Great North Childrens Hospital
Great North Childrens Hospital
Coulthard M.G.,Great North Childrens Hospital
Early Human Development | Year: 2016
Most babies with chronic renal failure are identified antenatally, and over half that are treated with peritoneal dialysis receive kidney transplants before school age. Most infants that develop acute renal failure have hypotension following cardiac surgery, or multiple organ failure. Sometimes the falls in glomerular filtration and urine output are physiological and reversible, and sometimes due to kidney injury, but (illogically) it is now common to define them all as having ‘acute kidney injury’. Contrary to widespread opinion, careful interpretation of the plasma creatinine concentrations can provide sensitive evidence of early acute renal failure. Conservative management frequently leads to under-nutrition or fluid overload. Acute peritoneal dialysis is often technically fraught in very small patients, and haemotherapies have been limited by vascular access and anticoagulation requirements, the need to blood-prime circuits, and serious limitations in regulating fluid removal. Newer devices, including the Nidus, have been specifically designed to reduce these difficulties. © 2016
Skinner R.,Great North Childrens Hospital
Pediatric Nephrology | Year: 2017
Chronic glomerular and tubular nephrotoxicity is reported in 20–50% and 20–25%, respectively, of children and adolescents treated with ifosfamide and 60–80% and 10–30%, respectively, of those given cisplatin. Up to 20% of children display evidence of chronic glomerular damage after unilateral nephrectomy for a renal tumour. Overall, childhood cancer survivors have a ninefold higher risk of developing renal failure compared with their siblings. Such chronic nephrotoxicity may have multiple causes, including chemotherapy, radiotherapy exposure to kidneys, renal surgery, supportive care drugs and tumour-related factors. These cause a wide range of chronic glomerular and tubular toxicities, often with potentially severe clinical sequelae. Many risk factors for developing nephrotoxicity, mostly patient and treatment related, have been described, but we remain unable to predict all episodes of renal damage. This implies that other factors may be involved, such as genetic polymorphisms influencing drug metabolism. Although our knowledge of the long-term outcomes of chronic nephrotoxicity is increasing, there is still much to learn, including how we can optimally predict or achieve early detection of nephrotoxicity. Greater understanding of the pathogenesis of nephrotoxicity is needed before its occurrence can be prevented. © 2017 The Author(s)
Anderson M.,Great North Childrens Hospital
Paediatrics and Child Health (United Kingdom) | Year: 2017
It is estimated that approximately one quarter of adults in the European Union will have used illicit drugs at some point in their lifetime for recreational purposes. Cannabis is the most commonly used drugs by a significant margin. Illicit drug use in younger teenagers appears to have fallen in the UK over the last 10 years. However the level of use in 16-19 year olds remains one of the highest compared with other age groups, with hospital admission due to poisoning also common in this group.Assessment and management of the young person with evidence of toxicity due to illicit drugs is based upon meticulous attention to resuscitation and supportive care, combined with risk assessment dependent upon the suspected causative drug. Good knowledge of the pharmacology of the implicated drug allows early identification and avoidance of complications. © 2017.
Bailey S.,Great North Childrens Hospital |
Parkes J.,University of Cape Town
Clinical Endocrinology | Year: 2015
A 13-year-old male presents with fluctuating visual disturbance and headaches. Imaging reveals a significant predominantly cystic suprasellar tumour, typical of a craniopharyngioma. The patient has growth hormone deficiency but the rest of the hypothalamic/ pituitary axis is intact. What are the options for therapy in 2014? Specifically, is there a role for local treatment with interferon injected into the cyst cavity? The aim of management in children with craniopharyngiomas is to reduce the impact of the tumour as much as possible, while minimising the morbidity associated with treatment. There are a number of therapeutic options available: surgery, radiotherapy and the insertion of therapeutic agents directly into the tumour cyst. The role of intracystic therapy in the form of interferon is discussed; including when to use this therapeutic option and practical details of its use. © 2014 John Wiley & Sons Ltd.
Johnson S.,Great North Childrens Hospital |
Waters A.,University College London
Immunobiology | Year: 2012
Haemolytic uraemic syndrome (HUS) accounts for the most common cause of childhood acute renal failure. Characterized by the classical triad of a microangiopathic haemolytic anaemia, thrombocytopaenia and acute renal failure, HUS occurs as a result of Shiga-toxin producing microbes in 90% of cases. The remaining 10% of cases represent a heterogeneous subgroup in which inherited and acquired forms of complement dysregulation have been described in up to 60%. Emerging evidence suggests that microbes associated with HUS exhibit interaction with the complement system. With the advent of improved genetic diagnosis, it is likely that certain cases of infection-induced HUS may be attributed to underlying defects in complement components. This review summarises the interplay between complement and infection in the pathogenesis of HUS. © 2011 Elsevier GmbH.
