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2.
Cureus ; 14(10): e30246, 2022 Oct.
Article in English | MEDLINE | ID: mdl-36381903

ABSTRACT

INTRODUCTION:  The use of complementary and alternative medicine (CAM) has become a customary practice among pediatric cancer patients worldwide. The frequency of its use by pediatric cancer patients in Croatia has not been previously determined.  Methodology: In order to establish the frequency and detect factors affecting the use of CAM, a single-center, observational, cross-sectional study was conducted at the Children's Hospital Zagreb during a two-year period. The patients' parents and caregivers were offered an anonymous, multi-item questionnaire that collected socio-economic and clinical data, as well as details on CAM and dietary supplement practice.  Results: Almost half of the participants reported CAM and more than two-thirds reported dietary supplement consumption, predominantly in the intensive phase of the treatment. Factors regarding children or parents had no effect on CAM and supplement utilization. Herbal medicine, vitamins, and minerals were among the most commonly used items. Every 10th child experienced at least one adverse event during CAM and supplement use. CONCLUSION:  Awareness of the CAM and dietary supplement application in pediatric oncology patients needs to be raised due to the potential interactions with conventional treatment modalities. For this reason, it is extremely important to inform parents and caregivers of pediatric oncology patients about the use of CAM and dietary supplements to predict and mitigate the occurrence and intensity of the side effects. In the majority of our cases, the patient's guardians informed the healthcare professionals about the CAM and supplement implementation in their children, therefore, they were offered additional information about the possible negative impact of CAM and supplement use on standard medical care in a timely manner.

3.
Pediatr Endocrinol Diabetes Metab ; 28(4): 245-249, 2022.
Article in English | MEDLINE | ID: mdl-35942829

ABSTRACT

INTRODUCTION: Steroid-induced central hypothyroidism (CH) is a frequent but under-diagnosed hormonal disturbance in children treated for acute lymphoblastic leukaemia (ALL) and lymphoma. AIM OF THE STUDY: To determine the occurrence, frequency of symptoms, replacement therapy administration, and association of CH with glucocorticoid therapy in children treated for haematological malignancies. MATERIAL AND METHODS: A prospective clinical survey was conducted on 21 patients (61.9% male, mean age 9.1 years) treated in the Children's Hospital Zagreb during 2019, of whom 12 were treated for for ALL and 6 for Hodgkin lymphoma (HL), based on clinical (signs and symptoms) and laboratory data (hormonal status). RESULTS: Overt CH was verified in 15 (71.4%) and mild CH in 3 patients (14.2%). The most common symptoms and signs were fatigue, apathy, and electrolyte imbalance, observed in 50% of CH cases. Hormonal substitutional therapy was initiated in 44.4% of affected patients, during a mean of 2.08 months, with significant clinical improvement. Overt CH was more prevalent in patients with ALL than in those with HL (p = 0.025). Among children with ALL there was no difference in CH occurrence between the prednisone and dexamethasone groups; however, dexamethasone-induced CH was more frequently symptomatic (p = 0.03). The prednisone dosage played no role in CH incidence in patients with HL. CONCLUSIONS: Further studies are needed to determine the real incidence of thyroid dysfunction during intensive chemotherapy treatment in children with ALL and lymphoma. Recommendations for optimal hormonal replacement therapy and a follow-up plan for paediatric oncology patients with CH are also urgently required.


Subject(s)
Congenital Hypothyroidism , Hematologic Neoplasms , Hypothyroidism , Humans , Male , Child , Female , Prednisone/therapeutic use , Prospective Studies , Hypothyroidism/chemically induced , Hypothyroidism/epidemiology , Hypothyroidism/drug therapy , Hematologic Neoplasms/drug therapy , Dexamethasone/therapeutic use
4.
J Med Case Rep ; 16(1): 147, 2022 Apr 11.
Article in English | MEDLINE | ID: mdl-35399095

