Flu-Related Hospitalizations in Children

An estimated 20,000 children are hospitalized each year with influenza-related illnesses. Children with certain chronic conditions are at higher risk for serious influenza (flu) complications, and recommendations for annual flu vaccines have been targeted at these children. Over the past four years, public health officials have expanded their recommendations about which children should be immunized against the flu. This Issue Brief summarizes clinical outcomes and costs from the largest study to date of children hospitalized with the flu. These findings should help inform clinicians and policymakers in prioritizing their efforts to implement the new recommendations

Public Spending on Elders and Children: The gap is Growing

Social welfare programs support the income, education, nutrition, and medical care needs of many of this country’s elders and children. Over the past twenty years, however, three times as many children as elders have lived in poverty, and poverty rates for children have consistently exceeded those for the elderly. Given the continued disparity in poverty rates, it is important to track levels of public spending for each group and the generational balance in allocating limited public funds. This Issue Brief evaluates trends in social welfare spending for children and the elderly from 1980 to 2000, and the relationship of national economic trends to public spending patterns

Depression and anxiety and their association with healthcare utilization in pediatric lupus and mixed connective tissue disease patients: a cross-sectional study

Background Depression and anxiety adversely affects outcomes in systemic lupus erythematosus (SLE) and healthcare utilization is high for pediatric SLE. We aimed to characterize the prevalence of depression and anxiety in pediatric SLE, and their association with healthcare utilization. Methods We conducted a cross-sectional analysis of pediatric SLE and mixed connective tissue disease (MCTD) subjects and healthy controls aged 8 years and above. We used the Patient Health Questionnaire 9 (PHQ-9) and the Screen for Childhood Anxiety Related Disorders (SCARED) to identify depression, suicidal ideation and anxiety symptoms, respectively. We compared symptom prevalence in SLE/MCTD and healthy subjects using logistic regression. For SLE/MCTD subjects, we calculated the rate of annual outpatient visits [rheumatology/nephrology, primary care provider (PCP) and emergency department], hospitalizations and rheumatology/nephrology telephone consultations in the preceding year. We compared these outcomes in those with and without depression and anxiety using negative binomial regression. Results We identified depression symptoms in 10 (20%) SLE/MCTD and 4 (8%) healthy subjects, representing a trend towards increased prevalence in unadjusted analysis (OR = 2.9, 95% CI 0.8-9.9, p = 0.09). Adjusted analysis did not show a significant difference; however, non-white race was a statistically significant independent risk factor for depression symptoms compared to white race (OR = 5.4, 95% CI 1.1-27.2, p = 0.04). We identified anxiety symptoms in 11 (22%) SLE/MCTD and 13 (26%) healthy subjects, which was not statistically different. Suicidal ideation was present in 7 (14%) SLE/MCTD and 2 (4%) healthy subjects, which was a statistically significant difference (OR = 5.4, 95% CI 1.02-28.3, p = 0.047). Of the 34% of SLE/MCTD subjects with any symptoms, only 24% had previous mental health care. Those with depression symptoms had a statistically significant lower rate of visits to the PCP (IRR = 0.38, 95% CI 0.19-0.76, p \u3c 0.001). Anxiety symptoms were not associated with the healthcare utilization outcomes. Conclusions Depression and anxiety symptoms were prevalent, and suicidal ideation significantly more common in SLE/MCTD than in healthy subjects. Non-white race was an independent risk factor for depression. Despite prevalent symptoms, there were poor rates of prior mental health treatment, and less frequent PCP visits among those with depression symptoms. Further investigation of barriers to mental health care and interventional strategies for symptomatic youth with SLE/MCTD is needed

Predictors Of Non-Escherichia Coli Urinary Tract Infection

We aimed to determine which children are prone to non-Escherichia coli coli UTIs. We included 769 children with UTI. We found that circumcised males, Hispanic children, children without fever, and children with Grade 3–4 VUR were more likely to have a UTI caused by organisms other than E. coli. This information may guide clinicians in their choice of antimicrobial therapy

Clinical Scale Manufacturing Of Autologous Insulin Producing Liver Cells For The Treatment Of Diabetes

