• Title/Summary/Keyword: child mortality

Search Result 172, Processing Time 0.027 seconds

The impact of waiting time and delayed treatment on the outcomes of patients with hepatocellular carcinoma: A systematic review and meta-analysis

  • Feng Yi Cheo;Celeste Hong Fei Lim;Kai Siang Chan;Vishal Girishchandra Shelat
    • Annals of Hepato-Biliary-Pancreatic Surgery
    • /
    • v.28 no.1
    • /
    • pp.1-13
    • /
    • 2024
  • Hepatocellular carcinoma (HCC) is the sixth most diagnosed cancer worldwide. Healthcare resource constraints may predispose treatment delays. We aim to review existing literature on whether delayed treatment results in worse outcomes in HCC. PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till December 2022. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes included post-treatment mortality, readmission rates, and complications. Fourteen studies with a total of 135,389 patients (delayed n = 25,516, no delay n = 109,873) were included. Age, incidence of male patients, Child-Pugh B cirrhosis, and Barcelona Clinic Liver Cancer Stage 0/A HCC were comparable between delayed and no delay groups. Tumor size was significantly smaller in delayed versus no delay group (mean difference, -0.70 cm; 95% confidence interval [CI]: -1.14, 0.26; p = 0.002). More patients received radiofrequency ablation in delayed versus no delay group (OR, 1.22; 95% CI: 1.16, 1.27; p < 0.0001). OS was comparable between delayed and no delay in HCC treatment (hazard ratio [HR], 1.13; 95% CI: 0.99, 1.29; p = 0.07). Comparable DFS between delayed and no delay groups (HR, 0.99; 95% CI: 0.75, 1.30; p = 0.95) was observed. Subgroup analysis of studies that defined treatment delay as > 90 days showed comparable OS in the delayed group (HR, 1.04; 95% CI: 0.93, 1.16; p = 0.51). OS and DFS for delayed treatment were non-inferior compared to no delay, but might be due to better tumor biology/smaller tumor size in the delayed group.

The current child and adolescent health screening system: an assessment and proposal for an early and periodic check-up program (현행 영유아 및 소아청소년 건강검진제도의 평가 및 대안)

  • Eun, Baik-Lin;Moon, Jin Soo;Eun, So-Hee;Lee, Hea Kyoung;Shin, Son Moon;Seong, In Kyung;Chung, Hee Jung
    • Clinical and Experimental Pediatrics
    • /
    • v.53 no.3
    • /
    • pp.300-306
    • /
    • 2010
  • Purpose : Recent changes in the population structure of Korea, such as rapid decline in birth rate and exponential increase in old-aged people, prompted us to prepare a new health improvement program in children and adolescents. Methods : We reviewed current health screenings applied for children and adolescents in Korea and other developed countries. We collected and reviewed population-based data focused on mortality and morbidity, and other health-related statistical data. We generated problem lists in current systems and developed new principles. Results : Current health screening programs for children and adolescents were usually based on laboratory tests, such as blood tests, urinalysis, and radiologic tests. Almost all of these programs lacked evidence based on population data or controlled studies. In most developed countries, laboratory tests are used only very selectively, and they usually focus on primary prevention of diseases and health improvement using anticipatory guidance. In Korea, statistics on mortality and morbidity reveal that diseases related to lifestyle, such as obesity and metabolic syndrome, are increasing in all generations. Conclusion : We recommend a periodic health screening program with anticipatory guidance, which is focused on growth and developmental surveillance in infants and children. We no longer recommend old programs that are based on laboratory and radiologic examinations. School health screening programs should also be changed to meet current health issues, such as developing a healthier lifestyle to minimize risk behaviors—or example, good mental health, balanced nutrition, and more exercise.

Clinical Manifestations of Invasive Infections due to Streptococcus pyogenes in Children (소아에서 발생한 A군 연쇄구균에 의한 침습성 질환의 임상적 특성 분석)