ABSTRACT

BACKGROUND: Adolescents and young adults diagnosed with acute lymphoblastic leukemia are treated according to pediatric-based regimens to achieve better results. However, implementation of intensive chemotherapy protocols in this age group is associated with increased treatment-related toxicities, affecting almost every organ and system. In this case, the focus of our interest was on rather rare entities: steroid-induced psychosis that seldom develops in children and adolescents, and choroid plexus hemosiderosis, infrequently identified as a first sign of iron overload. CASE PRESENTATION: The aim of this paper is to present a challenging case of a 15-year-old Caucasian male patient treated for high-risk acute lymphoblastic leukemia and who experienced various adverse incidents during intensive chemotherapy, thus necessitating a high-quality multidisciplinary approach. Slow minimal residual disease clearance was an additional concerning issue. Induction and re-induction were complicated by steroid-induced hyperglycemia that required multiple-week insulin. During consolidation, acute kidney injury on the basis of chronic kidney disease was verified, demanding subsequent drug dose modifications. By the end of re-induction, after dexamethasone cessation, infrequent steroid-induced psychosis, presented as incoherent speech, aggressive behavior, and mood swings, required intensive psychiatric support. Neurological evaluation of seizures revealed uncommon choroid plexus hemosiderosis by brain magnetic resonance imaging, warranting appropriate selection of iron chelation therapy in the context of preexisting nephropathy. Ultimately, iron deposits of moderate intensity were verified by liver magnetic resonance imaging, while heart tissue remained intact. The early diagnosis and adequate treatment of aforementioned difficult toxicities resulted in complete recovery of the patient. CONCLUSIONS: Treating adolescents with high-risk acute leukemia and multiple therapy-related morbidities remains a challenge, even in the era of extensive and effective supportive therapy. Superior survival rates might be achieved by prompt recognition of both frequent and rarely encountered adverse episodes, as well as well-timed and appropriate management by a well-coordinated multidisciplinary team.


Subject(s)
Hemosiderosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Adolescent , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Child , Hemosiderosis/drug therapy , Hemosiderosis/etiology , Humans , Iron/therapeutic use , Male , Neoplasm, Residual/drug therapy , Neoplasm, Residual/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Young Adult
5.
Cureus ; 14(1): e21711, 2022 Jan.
Article in English | MEDLINE | ID: mdl-35242477

ABSTRACT

Achromobacter xylosoxidans is an aerobic, Gram-negative rod with a broad intrinsic and acquired antimicrobial resistance, usually isolated in patients with cystic fibrosis (CF), immunodeficiencies, or those undergoing invasive procedures. We report a case of a previously healthy 14-year-old girl who was hospitalized in our institution due to a prolonged, progressive cough and exertional dyspnea, which started after a mild viral respiratory tract infection. To elucidate the cause of her symptoms, a bronchoscopy was finally performed, showing bilateral purulent bronchitis caused by A. xylosoxidans, isolated from bronchoalveolar lavage (BAL) sample. Since the patient had positive serological testing for coronavirus disease 2019 (COVID-19), we concluded that it was the initial viral infection, although of a mild clinical course, the one that created favorable conditions for proliferation and further inflammation caused by A. xylosoxidans.

6.
Pediatr Hematol Oncol ; 37(8): 717-731, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32715852

ABSTRACT

Nutritional status is recognized as an independent and modifiable risk factor of outcome in stem cell transplant. Our research aim was to evaluate the impact of body mass index (BMI) and serum albumin on the prevalence of adverse events and survival in autologous transplant in children. A retrospective study was conducted of autologous transplants performed between 2006 and 2017 in the Children's Hospital Zagreb, Croatia. Nutritional status was assessed at the times of diagnosis, procedure, and discharge using BMI (underweight, normal, obese) and serum albumin (grades 1-4). Adverse events (fever, gastrointestinal toxicity, electrolyte disturbances, dysglycemia) and outcome (3-year, relapse, mortality) were documented. Seventy-seven children (54.5% males, mean age 7.9 years) underwent autologous transplant, mostly for neuroblastoma. In terms of BMI and albumin, which showed significant positive correlation at diagnosis (p = 0.026) and transplant (p = 0.016), most participants were well nourished. Average post-transplant weight loss was 4%. Major toxicities were severe mucositis (72.7%) and hypophosphatemia (31.2%). Relapse and mortality rates were 35.1% and 42.9%, respectively. Hypokalemia (p = 0.041) and hypomagnesemia (p = 0.044) were more prevalent in the underweight group, while obese children experienced significantly less severe mucositis (p = 0.016) and hypophosphatemia (p = 0.038). There was no significant difference regarding outcome among children of different nutritional status, although undernourished children tended to have lower relapse and mortality rates. In conclusion, underweight children are significantly more prone to severe electrolyte disorders and mucositis, and although statistical significance was not reached, are more likely to survive.