Vormoor B.,Northumbria University |
Vormoor B.,Great North Childrens Hospital |
Curtin N.J.,Northumbria University
Current Opinion in Oncology | Year: 2014
In 2012, two publications revealed a particular sensitivity of Ewing sarcoma cells to the inhibition of poly(ADP-ribose) polymerase (PARP). This review updates the reader on PARP function, the development of PARP inhibitors (PARPi) and the evidence for targeting PARP in Ewing sarcoma. It concludes with a description of ongoing/emerging PARPi clinical trials in patients with Ewing sarcoma. RECENT FINDINGS: PARP has a major role in DNA repair, and is a transcription regulator. The oncoprotein in Ewing sarcoma, EWS-FLI1, is proposed to interact with PARP-1, driving PARP-1 expression, which further promotes transcriptional activation by EWS-FLI1. Thus, there are two rationales for PARPi in the treatment of Ewing sarcoma: to disrupt the interaction between EWS-FLI1 and PARP, and for chemo-potentiation or radio-potentiation. The first clinical trial with a single agent PARPi failed to show significant responses, but preclinical evidence for combinations of PARPi with chemotherapy or radiotherapy is very promising. SUMMARY: Despite initial excitement for the potential of PARPi as single agent therapy in Ewing sarcoma, the emerging preclinical data now strongly support testing PARPi in combination with chemo/radiotherapy clinically. Copyright © Lippincott Williams & Wilkins.
Reynolds B.C.,Great North Childrens Hospital |
Cheetham T.D.,Great North Childrens Hospital
Archives of Disease in Childhood: Education and Practice Edition | Year: 2015
Disorders of calcium homeostasis are uncommon but important because of the broad spectrum of potential underlying causes that lie on a spectrum from the benign to the life-threatening. Paediatricians may find them challenging because they do not arise often enough for the investigative approach to be second nature. We report a 4-year-old with acute onset profound hypercalcaemia. We focus on an approach to the clinical problem that is based on the potential organ systems affected, namely the gut, bone and kidney. Key biochemical parameters that may help the paediatric team to reach a diagnosis are discussed, as well as important components of acute management.
Innes R.F.,Great North Childrens Hospital
Nursing children and young people | Year: 2015
The most common background to hyperpyrexia and convulsions is immaturity of the child's physiological reactions to infection, so an understanding of the pathophysiology of pyrexia and febrile convulsions in young children enables nurses to take appropriate action. Correct management involves prompt recognition of rising temperature, administration of antipyretic medication, use of other cooling strategies and careful monitoring. Diagnosis of the underlying cause occasionally requires laboratory investigation, if no focus for infection is found, most cases being viral.
Anderson M.,Great North Childrens Hospital
Patient Preference and Adherence | Year: 2013
Prolonged seizures and status epilepticus are a common acute neurological presentation in pediatric practice. As a result, there is a need for effective and safe medications that can be delivered to convulsing children to effect rapid seizure termination both in hospital and community settings. The challenges of achieving intravenous access, particularly in young children, mandate alternative routes of administration for these drugs. Over the last ten years, midazolam delivered via the buccal mucosa has been demonstrated to be efficacious, safe, and acceptable to children and their caregivers, and a formulation has recently been licensed for use in Europe. The aim of this article is to review the clinical pharmacology with respect to these issues. © 2013 Anderson, publisher and licensee Dove Medical Press Ltd.
Lamb W.H.,Great North Childrens Hospital
Practical Diabetes | Year: 2012
Given the enormous changes in physiology and neurobiology prevalent during adolescence, it is hardly surprising that this is also the time when metabolic control of diabetes is at its worst. Clinical teams are constantly looking for ways to improve diabetes control in youth and exploiting the perceived fascination of adolescents for new technology offers an attractive option. The management of type 1 diabetes has always been heavily influenced by new developments and this personal review, influenced by a long experience of working with adolescents, explores how some of the emerging technologies have been used in an attempt to influence diabetes control in this challenging age group. Copyright © 2012 John Wiley & Sons.