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Fung E.B.,Childrens Hospital and Research Center | Kwiatkowski J.L.,Childrens Hospital of Philadelphia | Huang J.N.,University of California at San Francisco | Gildengorin G.,Pediatric Clinical Research Center | And 2 more authors.
American Journal of Clinical Nutrition | Year: 2013

Background: Patients with thalassemia major (Thal) frequently have low plasma zinc, which has been associated with low bone mass Objective: The objective was to determine the effect of zinc supplementation on bone mass in patients with Thal Design: Forty-two subjects (21 females aged 10-30 y) with Thal and low bone mass were randomly assigned to receive 25 mg Zn/d or placebo. Bone mineral content (BMC) and areal bone mineral density (aBMD) were assessed by using dual-energy X-ray absorptiometry, and fasting blood was collected for the measurement of plasma zinc at 0, 12, and 18 mo Results: Thirty-two subjects, 81% of whom were transfusion dependent, completed the study (mean 6 SD: 17.1 6 5.2 y). Plasma zinc was #70 mg/dL in 11 subjects at baseline and increased significantly with zinc supplementation (P = 0.014). Use of intentionto- treat analysis and linear models for longitudinal data, adjusted for baseline and pubertal stage, showed that the zinc group had significantly greater increases in whole-body BMC (adjusted mean 6 SE: 63 6 15 g; P = 0.02), and aBMD (0.023 6 0.006 g/cm2; P = 0.04) than did the placebo group after 18 mo. Furthermore, adjusted spine and hip aBMD z scores each decreased by 0.3 SDs (both P = 0.04) in the placebo compared with the zinc group over the 18-mo study Conclusions: In young patients with Thal, zinc supplementation resulted in greater gains in total-body bone mass than did placebo Zinc was well tolerated and is worthy of investigation in larger trials in Thal patients across a range of ages and disease severity. © 2013 American Society for Nutrition. Source


Kanathezhath B.,Childrens Hospital Oakland Research Institute | Shah A.,University of Southern California | Secola R.,University of Southern California | Hudes M.,Pediatric Clinical Research Center | Feusner J.H.,Childrens Hospital Oakland Research Institute
Journal of Pediatric Hematology/Oncology | Year: 2010

Introduction: Surveillance blood cultures (BCs) are often obtained in hematopoietic stem cell transplant (HSCT) patients for earlier detection of blood stream infections (BSI). The major aim of this study was to determine the utility of the current practice of obtaining surveillance blood cultures from asymptomatic transplant patients upon admission for the preparative regimen. Methods: We conducted an 8-year retrospective study of all patients consecutively admitted to the hospital for a HSCT from 2000 to 2008. Results: In this retrospective analysis, surveillance BCs from 191 eligible patients were analyzed. The incidence of definitive BSIs was 0.52% (1/191) with 6 BCs from other HSCT patients growing probable contaminants. The overall incidence of positive surveillance BCs was 2.9% (7/238) for the BCs taken and 3.7% (7/191) for patients cultured with coagulase negative staphylococcus being isolated from 6 of the 7 patients. The probability of increased BSI after transplantation in patients with initial positive surveillance BCs compared with those having negative BCs, was not significant (P = 0.675). No infection-related mortality was observed during the first 60 days posttransplantation in these patients. Conclusions: The frequency of positive surveillance BCs in asymptomatic HSCT patients at the time of hospital admission for transplant seems to be extremely low. These results, if confirmed by larger studies, show the reduced utility of obtaining surveillance BC in asymptomatic patients before administration of the conditioning regimen and the need for re-evaluation of this practice. Copyright © 2010 by Lippincott Williams & Wilkins. Source


Wahl S.K.,Blood Systems Research Institute | Gildengorin G.,Pediatric Clinical Research Center | Feusner J.,Childrens Hospital and Research Center Oakland
Journal of Pediatric Hematology/Oncology | Year: 2012

