9 research outputs found
Choosing the Optimal Method for Measuring Glomerular Filtration Rate in Pediatric Intensive Unit
Get PDFThe measurement of glomerular filtration rate (GFR) in intensive care unit patients is strategically important and determines the further treatment tactics. The article provides a literature review on choosing the various methods for assessing the glomerular filtration rate in children with kidney injury. We identified the main limitations of creatinine as a marker for measuring GFR; the features of laboratory methods for creatinine determination were detected
Clinical Risk Factors of Thrombosis in Children after Congenial Heart Diseases Management
Get PDFBackground. Development of thrombotic complications in the postoperative period worsens the course of the disease and increases mortality of children operated for congenital heart diseases (CDC). There is limited data on clinical risk factors of thrombosis after CDCs surgical correction in modern literature. In our opinion, there are several promising factors that have not been studied as predictors of thrombosis in children with CDCs. Aim of the study is to analyze possible effect of patient clinical characteristics on development of thrombotic complications in infants after surgical treatment of CDC. Methods. We have studied data of 156 children aged from birth to 11 months 29 days (median age — 5 months) with CDCs operated under artificial circulation. Following indexes were studied in all patients: age, surgical risk according to RACHS-1 (Risk adjustment for congenital heart surgery), anesthesia duration, surgery duration, aortic cross-clamping time, artificial circulation duration, gestation period, body weight and height at the time of surgery. Results. Thrombosis was diagnosed in 44 patients (28.2%) in the postoperative period. Thromboses of various localizations were found during the patients’ examination: cerebral, intracardiac, limbs vessels, etc. It was revealed that thrombosis detection in patients with RACHS-1 >3 has increased in 2.84 times (95% CI: 1.36-5.92), at anesthesia duration >220 minutes — in 2.64 times (95% CI: 1.15-6.05), at surgery duration >150 minutes — in 3.36 times (95% MD: 1.51-7.5), at aortic cross-clamping time >32 minutes – in 3.23 times (95% CI: 1.45-7.32), at artificial circulation duration >70 minutes — in 3.43 times (95% MD: 1.6-7.34), with gestation period less than 39 weeks — in 2.44 times (95% CI: 1.18-5.03), with child’s weight less than 5.000 grams – in 4.3 times (95% CI: 2.02-9.15), with child’s height less than 60 centimeters — in 4.57 times (95% CI: 2.15-9.73), and at the age less than 3 months old — in 2.31 times (95% CI: 1.08-4.92). Conclusion. RACHS-1 >3, anesthesia duration >220 minutes, surgery duration >150 minutes, aortic cross-clamping time >32 minutes, artificial circulation duration >70 minutes, gestation period less than 39 weeks, weight at the time of surgery less than 5000 grams, height at the time of surgery less than 60 centimeters, and age under 3 months increases the risk of thrombotic complications in postoperative period
Определение скорости клубочковой фильтрации у детей: история и современные подходы
Get PDFThe measurement of glomerular filtration rate (GFR) in intensive care unit patients is strategically important and determines the further treatment tactics. The article provides a literature review on choosing the various methods for assessing the glomerular filtration rate in children with kidney injury. We identified the main limitations of creatinine as a marker for measuring GFR; the features of laboratory methods for creatinine determination were detected.Измерение скорости клубочковой фильтрации у детей необходимо для определения тактики интенсивной терапии. В статье представлен обзор различных методов оценки скорости клубочковой фильтрации у детей при почечном повреждении. Выявлены основные недостатки креатинина как маркера для измерения скорости клубочковой фильтрации, а также особенности лабораторных методов его определения.КОНФЛИКТ ИНТЕРЕСОВАвторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи
Benzocaine-Induced Methemoglobinemia. A Clinical Case
Get PDFThe article describes a clinical case of the development of a severe, life-threatening methemoglobinemia in a patient with a dystrophic form of congenital epidermolysis bullosa while receiving a drug containing benzocaine. The current data on classification, pathogenesis, clinical course and methods for treating this state has been presented. Many substances and drugs that are methemoglobin formers are widespread and can cause chronic methemoglobinemia. Acute severe methemoglobinemia is accompanied by life-threatening organ disorders. In some cases, it may be difficult to diagnose methemoglobinemia due to the polymorphism of the clinical picture, the need for laboratory confirmation of the diagnosis, which may be underperformed in the absence of adequate alertness. The presented clinical case will be useful for doctors of various specialties
Метгемоглобинемия, ассоциированная с приемом бензокаина. Клинический случай
