Treatment and follow up of children with chronic hepatitis C in Albania

<p>Abstract</p> <p>Background</p> <p>Treatment of Hepatitis C in children has a better outcome than in adults, and for this reason the treatment had different views. However, in pediatric age hepatitis C is seen to have an evolution towards chronicity. Today is a normal option to treat chronic hepatitis C as early as possible according to certain criteria. The aim of this study is to show the results of treatment with interferon and ribavirin and the follow-up of children diagnosed with chronic hepatitis C in our service.</p> <p>Patients and methods</p> <p>This is a prospective study which has included children 3 up to 15 years old (13 boys and 4 girls) diagnosed with chronic hepatitis C. All patients underwent a certain protocol, including liver biopsy prior to treatment. Treatment consisted in use for 48 weeks of INF α-2b, 3 MIU/m2 three times a week s/c and ribavirin 15 mg/kg orally divided bid. Two patients were treated with PEGINF α-2b with dose 1.5 mcg/kg once a week s/c and ribavirin 15 mg/kg. After the treatment all patients have stayed under our control for an average period of 24 weeks.</p> <p>Results</p> <p>At the end of the treatment we detected a patient with HCV-RNA positive. End Treatment Viral Response was 94%. Six months later we found three patients who showed relapse of disease. Sustained Viral Response was approximately 83%</p> <p>Conclusion</p> <p>The combination therapy of interferon with Ribavirin in treatment of children with chronic hepatitis C provides a higher SVR when treatment is initiated at the earliest stages of hepatic changes. Side effects of therapy are insignificant in comparison with results obtained</p

Pediatric Hodgkin Lymphoma Overview in Albania during the Last Decade

Background: Hodgkin lymphoma (HL) is a rare malignancy characterized by a malignant proliferation of cells in the reticuloendothelial system, mainly lymph node, and the presence of Reed-Sternberg cells with a relatively good prognosis compared to other pediatric malignancies. This study aimed to produce epidemiologic and clinical data on HL for Albania, aiming for a better understanding of the disease presentation to diagnose it at an earlier stage with the result of a better outcome. Methods and Results: This single-center, retrospective study performed in the Mother Theresa University Hospital Center (Tirana, Albania) analyzed epidemiological and clinical data of pediatric patients under 14 years of age diagnosed with HL during a 10-year study period from 2012 to 2022. During the last 10 years, 25 children (ages 0-14) were diagnosed with HL at UHC "Mother Theresa," Tirana. From the demographic data of our study, most patients (68%) were in the age group of 10-14. The male-to-female ratio was 2.12:1. The first clinical presentation was mainly because of lymphadenopathy in 92% of patients, with the presence of B symptoms in 68%. In most cases, the CBC was not affected, yet 24% of patients had high platelets, and 12% had low RBCs, while WBCs increased in 16% of patients and decreased in 12%. Lymphopenia and monocytosis were found in more than half of cases. Around 68% of patients had high levels of LDH and CRP. ESR and ALP were high in 64% of patients, Ferritin was high in 32%, and fibrinogen level was high in 28%. According to the Ann Arbor system, most of our patients were at stage II (32%), followed closely by stage I (28%) and stage III (24%), and only 16% were at stage IV upon presentation. The most common histopathologic type was nodular sclerosis classical HL, presented in 44% of cases. Conclusion: HL is a relatively frequent pediatric malignancy in young adults, affecting mainly males, and is diagnosed at a relatively early stage in our country

Diagnosis and Treatment of Chronic Neuropathic and Mixed Pain in Children and Adolescents: Results of a Survey Study amongst Practitioners

Validated diagnostic tools to diagnose chronic neuropathic and mixed pain in children are missing. Therapeutic options are often derived from therapeutics for adults. To investigate the international practice amongst practitioners for the diagnosis and treatment of chronic, neuropathic pain in children and adolescents, we performed a survey study among members of learned societies or groups whose members are known to treat pediatric pain. The survey included questions concerning practitioners and practice characteristics, assessment and diagnosis, treatment and medication. We analyzed 117 returned questionnaires, of which 41 (35%) were fully completed and 76 (65%) were partially completed. Most respondents based the diagnosis of neuropathic pain on physical examination (68 (58.1%)), patient history (67 (57.3%)), and underlying disease (59 (50.4%)) combined. Gabapentin, amitriptyline, and pregabalin were the first-choice treatments for moderate neuropathic pain. Tramadol, ibuprofen, amitriptyline, and paracetamol were the first-choice treatments for moderate mixed pain. Consensus on the diagnostic process of neuropathic pain in children and adolescents is lacking. Drug treatment varies widely for moderate, severe neuropathic, and mixed pain. Hence, diagnostic tools and therapy need to be harmonized and validated for use in children

The impact of the endocrine disruptors on child health

During recent years, Endocrine Disruptor chemicals (EDCs) have been the subject of particular attention because they are ubiquitous and able to cause adverse effect in humans, and particularly in children. Substances capable of interfering with the normal activity of the endocrine system can be of both man-made and natural origin. They often come into contact with the body through diet, water, air or skin. However, although the body is continuously exposed to their action, it is difficult to fully quantify the negative effects of these substances. Available data show that individuals most exposed to endocrine disruptors more frequently have cancers, reproductive, (ie: infertility, endometriosis, miscarriage.), metabolic (ie: diabetes) and/or immune disorders. Behavioral and developmental disorders are also observed in children exposed to Endocrine Disruptors. The presence of EDCs has been demonstrated during pregnancy in maternal blood, urine, and hair. At the placental level, EDCs can affect normal development and endocrine function and promote inflammatory reactions. The aim of this brief narrative review is to raise the attention of general pediatricians on the most prevalent multiple or interconnecting risks caused by EDCs to children's health by summarizing the existing knowledge on these toxic chemicals. Authors also report the effort made by the European Union to develop an effective Hazard Control Decision Support System which aim is to improve risk-based procedures able of detecting, monitoring and managing toxic substances in food chain

Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study

Background: Child abuse and neglect, or maltreatment, is a serious public health problem, which may cause long-term effects on children's health and wellbeing and expose them to further adulthood vulnerabilities. Studies on child maltreatment performed in Europe are scarce, and the number of participants enrolled relatively small. The aim of this multi-national European pilot study, was to evaluate the level of understanding and perception of the concepts of child abuse and neglect by European paediatricians working in different medical settings, and the attitude toward these forms of maltreatment in their practice. Methods: The study was performed by a cross-sectional, descriptive, online survey, made available online to European paediatricians members of 50 national paediatric, who belonged to four different medical settings: hospital, family care, university centres and private practice. The questionnaire, designed as a multiple choice questions survey, with a single answer option consisted of 22 questions/statements. Frequency analyses were applied. Most of the data were described using univariate analysis and Chi-squared tests were used to compare the respondents and answers and a significance level of p ≤ 0.05 applied. Results: Findings show that European paediatricians consider the training on child maltreatment currently provided by medical school curricula and paediatric residency courses to be largely insufficient and continuing education courses were considered of great importance to cover educational gaps. Physical violence was recognized by paediatricians mostly during occasional visits with a significant correlation between detecting abuse during an occasional visit and being a primary care paediatrician. Results also showed a reluctance by paediatricians to report cases of maltreatment to the competent judicial authorities. Conclusions: Data of this study may provide useful contribution to the current limited knowledge about the familiarity of European paediatricians with child maltreatment and their skills to recognize, manage and contrast abusive childhood experiences in their practice. Finally, they could provide local legislators and health authorities with information useful to further improve public health approaches and rules able to effectively address shared risk and protective factors, which could prevent child abuse and neglect from ever occurring

The research gap in chronic paediatric pain : A systematic review of randomised controlled trials

Background and Objective: Chronic pain is associated with significant functional and social impairment. The objective of this review was to assess the characteristics and quality of randomized controlled trials (RCTs) evaluating pain management interventions in children and adolescents with chronic pain. Methods: We performed a systematic search of PubMed, Embase and the Cochrane Library up to July 2017. We included RCTs that involved children and adolescents (3 months-18 years) and evaluated the use of pharmacological or non-pharmacological intervention(s) in the context of pain persisting or re-occurring for more than 3 months. Methodological quality was evaluated using the Cochrane Risk of Bias (ROB) Tool. Results: A total of 58 RCTs were identified and numbers steadily increased over time. The majority were conducted in single hospital institutions, with no information on study funding. Median sample size was 47.5 participants (Q1,Q3: 32, 70). Forty-five percent of RCTs included both adults and children and the median of the mean ages at inclusion was 12.9 years (Q1,Q3: 11, 15). Testing of non-pharmacological interventions was predominant and only 5 RCTs evaluated analgesics or co-analgesics. Abdominal pain, headache/migraine and musculoskeletal pain were the most common types of chronic pain among participants. Methodological quality was poor with 90% of RCTs presenting a high or unclear ROB. Conclusions: Evaluation of analgesics targeting chronic pain relief in children and adolescents through RCTs is marginal. Infants and children with long-lasting painful conditions are insufficiently represented in RCTs. We discuss possible research constraints and challenges as well as methodologies to circumvent them. Significance: There is a substantial research gap regarding analgesic interventions for children and adolescents with chronic pain. Most clinical trials in the field focus on the evaluation of non-pharmacological interventions and are of low methodological quality. There is also a specific lack of trials involving infants and children and adolescents with long-lasting diseases

The research gap in chronic paediatric pain: A systematic review of randomised controlled trials

Background and Objective: Chronic pain is associated with significant functional and social impairment. The objective of this review was to assess the characteristics and quality of randomized controlled trials (RCTs) evaluating pain management interventions in children and adolescents with chronic pain. Methods: We performed a systematic search of PubMed, Embase and the Cochrane Library up to July 2017. We included RCTs that involved children and adolescents (3Â&nbsp;months-18Â&nbsp;years) and evaluated the use of pharmacological or non-pharmacological intervention(s) in the context of pain persisting or re-occurring for more than 3Â&nbsp;months. Methodological quality was evaluated using the Cochrane Risk of Bias (ROB) Tool. Results: A total of 58 RCTs were identified and numbers steadily increased over time. The majority were conducted in single hospital institutions, with no information on study funding. Median sample size was 47.5 participants (Q1,Q3: 32, 70). Forty-five percent of RCTs included both adults and children and the median of the mean ages at inclusion was 12.9Â&nbsp;years (Q1,Q3: 11, 15). Testing of non-pharmacological interventions was predominant and only 5 RCTs evaluated analgesics or co-analgesics. Abdominal pain, headache/migraine and musculoskeletal pain were the most common types of chronic pain among participants. Methodological quality was poor with 90% of RCTs presenting a high or unclear ROB. Conclusions: Evaluation of analgesics targeting chronic pain relief in children and adolescents through RCTs is marginal. Infants and children with long-lasting painful conditions are insufficiently represented in RCTs. We discuss possible research constraints and challenges as well as methodologies to circumvent them. Significance: There is a substantial research gap regarding analgesic interventions for children and adolescents with chronic pain. Most clinical trials in the field focus on the evaluation of non-pharmacological interventions and are of low methodological quality. There is also a specific lack of trials involving infants and children and adolescents with long-lasting diseases