  • Yang, Nuri;Lee, Hyeon Seung;Choi, Jae Hong;Cho, Eun Young;Choi, Eun Hwa;Lee, Hoan Jong;Lee, Hyunju
    • Pediatric Infection and Vaccine
    • /
    • v.21 no.2
    • /
    • pp.129-138
    • /
    • 2014
  • Purpose: Streptococcus pyogenes is an important cause of invasive diseases in children. We aimed to describe the clinical characteristics of invasive infections due to S. pyogenes in children in Korea. Methods: A retrospective study of children under 18 years of age with invasive infections due to S. pyogenes at Seoul National University Children's Hospital between March 1992 and December 2012, and Seoul National University Bundang Hospital between March 2003 and December 2012 was conducted. Demographic factors, clinical characteristics, laboratory findings, treatment, mortality and morbidity of all patients were reviewed. Results: A total of 30 among 36 cases identified as invasive disease due to S. pyogenes were available for review. There was a predominance for male subjects (male:female=2.75:1). The median age was 50 months (range 12 days to 15 years) and 53.3% were under 5 years of age. Skin and soft tissue infections (9/30, 30.0%), bacteremia without identified focus (4/30, 13.3%) and bone and joint infections (6/30, 20.0%) were the most frequent clinical presentations. Streptococcal toxic shock syndrome (3/30, 10.0%) pulmonary, abdomen and central nervous system infections (2/30, 6.7%) were also seen. There was a peak in number of patients in year 2012 (9/30, 30.0%). There were no cases of mortality. Erythromycin and clindamycin resistance rates were low by 3.8% and 7.5%, respectively. Conclusion: We studied the clinical presentations of invasive infections due to S. pyogenes during the past 20 years in Korean children. The findings of this study help us understand the characteristics of the disease, enhancing early recognition and prompting adequate antibiotic therapy which is important in reducing morbidity and mortality.

Valve Replacement in Children (소아심장판막치환술)

  • 김재현;이광숙;윤경찬;유영선;박창권;최세영
    • Journal of Chest Surgery
    • /
    • v.32 no.4
    • /
    • pp.341-346
    • /
    • 1999
  • Background: Thirty children ranging from 3 to 15 years of age underwent cardiac valve replacement at Dongsan Medical Center from 1982 to 1997. Material and Method: There were 16 boys and 14 girls. The mean age was 12.1. The underlying pathological cause for valve replacement was congenital heart disease in 17 children and acquired heart disease in 13. The valve replaced was mitral in 15 children, aortic in 11, tricuspid in 3, and combined aortic and mitral in 1. Twenty-one mechanical and 10 tissue valves were placed: primary mechanical valve have been utilized since 1985. Eight of ten patients with tissue valves have had successful second valve replacements 4 to 11 years after the initial operation. Result: The operative mortality was 6.7%, but mortality was higher among patients less than 5 years of age and patients who had previous cardiac operations. Of the 28 operative survivors, 4 patients were lost to follow-up: the remaining patients were observed for a total of 2091 patient/months(mean 74.7 months, maximum 187 months). There was one late death from dilated cardiomyopathy after mitral valve replacement in 7 year-old patient with atrioventricular septal defect. After the operation, all patients with mechanical valves were placed on a strict anticoagulant regimen with Coumadin. The actuarial survival rate was 96% at the end of the follow-up. No instance of thromboembolism or major bleeding were observed in the survivors. Conclusion: These results indicate that valve replacement can be performed with low mortality in children, and with satisfactory long-term survival.

  • PDF

Early postoperative arrhythmias after open heart surgery of pediatric congenital heart disease (소아 선천성 심장병 개심술 후 발생한 조기 부정맥)

  • Choi, Hee-Joung;Kim, Yeo-Hyang;Cho, Joon-Yong;Hyun, Myung-Chul;Lee, Sang-Bum;Kim, Kyu-Tae
    • Clinical and Experimental Pediatrics
    • /
    • v.53 no.4
    • /
    • pp.532-537
    • /
    • 2010
  • Purpose : Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. Methods : From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. Results : Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times ($P$<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer ($P$<0.05), the mortality rate was not significantly different among the 2 groups. Conclusion : Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.

Polymorphisms of XRCC1 and ADPRT Genes and Risk of Noncardia Gastric Cancer in a Chinese Population: a Case-control Study

