Search

Résumé La douleur est un problème courant chez les enfants. Des mesures pharmacologiques et non pharmacologiques sont utilisées pour la prendre en charge. Depuis quelques décennies, les opioïdes par voie orale sont populaires pour soulager la douleur modérée à grave. La codéine a longtemps été l’opioïde par voie orale le plus connu pour les enfants. Pour des raisons de sécurité, elle est désormais nettement moins accessible et moins employée. Divers autres opioïdes la remplacent, mais les données sur leur efficacité et leur sécurité sont limitées chez les enfants. L’oxycodone par voie orale emprunte les mêmes voies métaboliques que la codéine, mais sa pharmacocinétique est très variable. Les données sur la sécurité et l’efficacité de l’hydromorphone et du tramadol par voie orale chez les enfants sont également limitées. Lorsqu’on y recourt au lieu de la codéine, la morphine par voie orale est l’opiacé dont la sécurité et l’efficacité sont les mieux démontrées chez les enfants. Des recherches devront être réalisées pour explorer d’autres approches relatives aux médicaments opioïdes et non opioïdes, afin d’orienter les traitements analgésiques fondés sur des données probantes qui soulageront la douleur modérée à grave chez les enfants.

Key points Children with chronic debilitating illness and pain are increasingly using cannabis for medical purposes, particularly when conventional treatment options have limited benefit or substantial adverse effects. Caregivers are becoming aware of evidence that suggests medical cannabis provides

Background: In Canada and the United States, most families referred for pediatric weight management services do not start treatment. Of families who initiate care, many discontinue before ...

Objective Although anti-Saccharomyces cerevisiae antibodies (ASCAs) could be a useful biomarker in differentiating Crohn disease (CD) from ulcerative colitis (UC), their role as prognostic markers in children with CD has been underinvestigated. This longitudinal prospective observational study aimed to assess the prognostic value of ASCA status among children with CD managed using biologics. Methods The study population comprised children with inflammatory bowel disease diagnosed with CD from 2012 to 2018. Cox regression model with adjustment for a priori covariates was used to examine the response to anti-tumor necrosis factor (TNF) biological therapy among ASCA-positive patients in comparison to ASCA-negative patients. Results There were 273 measurements available from the study cohort comprising children with CD, who were followed up for a median duration of 14 months (interquartile range 5-42). ASCA-positive patients had a higher risk for moderate to severe clinical disease (odds ratio 2.88; 95% confidence interval [CI] 1.2-7.55) and extensive endoscopic distribution (odds ratio 3.30; CI 1.12-9.74) at baseline in comparison to ASCA-negative patients, respectively. In comparison to ASCA immunoglobulin G (IgG)-negative patients, ASCA IgG-positive patients who were treated with biologics had a significantly lower relapse rate (adjusted hazard ratio 0.12; CI 0.02-0.93). Ten (14%) patients had an unstable ASCA value with either ASCA immunoglobulin A or ASCA IgG status changing from positive to negative or vice versa. Conclusions ASCA-positive children with CD present with more extensive (endoscopic) and clinically severe disease. ASCA IgG is a useful prognostic marker among children with CD who receive biologics.

There is some evidence to date that those with asthma are overrepresented among the adult patients who have been admitted to hospital with coronavirus disease 2019 (COVID-19).[1][1],[2][2] This overrepresentation may occur because severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) triggers

