (iliac vein compression) syndrome. He was treated for a total of 6 months with warfarin followed by rivaroxaban (Xarelto) and was counseled about lifestyle changes but was unable to lose weight. Eight months after completing therapy, he had a second extensive deep vein thrombosis, this time in his right leg, and was restarted on rivaroxaban.
The third patient, a morbidly obese (BMI 56 kg/m2) 13-year-old boy, presented with left lower lobe pulmonary embolism following 3 weeks of immobility caused by the Guillain-Barré syndrome. As in the other cases, he confessed to a sedentary lifestyle and a predilection for gaming. His father had previously developed a line-associated thrombus. The family declined thrombophilia testing. The patient received 3 months of enoxaparin. He has not been followed since discontinuing therapy.
Move it, kid!
The risk of VTE in adolescent boys, especially obese and extreme gamers who spend most of their waking hours in a chair staring at a screen, is similar to that for adolescent girls who use oral contraceptives, Dr. Kohorst and her colleagues said.
“Many case reports link prolonged ‘gaming’ to thrombosis and fatal pulmonary emboli. Additionally, prolonged television viewing has become a documented risk factor for mortality from pulmonary emboli,” the investigators wrote.
They recommend that clinicians ask adolescents about their gaming and TV-watching habits and encourage them to become more active to lower their risk for VTE.
The study was internally supported. Dr. Kohorst and colleagues reported no relevant disclosures.
MONTREAL – It’s well known that airplane passengers, condemned to sit for endless hours in the claustrophobic cabins of the unfriendly skies, are at increased risk for venous thromboembolic events (VTEs). Less well documented, however, is the VTE risk encountered by overweight or obese teens who while their hours away playing video games.
“This is becoming a sedentary-type risk factor,” said Mira A. Kohorst, MD, from the division of pediatric hematology-oncology at the Mayo Clinic in Rochester, Minn.
Dr. Kohorst and her colleagues reported on a small but troubling trend of VTE episodes that they observed in teen boys over the last few years. They refer to obesity, sedentary lifestyle, and gaming as “the new thrombophilia cocktail in adolescent males.”
The reported incidence of pediatric VTE ranges from 0.7 to 4.9 per 100,000 person years, considerably lower than the 1 in 1000 estimated incidences reported in adults. But, thanks to the growing incidence of obesity in children, which more than doubled from 1980 to 2012 and quadrupled in teens age 12-19 years from 5% to 21%, youngsters appear to be catching up in the VTE department, the investigators reported.
“Given the direct mortality rate of 2% [that is] associated with VTE and risk for postthrombotic syndrome of 26%, it is important to understand underlying modifiable risk factors,” they wrote.
To do this, they retrospectively reviewed records of children who presented with VTE in their center.
All play, no exercise
The authors described three cases, including that of an 18-year old boy with a body mass index (BMI) of 37 kg/m2, putting him squarely in the obese category. This lad, who spent 12 or more hours a day playing video games and was sedentary at other times as well, presented with bilateral pulmonary emboli and an associated right lower lobe infarction. Testing for thrombophilia showed that he was heterozygous for factor V Leiden but did not have other coagulation abnormalities. He was started on enoxaparin (Lovenox) and then transitioned to apixaban (Eliquis) for a total of 6 months of thromboprophylaxis. He was counseled about modifying his lifestyle and did not have a recurrence after 14 months of follow-up.
A similarly sedentary 17-year old male with an even higher BMI (39 kg/m2) presented with bilateral basilar pulmonary emboli and infarctions in association with a left femoral deep vein thrombosis. This patients also had factor V Leiden heterozygosity and the May-Thurner (iliac vein compression) syndrome. He was treated for a total of 6 months with warfarin followed by rivaroxaban (Xarelto) and was counseled about lifestyle changes but was unable to lose weight. Eight months after completing therapy, he had a second extensive deep vein thrombosis, this time in his right leg, and was restarted on rivaroxaban.
The third patient, a morbidly obese (BMI 56 kg/m2) 13-year-old boy, presented with left lower lobe pulmonary embolism following 3 weeks of immobility caused by the Guillain-Barré syndrome. As in the other cases, he confessed to a sedentary lifestyle and a predilection for gaming. His father had previously developed a line-associated thrombus. The family declined thrombophilia testing. The patient received 3 months of enoxaparin. He has not been followed since discontinuing therapy.
Move it, kid!
The risk of VTE in adolescent boys, especially obese and extreme gamers who spend most of their waking hours in a chair staring at a screen, is similar to that for adolescent girls who use oral contraceptives, Dr. Kohorst and her colleagues said.
“Many case reports link prolonged ‘gaming’ to thrombosis and fatal pulmonary emboli. Additionally, prolonged television viewing has become a documented risk factor for mortality from pulmonary emboli,” the investigators wrote.
They recommend that clinicians ask adolescents about their gaming and TV-watching habits and encourage them to become more active to lower their risk for VTE.
The study was internally supported. Dr. Kohorst and colleagues reported no relevant disclosures.