The Friday afternoon admission of a child with a potential diagnosis of leukemia creates perceived delays in treatment initiation. Although generally not felt to affect prognosis, the effect of a few days delay in chemotherapy for children with acute lymphoblastic leukemia (ALL) has not been fully investigated. We retrospectively analyzed 207 patients consecutively diagnosed with ALL at Children's Hospital & Research Center Oakland from 1995 to 2007 to determine if delay in chemotherapy increased the risk of relapse, death, transfer to the intensive care unit, or bacteremia. Friday admission did not significantly delay chemotherapy initiation with treatment started at a mean of 4.13±2.40 days for Friday admits versus 3.72±1.57 days for all others (P=0.29). There was no significant association between treatment delay days and relapse (P=0.94) or death (P=0.55). In Cox regression analysis, treatment delay was not a predictor of time to relapse (P=0.80) or longer duration of hospitalization (corrected for delay, P=0.15). There were trends toward significant associations between treatment delay and bacteremia (P=0.07) and intensive care unit admissions (P=0.08), although both were associated with shorter, not longer, treatment delays.We were unable to demonstrate a significant effect of delay in chemotherapy initiation for pediatric patients with newly diagnosed ALL on the examined outcome variables. Copyright © 2011 by Lippincott Williams & Wilkins. Source


Stookey J.D.,Childrens Hospital Oakland Research Institute | Hamer J.,Childrens Hospital Oakland Research Institute | Espinoza G.,Childrens Hospital Oakland Research Institute | Higa A.,Pediatric Clinical Research Center | And 4 more authors.
Advances in Nutrition | Year: 2012

Caloric beverages may promote weight gain by simultaneously increasing total energy intake and limiting fat oxidation. During moderate intensity exercise, caloric beverage intake depresses fat oxidation by 25% or more. This randomized crossover study describes the impact of having a caloric beverage with a typical meal on fat oxidation under resting conditions. On 2 separate days, healthy normal-weight adolescents (n = 7) and adults (n = 10) consumed the same breakfast with either orange juice or drinking water and sat at rest for 3 h after breakfast. The meal paired with orange juice was 882 kJ (210 kcal) higher than the meal paired with drinking water. Both meals contained the same amount of fat (12 g). For both age groups, both meals resulted in a net positive energy balance 150 min after breakfast. Resting fat oxidation 150 min after breakfast was significantly lower after breakfast with orange juice, however. The results suggest that, independent of a state of energy excess, when individuals have a caloric beverage instead of drinking water with a meal, they are less likely to oxidize the amount of fat consumed in the meal before their next meal. © 2012 American Society for Nutrition. Source


Morris C.R.,Emory University | Kuypers F.A.,Childrens Hospital Oakland Research Institute | Lavrisha L.,Pediatric Clinical Research Center | Ansari M.,Childrens Hospital Oakland Research Institute | And 5 more authors.
Haematologica | Year: 2013

Painful episodes of vaso-occlusion are the leading cause of hospitalizations and emergency department visits in sickle cell disease, and are associated with increased mortality. Low nitric oxide bioavailability contributes to vasculopathy in sickle cell disease. Since arginine is the obligate substrate for nitric oxide production, and an acute deficiency is associated with pain, we hypothesized that arginine may be a beneficial treatment for pain related to sickle cell disease. Thirty-eight children with sickle cell disease hospitalized for 56 episodes of pain were randomized into this double-blinded placebo-controlled trial. Patients received L-arginine (100 mg/kg tid) or placebo for 5 days or until discharge. A significant reduction in total parenteral opioid use by 54% (1.9±2.0 mg/kg versus 4.1±4.1 mg/kg, P=0.02) and lower pain scores at discharge (1.9±2.4 versus 3.9±2.9, P=0.01) were observed in the treatment arm compared to the placebo one. There was no significant difference in hospital length of stay (4.1±01.8 versus 4.8±2.5 days, P=0.34), although a trend favored the arginine arm, and total opioid use was strongly correlated with the duration of the admission (r=0.86, P<0.0001). No drug-related adverse events were observed. Arginine therapy represents a novel intervention for painful vaso-occlusive episodes. A reduction of narcotic use by >50% is remarkable. Arginine is a safe and inexpensive intervention with narcotic-sparing effects that may be a beneficial adjunct to standard therapy for sickle cell-related pain in children. A large multi-center trial is warranted in order to confirm these observations. © 2013 Ferrata Storti Foundation. Source

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