Browsing by Author "Galante, Gary"

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    Anemia in Pediatric Intestinal Failure: Prevalence, Predictors and Etiologies
    (2025-01-22) Strauss, Jaclyn Carla; deBruyn, Jennifer; Raman, Maitreyi; Fenton, Tanis; Galante, Gary; Samuel, Susan
    Children with intestinal failure (IF) are at high-risk for different types of anemia, including iron deficiency anemia (IDA), anemia of inflammation (AI) and mixed IDA/AI. Data on the prevalence and underlying contributors to the types of anemia in the pediatric IF population is limited. Therefore, the aim of this thesis was to examine the prevalence and contributions of the various types of anemia in children with IF and identify factors associated with these anemias. A 10-year retrospective, multicenter study of pediatric IF patients managed by three separate intestinal rehabilitation programs (IRPs) in Canada was conducted. Anemia was defined by age-specific hemoglobin values, and anemia types were classified using a combination of hematologic measures and iron indices. Univariable regression analysis was performed to evaluate for demographic and clinical factors associated with anemia and anemia types. Among ninety children with IF, the period prevalence of anemia was 83% [75/90], with 76% [55/72] of children experiencing chronic anemia, defined as anemia on ≥2 annual hemoglobin measurements. AI (44%) [40/90] and mixed IDA/AI (36%) [32/90] were more prevalent than IDA (17%) [15/90]; 26% [19/90] children developed >1 type of anemia over time, and 84% [191/227] of anemic hemoglobin measurements occurred while receiving iron supplementation, oral or in parenteral nutrition (PN). The prevalence of mixed IDA/AI was higher at 2 IRPs that did not have access to iron-supplemented PN (75% vs 9%; p<0.001), as was small intestine bacterial overgrowth (SIBO) (58% vs 28%; p=0.004) and gastrointestinal bleeding (39% vs 15%; p=0.001). Children receiving iron-supplemented PN had lower odds of mixed IDA/AI compared to no anemia (OR 0.06, p<0.001), while oral iron supplementation was associated with an increased odds of mixed IDA/AI compared to no anemia (OR 3.40, p=.01). This study demonstrated a high prevalence of anemia in children with IF, specifically mixed IDA/AI and AI. This anemia is often chronic and dynamic with evolving anemia types. Our results suggest that mode of iron supplementation may impact IF-associated complications and anemia types. Future studies exploring the complex interactions between the gut microbiome, mode of iron supplementation and inflammation on anemia in pediatric IF are needed.
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    The Cost of Cystic Fibrosis Care in Canada: A Scoping Review
    (2024) Desai, Leena; Bomersback, Taryn; Galante, Gary; Bjornson, Candice; Hirota, Simon
    Background: Cystic fibrosis (CF) contributes a significant economic burden on individuals, health systems and society. This economic impact is highly relevant in a single-payer, publicly funded health system such as Canada. CFTR modulator therapy has been shown in large clinical trials to reduce the burden of disease in the pediatric population. Currently 17% of patients at the Alberta Children’s Hospital in Calgary, AB do not qualify for any CFTR modulator therapy, presumably resulting in an incremental cost to the system. Precision medicine tools such as organoid models may offer an opportunity for n-of-1 trials for individual patients who are currently not approved for therapy. Rationale: In order to better understand the health and economic impact of cystic fibrosis in Canada, we wish to identify direct, indirect and intangible costs of cystic fibrosis care in Alberta and Canada, and highlight the higher rate of heterogeneity amongst our southern Alberta CF population which predisposes to higher cost of care due to lack of approval to currently available therapies. Aim and Objective: This protocol describes the purpose of a scoping review which is to identify the most accurate estimation of the cost of cystic fibrosis care in Canada, and gather comprehensive data on how the costs of CF care (including direct, indirect and intangible costs) are defined and measured in Canada. Methodology: The protocol is developed using the JBI (Joanna Briggs Institute) guidance for scoping reviews and based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist, both of which will also guide its reporting. We will search PUBMED and OVID/MEDLINE for peer-reviewed English-language publications and grey literature search of relevant databases (ProQuest Dissertation and Theses, Canadian Health Research Collection) and organizational websites (Health Canada, Government of Canada, Cystic Fibrosis Foundation of Canda, Canadian Agency for Drugs and Technology in Health (CADTH)).