  • Pan, Xiong-Fei;Xie, Yao;Loh, Marie;Yang, Shu-Juan;Wen, Yuan-Yuan;Tian, Zhi;Huang, He;Lan, Hui;Chen, Feng;Soong, Richie;Yang, Chun-Xia
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.13 no.11
    • /
    • pp.5637-5642
    • /
    • 2012
  • Objective: Gastric cancer (GC) is one of the most common malignancies and its mortality ranks third among all cancers in China. We previously noted that XRCC1 Arg194Trp was associated with GC risk in Western China in a study on XRCC1 Arg194Trp and ADPRT Val762Ala. We aimed to further explore the association of these polymorphisms with risk of the noncardia subtype. Methods: We enrolled 176 noncardia GC patients and 308 controls from four hospitals and a community between October 2010 and August 2011. Genotyping was performed in a 384-well plate format on the Sequenom MassARRAY platform. A self-designed questionnaire was utilized to collect epidemiological data from the subjects regarding demographic factors and potential risk factors. Results: Subjects were aged $56.8{\pm}11.8$ (mean ${\pm}$ standard deviation) and $57.6{\pm}11.1$ years in the case and control groups, respectively. Individuals carrying the XRCC1 Trp/Trp or Arg/Trp variant genotype were at significantly increased risk of noncardia GC (adjusted OR, 1.48; 95% CI, 1.00-2.17), after adjustment for family history of cancer, drinking, and smoking. The increased risk of XRCC1 Arg194Trp variant genotype was more pronounced among subjects below 60 years old (adjusted OR, 1.78; 95% CI, 1.07-2.96), compared to older individuals. ADPRT Val762Ala variants (Ala/Ala or Val/Ala) were not associated with noncardia GC (adjusted OR, 1.03; 95% CI, 0.69-1.54). Conclusions: Our study suggests that XRCC1 Arg194Trp is a genetic susceptibility factor for developing noncardia GC in Han Chinese in Western China. In particular, individuals with the XRCC1 Arg194Trp variant genotype are at increased risk for GC below 60 years old.

A Consensus Plan for Action to Improve Access to Cancer Care in the Association of Southeast Asian Nations (ASEAN) Region

  • Woodward, Mark
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.15 no.19
    • /
    • pp.8521-8526
    • /
    • 2014
  • In many countries of the Association of Southeast Asian Nations (ASEAN), cancer is an increasing problem due to ageing and a transition to Western lifestyles. Governments have been slow to react to the health consequences of these socioeconomic changes, leading to the risk of a cancer epidemic overwhelming the region. A major limitation to motivating change is the paucity of high-quality data on cancer, and its socioeconomic repercussions, in ASEAN. Two initiatives have been launched to address these issues. First, a study of over 9000 new cancer patients in ASEAN - the ACTION study - which records information on financial difficulties, as well as clinical outcomes, subsequent to the diagnosis. Second, a series of roundtable meetings of key stakeholders and experts, with the broad aim of producing advice for governments in ASEAN to take appropriate account of issues relating to cancer, as well as to generate knowledge and interest through engagement with the media. An important product of these roundtables has been the Jakarta Call to Action on Cancer Control. The growth and ageing of populations is a global challenge for cancer services. In the less developed parts of Asia, and elsewhere, these problems are compounded by the epidemiological transition to Western lifestyles and lack of awareness of cancer at the government level. For many years, health services in less developed countries have concentrated on infectious diseases and mother-and-child health; despite a recent wake-up call (United Nations, 2010), these health services have so far failed to allow for the huge increase in cancer cases to come. It has been estimated that, in Asia, the number of new cancer cases per year will grow from 6.1 million in 2008 to 10.6 million in 2030 (Sankaranarayanan et al., 2014). In the countries of the Association of Southeast Asian Nations (ASEAN), corresponding figures are 770 thousand in 2012 (Figure 1), rising to 1.3 million in 2030 (Ferlay et al., 2012). ASEAN consists of Brunei Darussalam, Cambodia, Indonesia, Lao, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam. It, thus, includes low- and middle-income countries where the double whammy of infectious and chronic diseases will pose an enormous challenge in allocating limited resources to competing health issues. Cancer statistics, even at the sub-national level, only tell part of the story. Many individuals who contract cancer in poor countries have no medical insurance and no, or limited, expectation of public assistance. Whilst any person who has a family member with cancer can expect to bear some consequential burden of care or expense, in a poor family in a poor environment the burden will surely be greater. This additional burden from cancer is rarely considered, and even more rarely quantified, even in developed nations.

Sevoflurane Insufflation Sedation for the Dental Treatment of a Patient with Pulmonary Arterial Hypertension : A Case Report (폐동맥 고혈압 환자의 치과치료에서 세보플루란 흡입 진정의 사용 : 증례보고)

  • Chi, Seongin;Kim, Seungoh
    • Journal of the korean academy of Pediatric Dentistry
    • /
    • v.42 no.1
    • /
    • pp.75-79
    • /
    • 2015
  • Pulmonary arterial hypertension (PAH) is a common complication of Congenital heart defects (CHD) with left-to-right shunts, and PAH with increased pulmonary vascular resistance (PVR) is associated with considerable morbidity and mortality. General anesthesia (GA) can be life-threatening in patients with PAH, because the positive pressure ventilation during GA increases pulmonary arterial pressure and decreases pulmonary blood flow. This may also lead to hypoxia. Therefore, spontaneous ventilation may be safer than positive pressure ventilation in patients with PAH. A five-year-old male child, weighing 11 kg, with medical history showing a total correction of Tetralogy of Fallot (TOF) in 2009 and ongoing treatment with hypertension (HTN) medicine since 2007, visited the Dankook University Dental Hospital. He had multiple dental caries, and the treatment was completed under sevoflurane insufflation sedation via nasal cannula. The patient remained sedated throughout the operation while maintaining normal vital signs and spontaneous respiration. In conclusion, sevoflurane insufflation sedation may be a safer alternative to GA for the dental treatment of patients with PAH.

