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Characterizing distant metastases and also success inside oropharyngeal squamous cellular carcinoma.
There were no anaphylactic reactions. All infusion reactions occurred within 4 hours of starting IVIG. No hypotension reactions occurred after 4 hours. All subjects were able to complete their IVIG infusion without any further complications. see more CONCLUSIONS Given that the maximum IVIG infusion rate is reached at 1.5 hours per our hospital's policy and that the overwhelming majority of infusion reactions occurred within the first 4 hours, we found it is safe to coadminister IVIG with sedation 4 hours after initiation of IVIG infusion. For permissions, email [email protected] 2020.OBJECTIVES Adequate hydration status prior to chemotherapy initiation prevents nephrotoxicity in patients receiving potentially nephrotoxic regimens. The purpose of this study was to evaluate the time to initiation of ifosfamide administration between patients receiving standard 6-hour pre-hydration versus 1-hour rapid pre-hydration. METHODS A retrospective study was conducted to determine the primary endpoint of time to ifosfamide administration. Patients 1 to 21 years of age who received ifosfamide with standard 6-hour pre-hydration (125 mL/m2/hr for 6 hours) between September 2017 and January 2018 or 1-hour rapid pre-hydration (750 mL/m2/hr for 1 hour) between September 2018 and March 2019 were included. Secondary endpoints included the incidence of hemorrhagic cystitis, incidence of acute kidney injury (AKI), urine specific gravity, amount of time that ifosfamide was delayed from the originally scheduled administration time, the number of times ifosfamide was delayed greater than 4 hours from the originally scheduled administration time, and length of stay. RESULTS A total of 128 patients were included; 68 patients received standard 6-hour pre-hydration and 60 patients received 1-hour rapid pre-hydration prior to ifosfamide administration. Time to ifosfamide administration was reduced from an average of 9.3 hours to 2.4 hours (p less then 0.0001). There was no incidence of hemorrhagic cystitis or AKI in either group. CONCLUSIONS The 1-hour rapid pre-hydration protocol significantly reduced the time to ifosfamide administration without an increase in adverse effects. For permissions, email [email protected] 2020.OBJECTIVE Although levetiracetam is used for the prevention of early Post-traumatic seizures (EPTS) after traumatic brain injury (TBI), limited data exist describing the incidence of seizures in pediatric patients receiving levetiracetam prophylaxis. The objective of this research is to evaluate the prevalence of EPTS in children given prophylactic levetiracetam after severe TBI. METHODS This study was conducted at a Level 1 pediatric trauma center and included pediatric patients with severe TBI who received levetiracetam for EPTS prophylaxis. Demographics and clinical information were retrospectively collected and evaluated. The primary outcome was prevalence of clinical or electrographic seizures within 7 days of initial injury as noted in the EMR. RESULTS In 4 of 44 patients (9%), seizures developed despite levetiracetam prophylaxis. Concurrent use of other medications with antiepileptic properties was common (91%). There were no differences in demographic or baseline clinical characteristics between the group of patients experiencing seizures and those who did not. However, craniotomy was significantly more common in the seizure group (75% vs. 18%, p = 0.03). CONCLUSIONS Children receiving prophylaxis with levetiracetam after severe TBI had a lower incidence of seizures (9%) than had previously been reported in the literature (18%). Given the limited literature available supporting the use of levetiracetam for the prevention of EPTS in children experiencing severe TBI, further study is needed to support routine use. For permissions, email [email protected] 2020.OBJECTIVE To evaluate the incidence of apnea and requirement for positive pressure ventilation in patients who received caffeine for prevention while receiving alprostadil compared with those who did not receive caffeine. METHODS This was a single-center, retrospective study of patients who received alprostadil over a 7-year time frame. Patients were divided into 2 groups based on whether they received caffeine for prevention of apnea while receiving alprostadil. The incidence of apnea and requirements for positive pressure ventilation were recorded. RESULTS A total of 64 patients who received alprostadil were included for review. Thirty-two patients received caffeine for the prevention of apnea, and 32 patients received alprostadil only. Alprostadil doses were similar between the 2 groups (0.04-0.05 mcg/kg/min). Seven patients had a documented apneic event; 3 in the group given caffeine and 4 in the control group. One patient in each group required intubation because of apnea. All patients with documented apnea were on low-dose alprostadil therapy ( less then 0.05 mcg/kg/min). Three patients had apnea after dose reductions had been made. Six out of the seven patients experienced apnea within the first 24 hours after the infusion. Only 1 patient experienced multiple apneic events. CONCLUSIONS In this small sample, there was no difference in incidence of apnea between patients on low-dose alprostadil who received caffeine for prevention and those who did not. Despite the use of low-dose alprostadil therapy and dose reductions, the incidence of apnea remains low, and most patients did not have repeated apneic events or require intubation. For permissions, email [email protected] 2020.OBJECTIVES The prevalence of attention-deficit/hyperactivity disorder (ADHD) is increasing and psychostimulants are the pharmacological standard of care. Patients benefit most when there is efficient titration to a stable dose of medication as defined by maintaining that same dose for 6 months. The aims of this study were to describe time to stable dose in a cohort of children with ADHD and examine the impact of demographic factors. METHODS A list of pediatric patients with a diagnosis of ADHD in the electronic health record was generated, and a retrospective chart review of stimulant use was conducted on 500 patients randomly selected from 2010 to 2015 who met inclusion criteria. Time to stable dosing and its association with demographic characteristics were assessed. RESULTS Patients were predominantly male (72%), white (81%), and privately insured (67%). Fifty-five percent of patients achieved a stable dose of medication on first attempt; therefore, the median time to stable dosing for the cohort was 0 days with the interquartile range being 0 to 133.
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