Objective Mood and anxiety disorders (MADs) are common conditions with multiple aetiologies. Exposure to antibiotics has been proposed as a possible risk factor in animal studies. We aimed to assess maternal antibiotic use in pregnancy and child antibiotic use in the first three years of life, collectively called early life, as potential risk factors for subsequent development of MADs during childhood and adolescence. Methods A population-based retrospective cohort study was conducted including 221,139 children born in Manitoba, Canada between 1996 and 2012. Exposure was defined as having filled one or more antibiotic prescriptions during early life. Children were followed until the earliest MADs diagnoses, 19th birthday, migration, death, or end of the study period. We computed crude and adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs) using Cox proportional hazard regression. Results Children born to mothers who received one or more antibiotic courses in pregnancy had significantly higher rates of MADs compared with non-exposed children (aHR 1.08, 95% CI 1.03,1.13). Overall antibiotic exposure during the first three years of life was not significantly associated with MADs (aHR 1.00, 95% CI 0.94,1.07). A significantly increased risk of MADs was observed after postnatal exposure to tetracyclines, aminoglycosides, quinolones (33%) or sulfonamides and trimethoprim (28%). Postnatal exposure to macrolides, lincosamides, and streptogramins significantly reduced the risk of MADs by 16%. Conclusion Early life exposure to antibiotics is associated with different risk effects on MADs in children. The apparent associations may have been confounded by indication and may not be clinically meaningful.

Wernicke encephalopathy (WE) and Korsakoff psychosis (KP), together termed Wernicke–Korsakoff syndrome (WKS), are distinct yet overlapping neuropsychiatric disorders associated with thiamine deficiency. Thiamine pyrophosphate, the biologically active form of thiamine, is essential for multiple biochemical pathways involved in carbohydrate utilization. Both genetic susceptibilities and acquired deficiencies as a result of alcoholic and non-alcoholic factors are associated with thiamine deficiency or its impaired utilization. WKS is underdiagnosed because of the inconsistent clinical presentation and overlapping of symptoms with other neurological conditions. The identification and individualized treatment of WE based on the etiology is vital to prevent the development of the amnestic state associated with KP in genetically predisposed individuals. Through this review, we bring together the existing data from animal and human models to expound the etiopathogenesis, diagnosis, and therapeutic interventions for WE and KP.

BACKGROUND: Inflammatory bowel disease (IBD) is a collective term for diseases involving inflammation of the gastrointestinal tract, among which Crohn’s disease (CD) and ulcerative colitis (UC) are the two main sub-categories. Although Anti-Saccharomyces cerevisiae antibodies (ASCA) could be a useful biomarker in differentiating CD from ulcerative colitis UC, their role as prognostic markers in children with CD has been under-investigated. AIMS: Our longitudinal study aimed to assess the stability of ASCA status over time and the possibility of an association between ASCA-positive childhood CD and disease relapse during clinical follow-up. We also investigated the role of ASCA status as a prognostic marker of response to Anti-TNF biological therapy among children with CD. METHODS: The study population comprised of children with inflammatory bowel disease (IBD) diagnosed with CD from 2012 to 2018. Cox-regression model with adjustment for a priori covariates was used to examine the risk of disease relapse and response to biological therapy among ASCA positive patients in comparison to ASCA negative patients. The models were adjusted for age at diagnosis, sex, history of CD in the first-degree relatives, luminal disease distribution at baseline, pharmacological therapy and baseline clinical disease activity. RESULTS: A total of 273 measurements from 72 CD patients (mean age at diagnosis of 12.17±3.17 years), who were followed up for a median duration of 14 months (IQR: 5–42) were included. ASCA positive patients had a higher risk for moderate to severe clinical disease and extensive distribution at baseline in comparison to ASCA negative patients, (odds ratio (OR): 2.88; 95% confidence interval (CI): 1.2–7.55) (OR: 3.30; 95% CI: 1.12–9.74) respectively. In comparison to ASCA IgG negative patients, ASCA IgG positive patients who were treated with biologics had a significantly lower relapse rate (aHR: 0.12; 95% CI: 0.02–0.93). Ten (14%) patients had an unstable ASCA value with either ASCA IgA or ASCA IgG status changing from positive to negative or vice versa. CONCLUSIONS: ASCA positive children with CD present with more extensive and clinically severe disease. ASCA IgG is a useful prognostic marker among children with CD who receive biologics. [Image: see text] Survival plots for disease relapse during follow-up among biological therapy naïve children with Crohn’s disease (a and c) compared to those who were treated with biological therapy (b and d). (adjusted for age at diagnosis, sex, family history of IBD, luminal disease distribution at baseline, non-biologic pharmacological therapy and baseline disease severity) FUNDING AGENCIES: Children’s Hospital Research Institute of Manitoba

