Prirojena aplazija kože (PAK) je redka prirojena nepravilnost, za katero je značilna odsotnost kože, kožnih priveskov ali podkožnih struktur na določenem delu telesa ob rojstvu in se lahko kaže kot ...ulceracija, membranozna sprememba ali atrofična brazgotina. Spremembe pri PAK so lahko izolirane ali v povezavi z drugimi prirojenimi nepravilnostmi. V približno 20 % so prizadete globoke anatomske strukture (podkožno maščevje, mišice, kosti in možganske ovojnice). Najpogostejša lokacija je skalp. Čeprav so spremembe pogosto solitarne in omejene na zgornje plasti kože, so najhujše oblike PAK skalpa zaradi možnih okužb in krvavitev povezane z visoko smrtnostjo. Etiologija in patogeneza nista v celoti razjasnjeni. PAK razdelimo v devet kliničnih skupin (klasifikacija po Friednu). Glede na značilnosti in pridružene nepravilnosti postavimo diagnozo in pristopimo k zdravljenju. Zdravljenje je v večini primerov konzervativno, glede na kompleksnost bolezni pa ga lahko dopolnimo s kirurškim zdravljenjem. V prispevku predstavljamo primer novorojenčka s PAK.
Background: Significant improvement in neonatal care has enabled increasing survival of preterm infants. Metabolic bone disease of prematurity is often overlooked due to other comorbidities of ...preterm birth. The best approach is screening and prevention of the disease in high-risk infants such as preterm infants. Aim: We followed up the clinical, radiological, and serum biochemical markers of metabolic bone disease in extremely preterm infants (<28 weeks of gestation). The clinical applicability and validation of C-terminal telopeptide of type I collagen (CTX-I) as a novel bone turnover marker were assessed. Standard and novel biochemical bone turnover markers and quantitative ultrasound were compared. Method: Patients’ data were collected from medical records. Assessments of calcium, phosphate, alkaline phosphatase, bone-alkaline phosphatase, CTX-I, and quantitative ultrasound were prospectively performed twice in 42 extremely preterm infants at postmenstrual ages of 30–32 weeks and 36–40 weeks. Bone mineral density was measured by quantitative ultrasound. Conclusion: Phosphate, alkaline phosphatase, bone alkaline phosphatase, calcium, or ionized calcium are not related to gestational age, but bone mineral density, measured by quantitative ultrasound, is related. There is no correlation between standard and novel biochemical markers and quantitative ultrasound for the identification of metabolic bone disease.
Aim To identify the epidemiological and clinical features of acute viral lower respiratory tract infections (LRTI) caused by respiratory syncytial virus and other respiratory viruses, and to ...determine the risk factors for the severe disease among neonates. Methods We retrospectively reviewed the records of neonates aged up to 44 postconceptional weeks who were hospitalized at a tertiary referral hospital due to confirmed viral LRTI between January 2015 and December 2020. Results Of 228 neonates with viral LRTI, one-third were born prematurely. A seasonal distribution of LRTIs from December to March was noticed, peaking in February. Forty-two percent of neonates were treated in the neonatal intensive care unit. One third of these presented with complications and needed mechanical ventilation. The most detected viruses were respiratory syncytial virus and rhinovirus. Prematurity was identified as a risk factor for worse clinical course and more complications, while rhinovirus infection was associated with an increased risk of apnea. Conclusions The burden of respiratory syncytial virus LRTI in the neonatal period is high, although other respiratory viruses can also cause a severe respiratory disease. In preterm infants, rhinovirus infection presents an important risk factor for a severe course of LRTI with complications. Infection with two respiratory viruses leads to a more severe clinical course.
