Kevin Bax
University of Western Ontario
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Pediatrics | 2015
Carolina Jimenez-Rivera; Simon C. Ling; Najma Ahmed; Jason Yap; Mary Aglipay; Nick Barrowman; Samantha Graitson; Jeff Critch; Mohsin Rashid; Vicky L. Ng; Eve A. Roberts; Herbert Brill; Jenna K. Dowhaniuk; Garth Bruce; Kevin Bax; Mark Deneau; Orlee R. Guttman; Richard A. Schreiber; Steven R. Martin; Fernando Alvarez
BACKGROUND AND OBJECTIVES: Autoimmune hepatitis (AIH) is a progressive inflammatory liver disease of unknown etiology, with limited population-based estimates of pediatric incidence. We reported the incidence of pediatric AIH in Canada and described its clinical characteristics. METHODS: We conducted a retrospective cohort study of patients aged <18 years diagnosed with AIH between 2000–2009 at all pediatric centers in Canada. RESULTS: A total of 159 children with AIH (60.3% female, 13.2% type 2 AIH) were identified. Annual incidence was 0.23 per 100000 children. Median age at presentation for type 1 was 12 years (interquartile range: 11–14) versus 10 years for type 2 (interquartile range: 4.5–13) (P = .03). Fatigue (58%), jaundice (54%), and abdominal pain (49%) were the most common presenting symptoms. Serum albumin (33 vs 38 g/L; P = .03) and platelet count (187 000 vs 249 000; P <.001) were significantly lower and the international normalized ratio (1.4 vs 1.2; P <.001) was higher in cirrhotic versus noncirrhotic patients. Initial treatment included corticosteroids (80%), azathioprine (32%), and/or cyclosporine (13%). Response to treatment at 1 year was complete in 90%, and partial in 3%. 3% of patients had no response, and 3% responded and later relapsed. Nine patients underwent liver transplantation, and 4 patients died at a mean follow-up of 4 years. CONCLUSIONS: AIH is uncommon in children and adolescents in Canada. Type 1 AIH was diagnosed 5.5 times more frequently than type 2 AIH. Most patients respond well to conventional therapy, diminishing the need for liver transplantation.
Annals of Pharmacotherapy | 2014
Kevin Bax; Janice A. Tijssen; Michael J. Rieder; Guido Filler
Objective: To report a novel approach to the management of tacrolimus intoxication that leads to rapid normalization of serum tacrolimus concentrations. Case Summary: A 9-year-old female renal transplant recipient developed a severe tacrolimus intoxication as a result of prolonged diarrhea, which resulted in acute kidney injury, severe dehydration, and neurological symptoms. We used a combination of intravenous steroids and intravenous phenytoin to normalize the tacrolimus level from 32 to 5 ng/mL in less than 24 hours, with complete resolution of symptoms and signs. Discussion: Tacrolimus intoxication is a rare event but may result in life-threatening complications. Treatment recommendations beyond holding the drug and enzyme induction with phenytoin or phenobarbital are elusive. This approach leads to a relatively slow normalization of the tacrolimus level over 72 hours. The authors hypothesized that additional induction of the p-glycoprotein through steroids was synergistic. Conclusions: The combination of phenytoin and a corticosteroid may be an effective approach that leads to rapid normalization of severely elevated tacrolimus levels.
Pediatric Transplantation | 2016
Guido Filler; Ekaterina Kirilova Todorova; Kevin Bax; Ana Catalina Alvarez-Elías; Shih-Han Susan Huang; Marta Kobrzynski
Although de novo DSA are associated with inferior graft survival, there are no effective strategies to prevent their formation. Underexposure to MPA (prodrug: MMF) also contributes to rejection rates early after transplantation, but the effect of this phenomenon on the formation of DSA long‐term post‐transplantation is unknown. Data are expressed as mean (standard deviation). All available data from 32 renal transplant recipients (age at transplantation 7.5 [4.5] yr) on tacrolimus and MPA immunosuppression with an average follow‐up of 9.4 (s.d. 4.6) yr were analyzed. DSA were measured using the Luminex assay (>500 MFI was considered DSA‐positive). Tacrolimus and MPA levels were measured with the Abbot Tacro II and EMIT assay, respectively. Among 1964 MPA and 3462 tacrolimus trough levels, the average MPA trough level was 3.2 (1.5) mg/L and the average tacrolimus level was 6.7 (2.8) ng/mL. At last follow‐up, only 5/32 patients had undetectable DSA, with 5/32 having no class I antibodies and 6/32 having no class II antibodies. DSA formation was associated with a lower minimum MPA trough level (0.27 [0.23] vs. 0.47 [0.18] mg) and cystatin C eGFR (48 [21] vs. 70 [23] mL/min/1.73 m2) for class I DSA formers. The average eGFR of patients without class I DSA was 70 (23) mL/min/1.73 m2, whereas the average eGFR of patients with class I DSA was 48 (21) mL/min/1.73 m2 (p = 0.0071). MPA trough levels <1.3 mg/L long‐term post‐transplantation are associated with the formation of DSA. The association between the formation of DSA and minimum MPA exposure may support a strategy for preventing the formation of DSA.
