Objective: to conduct a comparative assessment of the effectiveness of immunomodulatory drugs in infectious mononucleosis of mixed etiology (EBV and CMV) in children, using the principles of ...evidence-based medicine.Materials and methods: a comprehensive comparative assessment of the effectiveness of immunomodulatory drugs in children with infectious mononucleosis EBV+CMV-etiology in 3 groups: group I-20 patients receiving recombinant interferon α-2β, group II-20 children receiving interferon – meglumin inducer acridonacetate and group III-20 children treated with a synthetic immunomodulator-inosin pranobex. The comparison group (IV) consisted of 20 children who received basic therapy.Results: Analysis of key intervention indicators for the outcome «fever Duration less than 5 days» showed the highest effectiveness of recombinant interferon α-2β, less effective were meglumina acridonacetate and inosine pranobex. According to the outcomes «Reduction of lymph nodes by 2 or more times» and «Reduction of the liver and spleen by 2 or more times», data on the advantage of meglumin acridonacetate were obtained. The recombinant interferon α-2β was the second most effective. All the studied drugs do notsignificantly affect the severity of the hematological syndrome. The expediency of using immunomodulatory therapy in infectious mononucleosis of EBV+CMV-etiology is shown, the deviation from the norm of the integral outcome indicator is significantly higher in the group of children who were on symptomatic therapy. The overall effectiveness of the studied immunomodulatory drugs with all clinical outcomes does not have statistically significant differences.Conclusion: the obtained data allow us to rationally approach the choice of immunomodulatory therapy, taking into account the effectiveness of clinical outcomes and the overall effectiveness of the drug.
Introduction . Ultrasound (US) diagnostics is used in the diagnosis of chronic pelvic pain (CPP). In difficult cases, magnetic resonance imaging (MRI), computed tomography (CT) with contrast ...enhancement are used. In modern medicine, there is no standard diagnostic algorithm for СРР and requires development. Aim . To compare the results of ultrasound and MRI for differentiating diagnosis between minor forms of external endometriosis and for studying chronic inflammatory processes in the reproductive tract of women with chronic pelvis pain (CPP). Materials and methods . A total of 183 patients of reproductive age with CPP were included in the examination, of which 95 had CCP associated with external endometriosis, and 88 - with chronic inflammatory diseases of the uterus and appendages not in the acute stage. Prior to initiating therapy, all patients underwent ultrasound and MRI examinations. Statistical analysis of the results was performed using Statistica 10 (StatSoft Inc., USA) and MedCalc (version 15.2) software. Results and discussion . Ultrasound confirmed the presence of endometriosis in 29 (30.52%) women of the main group and in 38 (3.18%) patients of the comparison group. MRI was effective in the main group in 54 examined women (56.84%), in the comparison group - in 41 patients (46.59%). The remaining 12 patients of the main group (12.64%) and 9 women from the comparison group (10.23%) were diagnosed based on laparoscopy performed before the women were included in the study. Conclusions . If early stages of external endometriosis are suspected in patients with СРР, MRI is justified. Differential diagnosis of small forms of external endometriosis and fibrosis associated with inflammation in MRI is difficult. Additional laboratory tests are required for accurate differential diagnosis.
The treatment of Hemophilia A and B has significantly evolved.
we conducted a retrospective, observational study among patients with HA and HB managed in a Pediatric Hematology and Oncology Unit for ...almost 22 years for a total of 34 patients.
Until 2009, more than 80 % of patients were treated only on demand, while in 2022,100 % of patients with moderate and severe disease were receiving continuous prophylaxis. The median age at the start of prophylaxis passed from 10,9 to 1,65 years. In 2022, only one patient was on Standard-half-life-rFVIII, 7 patients were on Extended Half-Life (EHL)-rFVIII/rFIX and 7 patients were on Emicizumab; 1 patient was on Concizumab. The mean ABR passed from 5,7 in the period 2001–2009 to 0,8 in the period 2019–2022. We performed 106 ultrasonographic exams in 19 patients to evaluate the HEAD-US score: a percentage of 45,3 % of these exams revealed a score of 0 and the HEAD-US score resulted inferior in patients who started prophylaxis at an age below the median age at the initiation of prophylaxis. The score showed a tendency to correlate with the number of previous hemarthrosis. In our cohort, the overall prevalence of inhibitors is 0,09 among all patients, and 0,14 in severe HA/HB. 4 patients needed a Central Venous Line (CVL), and 3 patients developed at least one severe complication. Before 2017, we observed 4 cases of life-threatening bleeding in children less than 2 years old not on prophylaxis.
our real-life experience reflects the changes in hemophilia management in the last two decades. In the future, other drugs are expected.