Objective − In this study we aimed to compare the occurrence of lower respiratory tract infections caused by respiratory syncytial virus in the neonatal population in the years before and during the ...COVID-19 pandemic.Methods − Cases of newborns, hospitalized due to viral lower respiratory tract infection from 2015 to 2020, were analyzed retrospectively, and compared according to cause (respiratory syncytial virus, non-respiratory syncytial virus) and treatment requirements before (2015−2019) and after (2020) the outbreak of the COVID-19 pandemic.Results − The number of newborns with lower respiratory tract infections and newborns contracting respiratory syncytial virus declined significantly during the COVID-19 pandemic. Respiratory syncytial virus was the major causative agent before the pandemic, while after the lockdown no more cases were reported. There were no significant differences between the two periods regarding the number of patients requiring treatment with oxygen (P=0.705), non-invasive (P=0.842) and invasive ventilation (P=0.574), or in terms of median hospital stay (P=0.670) and the duration of non-invasive (P=0.350) and invasive ventilation (P=0.556), while the difference in the duration of treatment with oxygen was statistically significant (P=0.048).Conclusions − A decline was found in the number of newborns hospitalized due to respiratory syncytial virus and non-respiratory syncytial virus lower respiratory tract infections during the COVID-19. Our results strongly suggest that social distancing and other lockdown strategies were effective in slowing down the spread of respiratory syncytial virus and decreasing the need for hospitalization among newborns, but may be not equally effective for all agents causing lower respiratory tract infections.
Aim To identify the epidemiological and clinical features of
acute viral lower respiratory tract infections (LRTI) caused
by respiratory syncytial virus and other respiratory viruses, and to ...determine the risk factors for the severe disease
among neonates.
Methods We retrospectively reviewed the records of neonates aged up to 44 postconceptional weeks who were
hospitalized at a tertiary referral hospital due to confirmed
viral LRTI between January 2015 and December 2020.
Results Of 228 neonates with viral LRTI, one-third were
born prematurely. A seasonal distribution of LRTIs from
December to March was noticed, peaking in February. Forty-two percent of neonates were treated in the neonatal
intensive care unit. One third of these presented with complications and needed mechanical ventilation. The most
detected viruses were respiratory syncytial virus and rhinovirus. Prematurity was identified as a risk factor for worse
clinical course and more complications, while rhinovirus
infection was associated with an increased risk of apnea.
Conclusions The burden of respiratory syncytial virus LRTI
in the neonatal period is high, although other respiratory
viruses can also cause a severe respiratory disease. In preterm infants, rhinovirus infection presents an important
risk factor for a severe course of LRTI with complications.
Infection with two respiratory viruses leads to a more severe clinical course
Molecular and genomic surveillance systems for bacterial pathogens currently rely on tracking clonally evolving lineages. By contrast, plasmids are usually excluded or analyzed with low-resolution ...techniques, despite being the primary vectors of antibiotic resistance genes across many key pathogens. Here, we used a combination of long- and short-read sequence data of Klebsiella pneumoniae isolates (n = 1,717) from a European survey to perform an integrated, continent-wide study of chromosomal and plasmid diversity. This revealed three contrasting modes of dissemination used by carbapenemase genes, which confer resistance to last-line carbapenems. First, bla
OXA-48-like genes have spread primarily via the single epidemic pOXA-48–like plasmid, which emerged recently in clinical settings and spread rapidly to numerous lineages. Second, bla
VIM and bla
NDM genes have spread via transient associations of many diverse plasmids with numerous lineages. Third, bla
KPC genes have transmitted predominantly by stable association with one successful clonal lineage (ST258/512) yet have been mobilized among diverse plasmids within this lineage. We show that these plasmids, which include pKpQIL-like and IncX3 plasmids, have a long association (and are coevolving) with the lineage, although frequent recombination and rearrangement events between them have led to a complex array of mosaic plasmids carrying bla
KPC. Taken altogether, these results reveal the diverse trajectories of antibiotic resistance genes in clinical settings, summarized as using one plasmid/multiple lineages, multiple plasmids/multiple lineages, and multiple plasmids/one lineage. Our study provides a framework for the much needed incorporation of plasmid data into genomic surveillance systems, an essential step toward a more comprehensive understanding of resistance spread.
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