Selon les donnees recueillies a ce jour, les personnes asthmatiques seraient surrepresentees parmi les adultes hospitalises pour la COVID-19 (maladie a coronavirus 2019)[1][1],[2][2]. Cette surrepresentation pourrait etre due au fait que le SRAS-CoV-2 (coronavirus du syndrome respiratoire

textabstractAims Low-dose aspirin (LDA) and non-steroidal-anti-inflammatory drugs (NSAIDs) both increase the risk of upper gastrointestinal events (UGIEs). In the Netherlands, recommendations regarding the prescription of gastroprotective agents (GPAs) in LDA users were first issued in 2009 in the HARM-Wrestling consensus. National guidelines on gastroprotective strategies (GPSs) in NSAID users were issued in the first part of the preceding. The aim of the present study was to examine time-trends in GPSs in patients initiating LDA and those initiating NSAIDs between 2000 and 2012. Methods Within a large electronic primary healthcare database, two cohorts were selected: (i) patients newly prescribed LDA and (ii) patients newly prescribed NSAIDs between 2000 and 2012. Patients who had been prescribed a GPA in the previous six months were excluded. For both cohorts, patients risk of a UGIE was classified as low, moderate or high, based on the HARM-Wrestling consensus, and the presence of an adequate GPSwas determined. Results A total of 37 578 patients were included in the LDA cohort and 352 025 patients in the NSAID cohort. In both cohorts, an increase in GPSs was observed over time, but prescription of GPAs was lower in the LDA cohort. By 2012, an adequate GPS was present in 31.8% of high-risk LDA initiators, vs. 48.0% of high-risk NSAID initiators. Conclusions Despite a comparable risk of UGIEs, GPSs are prescribed less in high-risk LDA initiators than in high-risk NSAID initiators. For both groups of patients, there is still room for improvement in guideline adherence.

Conduct of clinical trials is perceived to be more challenging in children than in adults. This study aimed to evaluate the impact of the age of participants on completion rates of randomized controlled trials (RCTs).A cross-sectional study on RCTs registered in the ClinicalTrials.gov database. All RCTs registered up to December 31, 2016, were extracted and were classified according to their recruitment status: active, completed, or discontinued and according to the age of participants: children (17 years), adults (≥18 years), and mixed-age population. A logistic regression model was applied to assess the impact of participant's age category on trial completion while controlling for other relevant trial features.A total of 65,095 registered RCTs were identified. Among pediatric trials, 49.9% were completed and 8.5% were discontinued. Among adult and mixed age RCTs, respectively, 49.7% and 47.9% were completed whereas, 10.2% and 9.4% were discontinued. Overall, pediatric and mixed age RCTs were more likely to be registered as completed than adult RCTs (odds ratio: 1.16, 95% CI: 1.02-1.30; odds ratio: 1.15, 95% CI: 1.04-1.27, respectively). Also, funding source, type of intervention under evaluation, primary trial purpose, use of a blinding procedure, use of a placebo, and participants' assignment model were identified as independent predictors of RCT completion.Contrary to current perceptions and despite several specific challenges, recruitment of children and adolescents is not a limiting factor to completing a RCT. Other study features such as funding source, impact completeness and should be carefully considered before initiating research.