Advanced Burkitt's lymphoma (BL) has an extremely poor prognosis in adults. With a previous protocol including CNS prophylaxis, 40% of our adult patients achieved CR and only 13% became long ...survivors. In 1988, following this poor experience, we adopted a very intensive pediatric-derived protocol.
Twenty-one consecutive patients, 8 adults (median age 35, stage III: 1; IV: 7; leukemias: 6) and 13 children (median age 10, state III: 8; IV: 5; leukemias: 4) were treated with the same protocol (POG 8617), based on alternate two-phase cycles with sequential high-dose CTX, VCR, ADM + CNS chemoprophylaxis (phase A) and HD MTX + HiDAC (phase B). Adults received 6 cycles, children 8; i.t. prophylaxis in phase B was omitted in adults.
Twenty of 21 (95%) patients achieved CR (adults 100%, children 92%). Two patients died early; 2 relapsed at 4 and 9 months. With a median follow-up of 28 months (4-96), 17 patients (81%) are event free (adults 75%, children 85%). Severe infections affected 62% of adults and 15% of children.
(1) The prognosis of adult advanced BL definitely improved with this intensive protocol. (2) There were no differences in outcome between adults and children. (3) Outcome of lymphoma and leukemia was similar. (4) Severe infections occurred frequently in adults. This intensive pediatric protocol requires a careful supportive therapy.
A postsurgical “stage-based” protocol for ependymoma was designed.
Children were given: (
1) focal hyperfractionated radiotherapy (HFRT) if with no evidence of disease (NED), or (
2) 4 courses with ...VEC followed by HFRT for residual disease (ED). HFRT dose was 70.4 Gy (1.1 Gy/fraction b.i.d.); VEC consisted of VCR 1.5 mg/m
2 1/w, VP16 100 mg/m
2/day × 3, CTX 3 g/m
2 d 1. When feasible, second-look surgery was recommended.
Sixty-three consecutive children were enrolled: 46 NED, 17 ED; the tumor was infratentorial in 47 and supratentorial in 16, with spinal metastasis in 1. Of NED patients, 35 of 46 have been treated with HFRT; 8 received conventionally fractionated radiotherapy, and 3 received no treatment. Of the 17 ED patients, 9 received VEC + HFRT; violations due to postsurgical morbidity were as follows: HFRT only (2), conventionally fractionated radiotherapy (3) + VEC (2), and no therapy (1). Objective responses to VEC were seen in 54%; objective responses to RT were seen in 75%. Overall survival and progression-free survival at 5 years for all 63 children were 75% and 56%, respectively; for the NED subgroup, 82% and 65%; and for the ED subgroup, 61% and 35%, respectively. All histologies were centrally reviewed. At multivariate analysis, grading, age, and site proved significant for prognosis.
HFRT, despite the high total dose adopted, did not change the prognosis of childhood ependymoma as compared to historical series: New radiotherapeutic approaches are needed to improve local control. Future ependymoma strategies should consider grading when stratifying treatment indications.
Integrating business and operational processes is necessary today to meet the market's increasingly demanding requirements. In particular, it allows rapid decision-making, customized production, and ...short time-to-market. To address these challenges, the authors built a mediation suite on top of a message-oriented middleware to help develop e-services based on industrial data. This software, based on a domain-specific component model, meets stringent market requirements and is being used in real-life service applications.
The paper studies the main performance indicators of the Samara Perinatal Center over the past three years. Positive dynamics which manifests itself in a decrease in the number of premature births ...and the number of newborns with extremely low body weight and in a decrease in perinatal mortality and morbidity in newborns is noted. It is emphasized that the positive results in practical medicine are interconnected with the introduction of new scientific approaches to the problems of gestation proposed by scientists and graduate students of Samara State Medical University.
We describe a premature twin born at 30 wk of gestational age, affected with familial haemophagocytic lymphohistiocytosis. Two different mutations were identified in his DNA: one inherited from the ...mother and one from the father. Haemophagocytosis had been confirmed in his twin brother, who died soon after birth, as well as in the re-evaluation of the autopsy of his older sister, who died 1 y earlier. At 26 d of age, chemotherapy and immune-suppressive treatment were started according to the HLH-94 protocol. At 6 mo of age, a bone marrow transplant from an HLA-identical, unrelated volunteer was performed. Now at 32 mo of age, the infant is healthy and without signs of graft-versus-host disease.
This case report shows that immuno-chemotherapy and allogenic bone marrow transplant are feasible even in premature infants affected with familial haemophagocytic lymphohistiocytosis, which should be ruled out in unknown bleeding disorders of neonates.
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