Temporary Abdominal Coverage with Malex Mesh Prosthesis in Cases of Severely Injured Abdominal Trauma Patients (중증 외상환자에서 mesh를 이용한 일시적 수술창 봉합의 경험)

  • Kim, Yeon Woo;Jung, Yong Sik;Kim, Wook Hwan;Min, Young Gi;Kim, Ki Woon;Lee, Kug Jong
    • Journal of Trauma and Injury
    • /
    • v.18 no.1
    • /
    • pp.70-79
    • /
    • 2005
  • Background: Abdominal compartment syndrome has multiple etiologies that are not only related to trauma but also any problem condition in the absence of abdominal injury. To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma victims justifies the use of temporary abdominal coverage with monofilament knitted polypropylene mesh (Malex mesh) in severely injured patients. Method: Medical records at the Ajou University Medical Center were reviewed for a 32-month period from May 1st, 2002 to December 31st, 2004. Twenty-nine consecutive patients requiring celiotomy who were survived until at the end of celiotomy received temporary abdominal coverage and staged abdominal repairs with Malex mesh. One of them was dissecting aortic aneurysm patient and the others were all trauma victims. Malex mesh prosthesis coverage was used in cases of abdominal compartment syndrome due to excessive fascial tension, severe bowel edema and retroperitoneal hemorrhage or edema followed by staged abdominal repairs. Result: Eighteen of twenty-nine patients were survived. Demographic characteristics, injury severity number of abdominal-pelvic bone injuries, mortality rate, complications, number of operations for permanent closure, required time for permanent closure showed no difference between man and women or child and adult. Except one dissecting aortic aneurysm patient, trauma cases showed $3.24{\pm}0.98$ injury sites. All cases that received temporary abdominal coverage and staged abdominal repairs did not show abdominal compartment syndrome. $10.08{\pm}5.85$ days and $2.27{\pm}0.82$ times of operation required making permanent abdominal closure after temporary abdominal coverage followed by staged abdominal repairs. Most of surviving patients have shown antibiotic-resistant organism and fungus infection. Patients who received permanent closure recovered from infectious problem completely. Conclusion: The use of Malex mesh for temporary abdominal coverage in severely injured patients undergoing celiotomy was effective treatment method.

Effects of total body irradiation-based conditioning on allogeneic stem cell transplantation for pediatric acute leukemia: a single-institution study

  • Park, Jongmoo;Choi, Eun Kyung;Kim, Jong Hoon;Lee, Sang-Wook;Song, Si Yeol;Yoon, Sang Min;Kim, Young Seok;Kim, Su Ssan;Park, Jin-Hong;Park, Jaehyeon;Ahn, Seung Do
    • Radiation Oncology Journal
    • /
    • v.32 no.3
    • /
    • pp.198-207
    • /
    • 2014
  • Purpose: To evaluate the effects of total body irradiation (TBI), as a conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT), in pediatric acute leukemia patients. Materials and Methods: From January 2001 to December 2011, 28 patients, aged less than 18 years, were treated with TBI-based conditioning for allo-SCT in our institution. Of the 28 patients, 21 patients were diagnosed with acute lymphoblastic leukemia (ALL, 75%) and 7 were diagnosed with acute myeloid leukemia (AML, 25%). TBI was completed 4 days or 1 day before stem cell infusion. Patients underwent radiation therapy with bilateral parallel opposing fields and 6-MV X-rays. The Kaplan-Meier method was used to calculate survival outcomes. Results: The 2-year event-free survival and overall survival rates were 66% and 56%, respectively (71.4% and 60.0% in AML patients vs. 64.3% and 52.4% in ALL patients, respectively). Treatment related mortality rate were 25%. Acute and chronic graft-versus-host disease was a major complication; other complications included endocrine dysfunction and pulmonary complications. Common complications from TBI were nausea (89%) and cataracts (7.1%). Conclusion: The efficacy and toxicity data in this study of TBI-based conditioning to pediatric acute leukemia patients were comparable with previous studies. However, clinicians need to focus on the acute and chronic complications related to allo-SCT.