106 research outputs found
Parvovirus B19-triggered acute hemolytic anemia and thrombocytopenia in a child with Evans syndrome
No full textBackground: Human parvovirus B19 (HPV-B19) is the etiologic agent of erythema infectiosum, of transient aplastic crises in individuals with underlying chronic hemolytic disorders, and of chronic pure red cell aplasia in immunocompromised individuals.
Case report. We describe a 14-year-old girl with long-standing Evans syndrome, who presented with severe anemia, reticulocytopenia and thromocytopenia. A bone marrow aspirate revealed severe erythroid hypoplasia along with presence of giant pronormoblasts, while serological studies and real-time PCR of whole blood were positive for acute parvovirus B19 infection. The patient was initially managed with corticosteroids, but both cytopenias resolved only after administration of intravenous gamma globulin 0.8g/kg.
Conclusion: Acute parvovirus B19 infection should be suspected in patients with immunologic diseases, who present with reticulocytopenic hemolytic anemia and thrombocytopenia. In this setting, intravenous gamma globulin is effective for both cytopenias
Bone and joint infections
No full textThe European Society for Paediatric Infectious Diseases (ESPID) Bone and Joint Infection Guidelines (ESPID Guidelines) are intended for use by health providers who take care of children with bone and joint infection (BJI). Although BJI can include a diverse range of presentations, these guidelines will focus on “acute, hematogenous BJI in children,” with an emphasis on bacterial infections.ESPID Guidelines are consensus-based practice recommendations developed in a systematic manner that aim to be clear, valid and reliable, and presented with clinical applicability. Because evidence from large randomized controlled trials is rare or lacking, practice statements and recommendations provided here frequently reflect our expert consensus process based on best current practice.Although these guidelines include evidence-based and opinion-based recommendations for the diagnosis and management of children with BJI, these guidelines may not provide the best clinical solution and are not intended to serve as a substitute for the clinical judgment of physicians in individual cases or to establish a protocol valid for all children with these infections. Consequently, they do not represent the “only” appropriate approach for children with this kind of infection.We kindly refer to the full version available online (Supplemental Digital Content, http://links.lww.com/INF/C729) for more information on sources used, literature search strategies, guideline development methodology and the ESPID Review Team.The authors of these ESPID Guidelines have made considerable efforts to ensure that the information upon which they are based is accurate and up-to-date. Users of these guidelines are strongly recommended to confirm that the information contained within them, especially drug doses, is correct by way of independent sources. ESPID and the authors of these guidelines accept no responsibility for any inaccuracies, information perceived as misleading or the outcome of any treatment regimen detailed in the guidelines
新約聖書におけるelpisとその根拠 : ギリシア文学の視点から
No full textIn Pet 3.15 the apostle Peter orders the early Christians to be ready to account to anybody at any time for elpis (hope) that they have within them. But why elpis, rather than faith or charity? This suggests how great is the importance that the apostle (or the author) attached to elpis. Since, in Greek Literature, elpis is not always regarded as a good and helpful thing, but can, rather, be seen as something unreliable and delusive, the conspicuous and positive emphasis given to elpis in the NT is note-worthy. Particularly remarkable in this regard is that in the NT the grounds for elpis are quite often given. This essay examines how the term elpis is used and how the hope is grounded in all the 85 instances of elpis in the NT, and the result is shown in a table, which elucidates how the NT advocates hope both systematically and positively.departmental bulletin pape
Pneumocystis jirovecii Pneumonia in Children with Hematological Malignancies: Diagnosis and Approaches to Management