Get PDFThe article describes a clinical case of the development of a severe, life-threatening methemoglobinemia in a patient with a dystrophic form of congenital epidermolysis bullosa while receiving a drug containing benzocaine. The current data on classification, pathogenesis, clinical course and methods for treating this state has been presented. Many substances and drugs that are methemoglobin formers are widespread and can cause chronic methemoglobinemia. Acute severe methemoglobinemia is accompanied by life-threatening organ disorders. In some cases, it may be difficult to diagnose methemoglobinemia due to the polymorphism of the clinical picture, the need for laboratory confirmation of the diagnosis, which may be underperformed in the absence of adequate alertness. The presented clinical case will be useful for doctors of various specialties.В статье представлено описание клинического случая развития тяжелой, угрожающей жизни метгемоглобинемии у пациента с дистрофической формой врожденного буллезного эпидермолиза на фоне приема препарата, содержащего бензокаин. Приведены современные данные о классификации, патогенезе, клиническом течении и способах терапии указанного состояния. Многие вещества и лекарства, являющиеся метгемоглобинобразователями, широко распространены и могут вызывать хроническую метгемоглобинемию. Острая тяжелая метгемоглобинемия сопровождается угрожающими жизни органными нарушениями. Диагностика метгемоглобинемии в ряде случаев может быть затруднена в силу полиморфизма клинической картины, необходимости лабораторного подтверждения диагноза, которое может быть не выполнено в случае отсутствия должной настороженности. Представленный клинический случай будет полезен для врачей различных специальностей
Clinical Features and Management of the Disease Caused by New Coronaviral Infection (COVID-19) in Children. Version 2
Get PDFThe Ministry of Health of the Russian Federation jointly with professional association and experts in the field of pediatrics, infectious diseases and resuscitation has revised guidelines “Clinical Features and Management of the Disease Caused by New Coronaviral Infection (COVID-19) in Children” in order to provide the child population with effective medical care during the pandemic of the new coronaviral infection. The practical experience of specialists from various countries was considered during the development of this document. Special attention should be given to the evidence base of the presented data, as well as to the efficiency and safety issues of medications used in treatment of coronaviral infection and its complications. The authors highlight the problems of prevention, diagnostics and management of pathological conditions caused by COVID-19 in the article according to the presented guidelines. Patient’s management is presented depending on the age and severity of the disease itself. The therapy is considered with regard to etiological, pathogenetic and symptom focus
Особенности клинических проявлений и лечения заболевания, вызванного новой коронавирусной инфекцией (COVID-19), у детей. Версия 2
No full textThe Ministry of Health of the Russian Federation jointly with professional association and experts in the field of pediatrics, infectious diseases and resuscitation has revised guidelines “Clinical Features and Management of the Disease Caused by New Coronaviral Infection (COVID-19) in Children” in order to provide the child population with effective medical care during the pandemic of the new coronaviral infection. The practical experience of specialists from various countries was considered during the development of this document. Special attention should be given to the evidence base of the presented data, as well as to the efficiency and safety issues of medications used in treatment of coronaviral infection and its complications. The authors highlight the problems of prevention, diagnostics and management of pathological conditions caused by COVID-19 in the article according to the presented guidelines. Patient’s management is presented depending on the age and severity of the disease itself. The therapy is considered with regard to etiological, pathogenetic and symptom focus.С целью обеспечения детского населения эффективной медицинской помощью в условиях пандемии новой коронавирусной инфекции Минздравом России совместно с профессиональными ассоциациями и экспертами в области педиатрии, инфекционных болезней и реанимации были переработаны методические рекомендации «Особенности клинических проявлений и лечения заболевания, вызванного новой коронавирусной инфекцией (COVID-19), у детей». При разработке документа был учтен практический опыт не только специалистов нашей страны, но и зарубежных коллег. Особое внимание уделено доказательной базе представленных данных, а также вопросам эффективности и безопасности лекарственных препаратов, применяемых при лечении данной инфекции и ее осложнений. В статье на основании указанных методических рекомендаций авторы освещают вопросы профилактики, диагностики, лечения патологических состояний, обусловленных COVID-19. Тактика ведения пациента представлена в зависимости от возраста и степени тяжести течения болезни, терапия рассмотрена с позиций этиологической, патогенетической и симптоматической направленности
Treatment of Multisystem Inflammatory Syndrome in Children
No full textBACKGROUNDEvidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2.METHODSWe performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation.RESULTSData were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups.CONCLUSIONSWe found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue
Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study
Get PDFBackground: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health