Case Reports | 2017
Amrit Kirpalani; Michael J. Rieder; Kevin Bax; Guido Filler
An infant boy with steroid-resistant nephrotic syndrome (idiopathic membranous glomerulonephropathy) achieved remission with ciclosporin but developed eosinophilia and high IgE levels (max 19 000 iU/mL). Conversion to tacrolimus resulted in chronic diarrhoea (eosinophilic gastroenteritis), muscle weakness, polyserositis and failure-to-thrive. In contrast, a trial without tacrolimus resulted in a ciclosporin-responsive relapse, therapy-resistant focal seizures with generalised spikes, worsening muscle weakness and diarrhoea. The patient was weaned off of ciclosporin and completely normalised. In vitro testing demonstrated decreased viability of the patients cells when incubated with calcineurin inhibitors (ciclosporin, 70%; tacrolimus, 80% compared to control cells), supporting their role in this adverse drug reaction.
Health Economics Review | 2011
Kevin Bax; Kambiz Norozi; Ajay Sharma; Guido Filler
BackgroundElectronic medical records (EMR) are considered the best solution to improved dissemination of health information for patients. The associated transcription caused a significant cost increase in an academic pediatric center. An educational campaign was implemented to achieve cost-effective transcriptions without compromising the number of EMR transcriptions.MethodsWe analyzed the effect of seniority on transcription times over a 4-month period. We also compared the dictation volume before and 4 months after educational interventions. This study was performed in a pediatric academic center with both inpatient and outpatient transcription utilization analyzed. All clinicians providing pediatric care and utilizing the hospital-based transcription over the study time period were analyzed. Interventions included targeted education about efficiencies in transcription, time-based dictation costs, avoidance of lengthy pauses and unnecessary detail, shortening of total transcriptions, superfluous phrases as well as structured templates. Level of training by postgraduate year of training and seniority within faculty were measured for impact on dictation time and effect of education to improve times.ResultsLearners in year one had an average dictation time of 7.5 ± 2.2 minutes, which decreased with seniority to an average of 4.1 ± 2.2 minutes for senior faculty (0.0007, ANOVA). After educational initiatives were implemented, there was progressive decline in dictation utilization. The total dictation time decreased from 8,750 minutes per month in August 2009 to 4,296 minutes in December of 2009 (p = 0.0045, unpaired t-test).ConclusionWe identified a substantial need for education in dictation utilization and demonstrated that relatively simple interventions can result in substantial costs savings.
Journal of the Canadian Association of Gastroenterology | 2018
Jasbir Dhaliwal; Peter Church; David R. Mack; Hien Q. Huynh; Kevan Jacobson; Wael El-Matary; Jennifer deBruyn; Anthony Otley; Colette Deslandres; Mary Sherlock; J Critch; Kevin Bax; E G Seidman; Mohsin Rashid; Prevost Jantchou; Robert M. Issenman; Aleixo M. Muise; Eric I. Benchimol; Eytan Wine; Matthew Carroll; Sally Lawrence; J. Van Limbergen; Thomas D. Walters; Anne M. Griffiths
Journal of the Canadian Association of Gastroenterology | 2018
Thomas D. Walters; David R. Mack; Hien Q. Huynh; Jennifer deBruyn; Kevan Jacobson; Anthony Otley; Wael El-Matary; Colette Deslandres; Mary Sherlock; Ernest G. Seidman; Kevin Bax; Jeff Critch; Peter Church; Eric I. Benchimol; Eytan Wine; Sally Lawrence; J Van Limbergen; Prevost Jantchou; Matthew Carroll; Anne M. Griffiths
Gastroenterology | 2018
Jennifer deBruyn; Caitlin M. Goedhart; Thomas D. Walters; David R. Mack; Kevan Jacobson; Anthony Otley; Hien Q. Huynh; Wael El-Matary; Colette Deslandres; Mary Sherlock; Kevin Bax; Eric I. Benchimol; Sally Lawrence; Johan Van Limbergen; Eytan Wine; Matthew Carroll; Peter Church; Jeffrey Critch; Ernest G. Seidman; Prevost Jantchou; Anne M. Griffiths
Gastroenterology | 2018
Jasbir Dhaliwal; Peter Church; David R. Mack; Hien Q. Huynh; Kevan Jacobson; Wael El-Matary; Jennifer deBruyn; Anthony Otley; Colette Deslandres; Mary Sherlock; Jeffrey Critch; Kevin Bax; Ernest G. Seidman; Mohsin Rashid; Prevost Jantchou; Robert M. Issenman; Aleixo M. Muise; Eric I. Benchimol; Eytan Wine; Matthew Carroll; Sally Lawrence; Johan Van Limbergen; Thomas D. Walters; Anne M. Griffiths
Gastroenterology | 2018
Jocelyn Jeong; Amy Lee Wing Ngok; Thomas D. Walters; Anne M. Griffiths; David R. Mack; Eric I. Benchimol; Hien Q. Huynh; Kevan Jacobson; Anthony Otley; Wael El-Matary; Colette Deslandres; Ernest G. Seidman; Mary Sherlock; Kevin Bax; Herbert Brill; Jeffrey Critch; Matthew Carroll; Eytan Wine; Sally Lawrence; Johan Van Limbergen; Peter Church; Jennifer deBruyn