FROM ASPHO 2017
Key clinical point: Obesity and a sedentary lifestyle are risk factors for venous thromboembolic events in teens, as well as adults.
Major finding: Teen boys who were obese and spent much of their day playing video games presented with VTE.
Data source: Retrospective review and case series.
Disclosures: The study was internally supported. Dr. Kohorst and colleagues reported no relevant disclosures.
Watchful waiting a suitable option for pediatric acute ITP
MONTREAL – Clinicians who manage the care of children with newly diagnosed idiopathic thrombocytopenic purpura (ITP) have to decide whether to treat patients early and possibly increase risk for chronic ITP down the road or to leave well enough alone and treat only as needed.
Evidence from a retrospective study suggests that, for most patients, early treatment of acute ITP does not appear to increase the risk for chronic ITP in the future, reported Chelsea L. Grama, a fourth-year medical student, and her colleagues from Penn State Health Children’s Hospital in Hershey, Pennsylvania.
“It’s controversial whether to treat or not. Some people think steroids are the best way to go, some think IVIG [intravenous immunoglobulin] is the best way to go, and some think that no treatment could be the best option. There is really no consensus in the literature to say what the ideal treatment for ITP is,” she commented in an interview at the annual meeting of the American Society of Pediatric Hematology/Oncology.
That lack of consensus is the result of the fact that serious consequences of ITP, such as intracranial hemorrhage, are rare, making it difficult for investigators to compare clinical outcomes with various forms of treatment. It’s also unclear whether early interventions could lead to later chronic disease.
In hopes of answering this question, Ms. Grama and her coinvestigators, led by Andrew S. Freiberg, MD, took a retrospective look at data on 249 patients with ITP diagnosed from birth through age 21 from 1994 to 2011.
They looked at demographic variables, treatments received, and subsequent platelet counts. Outcomes included intracranial hemorrhage and long-term improvements in platelet counts. They defined chronic ITP as a platelet count below 140,000/mcL for at least 6 months following diagnosis.
Of the 249 patients, 126 (66 boys and 60 girls) progressed to chronic ITP. The incidence of chronic ITP among treated patients was 51.1% and, in untreated patients, 49.3%.
However, in two subgroups, there was a significant association between treatment and chronic ITP. Among girls from birth through age 3 years, 58% of those treated went on to chronic ITP, compared with 0% for untreated patients (P = .008). When the age cohort was expanded to girls younger than 6 years, a similar pattern emerged, with chronic ITP rates of 45% for treated patients, compared with 0% for untreated patients. There were only 44 total patients in this age and sex subgroup, however, making it difficult to draw strong inferences about a potential relationship between treatment and chronic ITP, Ms. Grama noted.
Only three patients had cerebral hemorrhage. Two had hemorrhage as their initial ITP presentation, and the third had bleeding despite being on treatment. The sample size was too small to correlate the outcome with treatment, the authors noted.
In multivariate analysis controlling for demographic, clinical, and treatment factors, only age and platelet count at presentation independently predicted chronic thrombocytopenia (P less than .0001 for each). Steroid therapy was the only independent predictor for acute ITP (P = .0001).
Although their data suggest that there could be a benefit to treating patients who first present with acute ITP at age 12 years or older, “I do think it’s reasonable to wait and watch these patients,” Ms. Grama said.
“The incidence of brain bleeds, which is the really scary complication, was so low in these patients that I think watchful waiting would be a better way to go, just monitoring patients very closely. Hopefully, they will resolve without having treatment,” she added.
The study was internally supported. The authors reported no relevant disclosures.
MONTREAL – Clinicians who manage the care of children with newly diagnosed idiopathic thrombocytopenic purpura (ITP) have to decide whether to treat patients early and possibly increase risk for chronic ITP down the road or to leave well enough alone and treat only as needed.
Evidence from a retrospective study suggests that, for most patients, early treatment of acute ITP does not appear to increase the risk for chronic ITP in the future, reported Chelsea L. Grama, a fourth-year medical student, and her colleagues from Penn State Health Children’s Hospital in Hershey, Pennsylvania.
“It’s controversial whether to treat or not. Some people think steroids are the best way to go, some think IVIG [intravenous immunoglobulin] is the best way to go, and some think that no treatment could be the best option. There is really no consensus in the literature to say what the ideal treatment for ITP is,” she commented in an interview at the annual meeting of the American Society of Pediatric Hematology/Oncology.
That lack of consensus is the result of the fact that serious consequences of ITP, such as intracranial hemorrhage, are rare, making it difficult for investigators to compare clinical outcomes with various forms of treatment. It’s also unclear whether early interventions could lead to later chronic disease.
In hopes of answering this question, Ms. Grama and her coinvestigators, led by Andrew S. Freiberg, MD, took a retrospective look at data on 249 patients with ITP diagnosed from birth through age 21 from 1994 to 2011.
They looked at demographic variables, treatments received, and subsequent platelet counts. Outcomes included intracranial hemorrhage and long-term improvements in platelet counts. They defined chronic ITP as a platelet count below 140,000/mcL for at least 6 months following diagnosis.