Subject(s)
Hypophosphatemia/complications , Mucositis/complications , Neoplasms/therapy , Nutritional Status , Stem Cell Transplantation/adverse effects , Transplantation, Autologous/adverse effects , Adolescent , Body Mass Index , Body Weight , Child , Child, Preschool , Croatia , Female , Humans , Hypokalemia/complications , Infant , Infant, Newborn , Male , Mucositis/physiopathology , Neoplasms/blood , Neoplasms/mortality , Neuroblastoma/blood , Neuroblastoma/mortality , Neuroblastoma/therapy , Obesity/complications , Recurrence , Retrospective Studies , Risk Factors , Serum Albumin/metabolism , Stem Cell Transplantation/mortality , Transplantation, Autologous/mortality , Treatment Outcome , Young Adult
7.
Pediatr Allergy Immunol Pulmonol ; 32(3): 86-91, 2019 Sep 01.
Article in English | MEDLINE | ID: mdl-32140277

ABSTRACT

Background: Impaired lung function has been detected in up to 65% of all childhood cancer survivors. It is often caused by exposure to radiation therapy and various chemotherapeutics. The first cytotoxic drug ever identified as a causative agent of lung injury was busulfan, reported in the early 1960s. Signs and symptoms of busulfan lung are nonspecific and it is therefore difficult to differentiate the condition from pulmonary impairment caused by other pulmotoxic agents, infections, pulmonary metastases, graft-versus-host disease, or other noninfectious post-transplant complications involving the lungs. Methods: A case example is provided to illustrate the difficulties in management of busulfan-induced lung injury in children. A retrospective review of cases of busulfan-induced lung injury indexed in PubMed until March 2019 was performed. Inclusion criteria for articles was available in full text in English. Results: Impaired lung function caused by busulfan may become an increasing problem for young survivors. Conclusion: Newly developed dyspnea or subclinical damage detected on pulmonary function tests, indicating primarily restrictive disease, should always arouse suspicion of busulfan-induced lung injury in a child conditioned with busulfan, especially after excluding other leading culprits of pulmonary damage affecting oncology patients.

9.
Acta Paediatr ; 2018 Mar 30.
Article in English | MEDLINE | ID: mdl-29603354

ABSTRACT

AIM: This study investigated the diagnostic usefulness of combined multichannel intraluminal impedance-pH monitoring (MII-pH) in children with suspected reflux-related otitis media with effusion (OME) as existing data were scarce. METHODS: This was a prospective study that included children up to seven years of age who underwent MII-pH due to OME lasting more than three months. The study was conducted in the Children's Hospital Zagreb, Croatia, from January 2014 to August 2016. RESULTS: The study comprised 63 children (63% male) with a mean age of 4.7 years. Gastroesophageal reflux (GER) disease was detected by impedance in 22 (35%) of the children and by pH-metry in nine (14%). In children with OME, MII-pH found a median number of 24 proximal GER episodes, of which a median of nine was acidic and a median of 11 was weakly acidic. There was a significant positive correlation between the number of GER episodes and the presence of eosinophils in nasal swabs. CONCLUSION: Both acidic and weakly acidic refluxes seemed to play a significant role in the pathogenesis of OME. Localised nasal eosinophilia may serve as a marker of extraoesophageal reflux in children with suspected reflux-related OME.