Antibiotic use during infancy alters gut microbiota and immune development and is associated with an increased risk of childhood asthma. The impact of prenatal antibiotic exposure is unclear. We sought to characterise the association between prenatal antibiotic exposure and childhood asthma.We performed a population-based cohort study using prescription records, hospitalisation records and physician billing claims from 213 661 mother–child dyads born in Manitoba, Canada between 1996 and 2012. Associations were determined using Cox regression, adjusting for maternal asthma, postnatal antibiotics and other potential confounders. Sensitivity analyses evaluated maternal antibiotic use before and after pregnancy.36.8% of children were exposed prenatally to antibiotics and 10.1% developed asthma. Prenatal antibiotic exposure was associated with an increased risk of asthma (adjusted hazard ratio (aHR) 1.23, 95% CI 1.20–1.27). There was an apparent dose response (aHR 1.15, 95% CI 1.11–1.18 for one course; aHR 1.26, 95% CI 1.21–1.32 for two courses; and aHR 1.51, 95% CI 1.44–1.59 for three or more courses). Maternal antibiotic use during 9 months before pregnancy (aHR 1.27, 95% CI 1.24–1.31) and 9 months postpartum (aHR 1.32, 95% CI 1.28–1.36) were similarly associated with asthma.Prenatal antibiotic exposure was associated with a dose-dependent increase in asthma risk. However, similar associations were observed for maternal antibiotic use before and after pregnancy, suggesting the association is either not directly causal, or not specific to pregnancy.

Non-alcoholic fatty liver (NAFL) disease (NAFLD) affects 30% of overweight adolescents and increases the risk of type 2 diabetes mellitus (T2D). Resveratrol is a naturally occurring compound with potential to reverse NAFL and its associated insulin resistance in adults. The use of resveratrol to reduce risk for T2D through its effect on NAFL has not been examined to date in youth. This paper provides a literature review and protocol for a 30 day proof of principle trial of resveratrol in a population of adolescents at risk for T2D. This randomized double-blind controlled trial is designed with the primary objective of evaluating a twice daily supplementation of 75 mg of resveratrol for safety and tolerability in overweight and obese adolescent subjects (13 to

The Rosalind and Morris Goodman Family Paediatric For-mulations Centre of the CHU Sainte-Justine is a new non-profit organisation dedicated to supporting the development of safe and efficacious medicines that have a child-friendly formulation. One way of providing these paediatric medicines is to partner with industry to promote commercialising of a suitable paediatric formu-lation for commonly used medicines currently only avail-able in adult formulations. Working with all stakeholders including, pharmacists, paediatricians, Health Canada and the pharmaceutical industry, the Goodman Centre has identified commonly used off-label medicines that are currently compounded in pharmacies to produce pedi-atric formulations. In many cases, paediatric formulations and indications are available in other jurisdictions yet they have not been submitted by industry to Health Canada for regulatory approval. Using this novel approach, the Centre is to partnering with pharmaceutical companies to use existing data that has been submitted in other jurisdictions for Canadian approval. We will provide an overview of the Goodman Centre and outline the novel approach developed to improve access to paediatric for-mulations that we have undertaken.

ObjectiveTo confirm that gentamicin 5 mg/kg/dose every 48 hours in neonates less than 35 weeks corrected gestational age (CGA) results in the majority of gentamicin serum trough levels within the range of 0.5–2 mg/L and peak levels within the range of 6–12 mg/L.DesignProspective pharmacokinetic (PK) analysis.SettingTwo neonatal intensive care units and one intermediate care unit in two tertiary care centres. Patients: Neonates less than 35 weeks CGA who received empiric gentamicin for sepsis between March 10 and June 10, 2014 in whom at least one gentamicin serum level was measured. Methods: PK analysis was performed following implementation of empiric dosing for gentamicin of 5 mg/kg every 48 hours in neonates.ResultsMean Cl, t1/2 and V1 were 42±10 mL/kg/h, 10.0±1.8 h, and 0.58±0.09 L/kg, respectively (n=54). A one-compartment pharmacokinetic model best represented the data. The mean Cl of gentamicin at 24 h post dose was significantly lower in neonates.ConclusionsGentamicin 5 mg/kg q48h results in serum post dose levels between 6–12 mg/L 98% of the time compared to 5% of the time for once daily doses of 2.5 or 3 mg/kg. Gentamicin doses of 5 mg/kg q48h resulted in serum pre levels less than 0.5 mg/L 82% of the time (48 h post dose) compared to 9% of the time for once daily doses (24 h post dose). Increased clearance with advanced PNA suggests the need for more frequent dosing in neonates >14 days of age.