No full textPneumocystis jirovecii pneumonia (PJP) is an opportunistic infection that mostly affects children with suppressed cellular immunity. PJP was the most common cause of infectious death in children with acute lymphoblastic leukemia prior to the inclusion of cotrimoxazole prophylaxis as part of the standard medical care in the late 1980s. Children with acute leukemia, lymphomas, and those undergoing hematopoietic stem cell transplantation, especially allogeneic transplantation, are also at high risk of PJP. Persistent lymphopenia, graft versus host disease, poor immune reconstitution, and lengthy use of corticosteroids are significant risk factors for PJP. Active infection may be due to reactivation of latent infection or recent acquisition from environmental exposure. Intense hypoxemia and impaired diffusing capacity of the lungs are hallmarks of PJP, while computerized tomography of the lungs is the diagnostic technique of choice. Immunofluorescence testing with monoclonal antibodies followed by fluorescent microscopy and polymerase chain reaction testing of respiratory specimens have emerged as the best diagnostic methods. Measurement of (1-3)-β-D-glucan in the serum has a high negative predictive value in ruling out PJP. Oral cotrimoxazole is effective for prophylaxis, but in intolerant patients, intravenous and aerosolized pentamidine, dapsone, and atovaquone are effective alternatives. Ιntravenous cotrimoxazole is the treatment of choice, but PJP has a high mortality even with appropriate therapy
IRON DEFICIENCY ANEMIA IN CHILDREN RESIDING IN HIGH AND LOW-INCOME COUNTRIES: RISK FACTORS, PREVENTION, DIAGNOSIS AND THERAPY
No full textIron deficiency and iron deficiency anemia (IDA) affect approximately two billion people worldwide and most of them reside in low- and middle-income countries. In these countries, additional causes of anemia include parasitic infections like malaria, other nutritional deficiencies, chronic diseases, hemoglobinopathies and lead poisoning. Maternal anemia in resource-poor nations is associated with low birth weight, increased perinatal mortality and decreased work productivity. Maintaining a normal iron balance in these settings is challenging, as iron-rich foods with good bioavailability are of animal origin that are expensive and/or available in short supply. Apart from infrequent consumption of meat, inadequate vitamin C intake and diets rich in inhibitors of iron absorption are additional important risk factors for IDA in low-income countries. In-home iron fortification of complementary foods with micronutrient powders has been shown to effectively reduce the risk of iron deficiency and IDA in infants and young children in developing countries but is associated with unfavorable changes in gut flora and induction of intestinal inflammation that may lead to diarrhea and hospitalization. In developed countries, iron deficiency is the only frequent micronutrient deficiency. In the industrialized world, IDA is more common in infants beyond the sixth month of life, in adolescent females with heavy menstrual bleeding, in women of childbearing age and elderly people. Other special at-risk populations for IDA in developed countries are regular blood donors, endurance athletes and vegetarians. Several medicinal ferrous or ferric oral iron products exist, and their use is not apparently associated with harmful effects on the overall incidence of infectious illnesses in sideropenic and/or anemic subjects. Further research is needed to clarify the risks and benefits of supplemental iron for children exposed to parasitic infections in the third world, and for children genetically predisposed to iron overload
Safety and efficacy of ferric carboxymaltose in children and adolescents with iron deficiency anemia
No full textSafety and efficacy of ferric carboxymaltose in children and adolescents with iron deficiency anemi
Elpis in the Letters to the Collossians and to the Ephesians
No full textThe NT concept of hope is essentially determined by the OT' Among
different words for expressing the reality of biblical hope, elpis and elpiso are of the greatest importance.
After describing the Greek view of the two mentioned words, the article first considers their role and their meaning in the OT - emphasizing the fact that in the OT there is no neutral concept of expectation. An expectation is either good or bad and therefore it is either hope or fear. God's promise(s) and covenant(s) with Israel is assumed to be the ground and object of man's expectation. NT gives a new content to the concept of hope. God is the ultimate author
and ground of elpis and elpiso. His promise to the fathers is fulfilled
in the resurrection of Jesus Christ. He is, through the action of the Holy Spirit, the sustaining power and the unseen yet certain object of every hope. From this background originates the understanding of hope in the letters to the Colossians and to the Ephesians. A detailed textual analysis of all "elpis and elpiso verses" in the two mentioned letters offers a comprehensive insight into the two of the deuteropauline texts. In both letters, with some minor
differences, the risen Christ 'seated at the right hand of God" (Col 3,3) is the object of elpis. This hope is "laid up for you in heaven" (Col 1,5). God makes it known through the Gospel which becomes a sign and a mediator of hope. Because of this the hope is called the elpis tou euangeliou. The community was called to the one hope that belongs to the christian call (cf. Eph 4,4)
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