10.
Acta Med Acad ; 44(2): 186-90, 2015.
Article in English | MEDLINE | ID: mdl-26702913

ABSTRACT

OBJECTIVE: Nasopharyngeal carcinoma is an extremely rare pediatric malignancy predominantly occurring in adolescent males. Its multifactorial pathogenesis is most strongly associated with the exposure to Epstein-Barr virus in genetically susceptible hosts. In younger patients, more aggressive biological behavior has been observed, although the overall survival is better compared to adults. Due to its rarity and nonspecific clinical presentation, the diagnosis in children is often delayed and misinterpreted. CASE REPORT: We report a case of a 16-year-old boy with stage IVB nasopharyngeal carcinoma. He presented with a painless palpable neck mass, nasal congestion and a history of occasional epistaxis and headaches. Four years after the completion of a multimodal treatment, the patient is in complete remission. CONCLUSION: Although exceedingly rare, pediatricians should consider nasopharyngeal carcinoma in the differential diagnosis of palpable neck masses, especially in male adolescents. A multidisciplinary approach in the diagnosis, treatment, supportive care and follow-up is of utmost importance.


Subject(s)
Lymph Nodes/pathology , Nasopharyngeal Neoplasms/pathology , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma , Cisplatin/administration & dosage , Fluorouracil/administration & dosage , Humans , Leucovorin/administration & dosage , Lymphatic Metastasis , Male , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms/diagnosis , Nasopharyngeal Neoplasms/therapy , Neck , Neoadjuvant Therapy , Neoplasm Staging , Radiotherapy , Tomography, X-Ray Computed
11.
Hepatogastroenterology ; 60(123): 475-80, 2013 May.
Article in English | MEDLINE | ID: mdl-23108082

ABSTRACT

BACKGROUND/AIMS: Early intervention with nutritional supplementation has been shown to halt malnutrition and may improve outcome in some patients with colorectal cancer. The aim of this study was to investigate whether dietary counseling, oral nutrition and megestrol acetate during chemotherapy affected nutritional status and survival in patients with advanced disease. METHODOLOGY: Six hundred and twenty-eight patients with colorectal advanced disease were included in the study from January 2000 through December 2009 and divided into one of two groups. Group I consisted of 315 patients who were monitored prospectively and were given nutritional support. Group II included 313 patients without nutritional counseling and support. After the completion of chemotherapy all patients were evaluated (BMI, NST, Appetite Loss Scale and ECOG). RESULTS: After the completion of chemotherapy, there were lower proportions of patients in Group I with a BMI<20, NST>=5, loss of appetite and decreased weight gain. Nutritional counseling and supplemental feeding temporarily halted weight loss and improved appetite. This improvement may have implications for patient survival. Patients with early nutritional support lived 19.1 months while patients in the control group had a survival of 12.4 months (p=0.022). CONCLUSIONS: This study demonstrated that concurrent individualized dietary counseling and nutritional support are effective in improving nutritional status thereby lessening chemotherapy-induced morbidity.


Subject(s)
Adenocarcinoma/therapy , Antineoplastic Agents/therapeutic use , Cachexia/prevention & control , Colorectal Neoplasms/therapy , Nutritional Support , Adenocarcinoma/complications , Adenocarcinoma/drug therapy , Adenocarcinoma/mortality , Adenocarcinoma/secondary , Aged , Antineoplastic Agents/adverse effects , Appetite Regulation , Appetite Stimulants/therapeutic use , Body Mass Index , Cachexia/etiology , Cachexia/mortality , Chi-Square Distribution , Colorectal Neoplasms/complications , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Combined Modality Therapy , Counseling , Enteral Nutrition , Female , Humans , Kaplan-Meier Estimate , Male , Megestrol Acetate/therapeutic use , Nutrition Assessment , Nutritional Status , Nutritional Support/methods , Prospective Studies , Retrospective Studies , Time Factors , Treatment Outcome , Weight Loss
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