Of the 249 patients, 126 (66 boys and 60 girls) progressed to chronic ITP. The incidence of chronic ITP among treated patients was 51.1% and, in untreated patients, 49.3%.
However, in two subgroups, there was a significant association between treatment and chronic ITP. Among girls from birth through age 3 years, 58% of those treated went on to chronic ITP, compared with 0% for untreated patients (P = .008). When the age cohort was expanded to girls younger than 6 years, a similar pattern emerged, with chronic ITP rates of 45% for treated patients, compared with 0% for untreated patients. There were only 44 total patients in this age and sex subgroup, however, making it difficult to draw strong inferences about a potential relationship between treatment and chronic ITP, Ms. Grama noted.
Only three patients had cerebral hemorrhage. Two had hemorrhage as their initial ITP presentation, and the third had bleeding despite being on treatment. The sample size was too small to correlate the outcome with treatment, the authors noted.
In multivariate analysis controlling for demographic, clinical, and treatment factors, only age and platelet count at presentation independently predicted chronic thrombocytopenia (P less than .0001 for each). Steroid therapy was the only independent predictor for acute ITP (P = .0001).
Although their data suggest that there could be a benefit to treating patients who first present with acute ITP at age 12 years or older, “I do think it’s reasonable to wait and watch these patients,” Ms. Grama said.
“The incidence of brain bleeds, which is the really scary complication, was so low in these patients that I think watchful waiting would be a better way to go, just monitoring patients very closely. Hopefully, they will resolve without having treatment,” she added.
The study was internally supported. The authors reported no relevant disclosures.
MONTREAL – Clinicians who manage the care of children with newly diagnosed idiopathic thrombocytopenic purpura (ITP) have to decide whether to treat patients early and possibly increase risk for chronic ITP down the road or to leave well enough alone and treat only as needed.
Evidence from a retrospective study suggests that, for most patients, early treatment of acute ITP does not appear to increase the risk for chronic ITP in the future, reported Chelsea L. Grama, a fourth-year medical student, and her colleagues from Penn State Health Children’s Hospital in Hershey, Pennsylvania.
“It’s controversial whether to treat or not. Some people think steroids are the best way to go, some think IVIG [intravenous immunoglobulin] is the best way to go, and some think that no treatment could be the best option. There is really no consensus in the literature to say what the ideal treatment for ITP is,” she commented in an interview at the annual meeting of the American Society of Pediatric Hematology/Oncology.
That lack of consensus is the result of the fact that serious consequences of ITP, such as intracranial hemorrhage, are rare, making it difficult for investigators to compare clinical outcomes with various forms of treatment. It’s also unclear whether early interventions could lead to later chronic disease.
In hopes of answering this question, Ms. Grama and her coinvestigators, led by Andrew S. Freiberg, MD, took a retrospective look at data on 249 patients with ITP diagnosed from birth through age 21 from 1994 to 2011.
They looked at demographic variables, treatments received, and subsequent platelet counts. Outcomes included intracranial hemorrhage and long-term improvements in platelet counts. They defined chronic ITP as a platelet count below 140,000/mcL for at least 6 months following diagnosis.
Of the 249 patients, 126 (66 boys and 60 girls) progressed to chronic ITP. The incidence of chronic ITP among treated patients was 51.1% and, in untreated patients, 49.3%.
However, in two subgroups, there was a significant association between treatment and chronic ITP. Among girls from birth through age 3 years, 58% of those treated went on to chronic ITP, compared with 0% for untreated patients (P = .008). When the age cohort was expanded to girls younger than 6 years, a similar pattern emerged, with chronic ITP rates of 45% for treated patients, compared with 0% for untreated patients. There were only 44 total patients in this age and sex subgroup, however, making it difficult to draw strong inferences about a potential relationship between treatment and chronic ITP, Ms. Grama noted.
Only three patients had cerebral hemorrhage. Two had hemorrhage as their initial ITP presentation, and the third had bleeding despite being on treatment. The sample size was too small to correlate the outcome with treatment, the authors noted.
In multivariate analysis controlling for demographic, clinical, and treatment factors, only age and platelet count at presentation independently predicted chronic thrombocytopenia (P less than .0001 for each). Steroid therapy was the only independent predictor for acute ITP (P = .0001).
Although their data suggest that there could be a benefit to treating patients who first present with acute ITP at age 12 years or older, “I do think it’s reasonable to wait and watch these patients,” Ms. Grama said.
“The incidence of brain bleeds, which is the really scary complication, was so low in these patients that I think watchful waiting would be a better way to go, just monitoring patients very closely. Hopefully, they will resolve without having treatment,” she added.
The study was internally supported. The authors reported no relevant disclosures.
FROM ASPHO 2017
Key clinical point: Treatment of acute idiopathic thrombocytopenic purpura does not appear to increase risk of later chronic ITP in children older than 6 years.
Major finding: Girls younger than 6 years were the only group in which early treatment of acute ITP may have increased risk for chronic ITP.
Data source: Retrospective data review on 249 children and young adults with ITP.
Disclosures: The study was internally supported. The authors reported no relevant disclosures.