Endoscopic retrograde cholangiopancreatography in infants and children

Abstract Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients < 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic. Complications were uncommon in infants; only two episodes of infection were registered. In children (> 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children

Tromboseprofylakse ved innsettelse av total hofteprotese- en KLoK-oppgave

Bakgrunn og kunnskapsgrunnlag: Gjennom studiet har vi lært om tromboemboliske hendelser og konsekvensene av dem. Videre vet vi at innsettelse av total hofteleddsprotese er et vanlig ortopedisk inngrep, rundt 7000 førstegangsinnsettelser årlig. Inngrep i hofteleddsregionen regnes for å være høyrisikoinngrep med tanke på utvikling av venøs tromboembolisme (VTE) i det postoperative forløpet. Bruk av lavmolekylært heparin har vist seg å forebygge VTE, men hvor lenge dette bør brukes har vært mer omdiskutert. Studier tyder imidlertid på at man får en reduksjon av antall VTE ved langvarig profylakse på rundt 4 uker uten at blødningsrisikoen øker. Bruk av kompresjonsstrømper er dårligere dokumentert. Ved ulike ortopediske avdelinger er det en rekke ulike retningslinjer for bruken av tromboseprofylakse postoperativt. Vi ønsker å implementere en felles nasjonal retningslinje basert på dokumentert kunnskap. Begrunnet tiltak, metode og organisering: Det er viktig at ledelsen på avdelingen blir involvert i prosjektet fra første stund. Selve arbeidet bør delegeres til en dedikert medarbeider, og flere faggrupper bør involveres. Med bakgrunn i forskning vedrørende effektive tiltak innen kvalitetsforbedring, har vi funnet at en multifasettert intervensjon er det som vil fungere best. Det er viktig med kartlegging av barrierer for implementeringen. Deretter er det nødvendig med informasjon til de involverte om nye retningslinjer. For at disse skal følges opp i det daglige vil en sjekkliste kunne bidra til økt bevissthet. Tilbakemelding til de ansatte i avdelingen med tanke på hvor ”flinke” de er til å følge opp retningslinjene og andelen pasienter som får profylakse i henhold til retningslinjen vil være nødvendig. Dette kan også benyttes som en ”konkurranse” mellom de ulike sykehusene. Underveis vil det være nødvendig med evaluering av tiltakene og eventuelle justeringer. Resultater / Vurdering: Vi mener at dette kvalitetsforbedrings-prosjektet vil kunne la seg gjennomføre på alle ortopediske avdelinger. Ut fra lokale forhold og barrierer bør det gjøres tilpasninger. Det er til det beste for pasientene at det etableres en nasjonal retningslinje, da dette sikrer alle lik behandling

Psychologic Distress and Anxiety in Mothers of Children With Gastroesophageal Reflux Undergoing Antireflux Surgery

Objectives: Parents of children with a chronic illness are at risk for impaired psychosocial functioning. Gastroesophageal reflux disease (GERD) is such a disease, and no studies have investigated effects of antireflux surgery on parental psychological distress. The aims of this study were to assess psychological distress and state and trait anxiety in mothers of children with GERD, and to explore possible changes after antireflux surgery. Methods: Mothers of children referred for antireflux surgery were included in this prospective study. Standardized questionnaires were used to evaluate psychological distress and state and trait anxiety before and 12 months after antireflux surgery. Results: Of 87 eligible mothers of children with GERD, 62 (71%) agreed to participate. All children had objectively verified GERD by 24-hour pH-monitoring and/or upper gastrointestinal contrast study and unsatisfactory symptom relief of pharmacological treatment. Thirty-one (50%) mothers returned questionnaires postoperatively. Preoperatively, mothers of children undergoing antireflux surgery reported high levels of psychological distress and state anxiety, and 54% had scores indicating clinically significant psychological distress. None of the preoperative child characteristics were found to significantly influence maternal psychological distress or state anxiety. Twelve months postoperatively, both psychological distress and state anxiety were reduced. Conclusions: Mothers of children undergoing antireflux surgery reported reduced levels of psychological distress and state anxiety 12 months after the operation

Titers of antibodies against ancestral SARS-CoV-2 correlate with levels of neutralizing antibodies to multiple variants

Diagnostic assays currently used to monitor the efficacy of COVID-19 vaccines measure levels of antibodies to the receptor-binding domain of ancestral SARS-CoV-2 (RBDwt). However, the predictive value for protection against new variants of concern (VOCs) has not been firmly established. Here, we used bead-based arrays and flow cytometry to measure binding of antibodies to spike proteins and receptor-binding domains (RBDs) from VOCs in 12,000 serum samples. Effects of sera on RBD-ACE2 interactions were measured as a proxy for neutralizing antibodies. The samples were obtained from healthy individuals or patients on immunosuppressive therapy who had received two to four doses of COVID-19 vaccines and from COVID-19 convalescents. The results show that anti-RBDwt titers correlate with the levels of binding- and neutralizing antibodies against the Alpha, Beta, Gamma, Delta, Epsilon and Omicron variants. The benefit of multiplexed analysis lies in the ability to measure a wide range of anti-RBD titers using a single dilution of serum for each assay. The reactivity patterns also yield an internal reference for neutralizing activity and binding antibody units per milliliter (BAU/ml). Results obtained with sera from vaccinated healthy individuals and patients confirmed and extended results from previous studies on time-dependent waning of antibody levels and effects of immunosuppressive agents. We conclude that anti-RBDwt titers correlate with levels of neutralizing antibodies against VOCs and propose that our method may be implemented to enhance the precision and throughput of immunomonitoring.publishedVersio