Diabetes is a major global health problem with over 387 million diabetics causing 4.9 million deaths worldwide. Current therapies rely on recombinant insulin injection to the patients several times a day to control glucose levels but do not address the fundamental problem; the loss of insulin producing cells of the pancreas. Orgenesis developed a cell therapy to replace these cells by taking a small biopsy from a patient’s liver; growing the cells in flatware treating; and transdifferentiating these cells with adenovirus vectors containing genes for insulin production. This approach allows the diabetic patient to be the donor of their own therapeutic tissue, overcoming both the shortage in cadaver tissue availability and immune suppression. To bring this cell therapy approach into the pre-clinical and clinical phases, Orgenesis and Pall combined their respective expertise to develop a manufacturing strategy for both viral vector and cell products at large scale with the added benefit of greater process control incorporating two single-use large scale bioreactors. The Xpansion® 200 single-use bioreactor was successfully used to scale-up the human adult liver-derived cells proliferation process. By using the Xpansion platform, Orgenesis now has a reliable process to amplify their cells from 10-25 million up to 1.8-2 billion cells required for curing a diabetic patient. The cell mass generated by the bioreactor preserves their viability and potential for trans-differentiation. As a result of this successful co-development partnership, Orgenesis is moving forward with their process to large-scale clinical studies for GMP-compliant commercial manufacturing of AIP cell for transplantation. For large scale viral production we used the packed-bed iCellis® 500 disposable bioreactor that provides 3D matrix in a controlled system with low shear stress for adherent cells. In this study, we have optimized manufacturing for three adenovirus serotype 5 using the predictive small scale iCellis® nano and the manufacture scale iCellis® 500 bioreactor with cultivation area of 66 m2. By optimizing culture and infection parameters such as HEK293 cell seeding density, multiplicity of infection, time of infection, day of harvest, and media circulation parameters, yield was increased to 5.6x1015 infectious virus particle per batch (iCellis 50066). These cells and viral vector yields make the Xpansion® 200 and the iCellis® promising scalable technologies for the production of adenovirus products. The purified adenovirus hPDX-1, hNeuroD and hMafA were fully functional and successfully transduced the target liver derived cells. Next step of the study is to incorporate the viral trans-differentiation step into the developed cGMP cell expansion process. Please click Additional Files below to see the full abstract

Pediatric SLE hospitalization Personal non-commercial use only

ABSTRACT. Objective. In the setting of recent healthcare advances and emphasis on reduced spending, we aimed to characterize US trends in inpatient healthcare use and mortality for pediatric systemic lupus erythematosus (SLE). Methods. We performed a retrospective, serial, cross-sectional analysis of the national Kids' Inpatient Database (for 2000, 2003, 2006, and 2009). We identified patients with SLE aged 2 to 21 years using an International Classification of Diseases, 9th revision (ICD-9) code of 710.0 listed as a discharge diagnosis. Using sampling weights, we estimated trends in hospitalization, inpatient mortality, procedure rates, and length of stay (LOS). We analyzed patient and hospital-specific risk factors for mortality and LOS, and compared those outcomes to those without SLE. Results. We identified 26,903 estimated pediatric SLE hospitalizations. The hospitalization rate of 8.6 (95% CI 7.6-9.6) per 100,000 population and mean LOS of 5.9 days (95% CI 5.6-6.2) were stable over time. We found a significant downward trend in mortality, decreasing from 1% to 0.6% (p = 0.04), which paralleled a less pronounced trend for those without SLE. The rate of dialysis, blood transfusions, and vascular catheterization procedures increased. Patients with SLE nephritis and non-white race were at risk for increased healthcare use and death. Conclusion. Pediatric SLE hospitalization rate and LOS remained stable, but inpatient mortality decreased as the rate of common therapeutic procedures increased. More research is needed to understand the drivers of these relationships

Predictors of Antimicrobial Resistance among Pathogens Causing Urinary Tract Infection in Children

To determine which children with urinary tract infection (UTI) are likely to have pathogens resistant to narrow-spectrum antimicrobials

Utility of sedation for young children undergoing dimercaptosuccinic acid renal scans

No studies have examined whether use of sedation during a Tc-99m dimercaptosuccinic acid (DMSA) renal scan reduces patient discomfort

Antimicrobial Resistance and Urinary Tract Infection Recurrence

The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial found that recurrent urinary tract infections (rUTI) with resistant organisms were more common in the trimethoprim-sulfamethoxazole prophylaxis (TSP) arm. We describe factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) resistance of rUTIs in RIVUR