Abstract
Objective: To estimate time trends in prevalence of symptoms and reported diagnosis related to asthma, allergic rhinitis/conjunctivitis and eczema among school children in the north-west ...coastal part of Croatia. Methods: Results of two identical cross-sectional surveys conducted on the same area 8 years apart (school years 2001/02 versus 2009/10) in complete adherence to the protocol of the International Study of Asthma and Allergies in Childhood were compared. Surveyed population comprised two age groups: 6-7 years (n = 1634 versus n = 1052) and 13-14 years (n = 2194 versus 1181). Results: Significant (p < 0.001) increases in prevalence (%) of symptoms related to asthma (8.4 versus 14.0), allergic rhinitis (17.5 versus 25.6), allergic rhinoconjunctivitis (6.7 versus 15.3) and eczema (3.4 versus 5.9) were observed in the 13-14-year-olds. In the 6-7-year-olds there were observed significant (p < 0.001) increases in prevalence of symptoms of eczema (5.4 versus 8.7) and allergic rhinitis (16.9 versus 22.1) whereas prevalence of symptoms related to asthma (9.7 versus 9.4; p = 0.398) and allergic rhinoconjunctivitis (5.6 versus 6.8; p = 0.102) showed to be stable. Significant increases in prevalence of reported diagnosis were observed for asthma (5.2 versus 6.9; p = 0.02) and hay fever (10.5 versus 14.6; p < 0.001) in the older, and for eczema (10.6 versus 14.1; p < 0.001) in the younger age group. Conclusion: Prevalence of asthma and allergic diseases among the school children living on the surveyed area showed a rising trend.
Cilj: Amoksicilinski osip je generalizirani makulopapulozni egzantem koji se javlja nakon primjene semisintetskih penicilina u liječenju bolesnika koji imaju klinički neprepoznatu infektivnu ...mononukleozu. Često se kod takvih bolesnika pogrešno postavlja dijagnoza alergije na penicilin. Cilj ovog rada bio je prikazati pojavu osipa u djevojčice koja je liječena amoksicilinom zbog znakova upale gornjih dišnih putova. Nije imala tipičnu kliničku prezentaciju infektivne mononukleoze. Prikaz slučaja: Četverogodišnja djevojčica primljena je zbog akutnih simptoma kataralne upale gornjih dišnih putova i vrućice do 39,7 °C uz zimicu i tresavicu, na što je uvedena terapija amoksicilinom. Nakon prve doze amoksicilina javio se osip – prvo na glavi, iza uški, da bi se zatim difuzno proširio „spustivši“ se na trup i ektremitete. S obzirom na perzistirajuću vrućicu, širenje i konfluiranje osipa i grlobolju, djevojčica je hospitalizirana. Pri prijamu je bio prisutan makulopapulozni eritematozni osip, crveno ždrijelo s hipertrofičnim tonzilama i uvećani angularni limfni čvorovi. CRP je iznosio 37,1, a krvna slika bila je obilježena relativnom neutrofilijom. Iz biokemijske analize seruma za izdvojiti su bile normalne vrijednosti transaminaza. Serologijom je potvrđena akutna infekcija Epstein-Barrovim virusom. Nakon simptomatskog liječenja kožni simptomi su se postupno povukli. Pacijentica je četvrtog dana hospitalizacije postala afebrilna, a šestog dana otpuštena je kući. Zaključak: Patogeneza ovakvog kožnog osipa još je uvijek nedovoljno istražena. Najčešće je riječ o prolaznoj imunološkoj reakciji zbog virusne infekcije, a ne o razvoju prave alergijske reakcije na amoksicilin, na što se najčešće u praksi pogrešno posumnja. Zaključno, na infektivnu mononukleozu treba posumnjati čak i kada nema tipičnih kliničkih elemenata za tu bolest poput limfocitoze i povišenih vrijednosti transaminaza.
Aim: Amoxicillin rash is a generalized maculopapular exanthema that occurs after the use of semisynthetic penicillins in the treatment of patients with clinically unrecognized infectious mononucleosis. Such patients are often misdiagnosed as allergic to penicillin. The aim of this study was to present the rash that occurred in a girl treated with amoxicillin due to the signs of upper respiratory tract inflammation. She did not have the typical clinical presentation of infectious mononucleosis. Case report: A four-year-old girl presented with acute symptoms of catarrhal inflammation of the upper respiratory tract and fever up to 39.7°C with chills and shivering, to which amoxicillin was introduced. After the first dose of amoxicillin, a rash appeared. First on the head, behind the ears, and then diffusely spread “descending” to the trunk and extremities. Due to persistent fever, spreading and confusing rash and sore throat, the girl was hospitalized. Maculopapular erythematous rash, red throat with hypertrophic tonsils, and enlarged angular lymph nodes were present at admission. CRP was 37.1 and blood count was marked by relative neutrophilia. It is important to point out normal transaminase values from serum biochemistry. Acute Epstein-Barr virus infection was confirmed by serology. After symptomatic treatment, the skin symptoms gradually subsided. The patient became afebrile on the fourth day of hospitalization, and was discharged home on the sixth day. Conclusion: The pathogenesis of this skin rash is still insufficiently investigated. It is most often a transient immune reaction due to a viral infection, and not a real allergic reaction to amoxicillin, which is most often mistakenly suspected in practice. In conclusion, infectious mononucleosis should be suspected even when there are no typical clinical signs for the disease, such as lymphocytosis and elevated transaminases.
Current evidence suggests that additional pathogenetic factors could play a role in the development of chronic lung disease of prematurity, other than mechanical ventilation and free radical injury. ...The introduction of the concept of "fetal inflammatory response syndrome" offers a new perspective on the pathogenesis of chronic lung disease of prematurity. New statistical approaches could be useful tools in evaluating causal relationships in the development of chronic morbidity in preterm infants. The aim of this study was to test a new statistical framework incorporating path analysis to evaluate causality between exposure to chorioamnionitis and fetal inflammatory response syndrome and the development of chronic lung disease of prematurity. We designed a prospective cohort study that included consecutively born premature infants less than 32 weeks of gestation whose placentas were collected for histological analysis. Histological chorioamnionitis, clinical data, and neonatal outcomes were related to chronic lung disease. Along with standard statistical methods, a path analysis was performed to test the relationship between histological chorioamnionitis, gestational age, mechanical ventilation, and development of chronic lung disease of prematurity. Among the newborns enrolled in the study, 69/189 (36%) had histological chorioamnionitis. Of those with histological chorioamnionitis, 28/69 (37%) were classified as having fetal inflammatory response syndrome, according to the presence of severe chorioamnionitis and funisitis. Histological chorioamnionitis was associated with a lower birth weight, shorter gestation, higher frequency of patent ductus arteriosus, greater use of surfactant, and higher frequency of chronic lung disease of prematurity. Severe chorioamnionitis and funisitis were significantly associated with lower birth weight, lower gestational age, lower Apgar score at 5 minutes, more frequent use of mechanical ventilatory support and surfactant, as well as higher frequency of patent ductus arteriosus and chronic lung disease. The results of the path analysis showed that fetal inflammatory response syndrome has a significant direct (0.66), indirect (0.11), and overall (0.77) effect on chronic lung disease. This study demonstrated a strong positive correlation between exposure of the fetus to a severe inflammatory response and the development of chronic lung disease of prematurity.
Cilj: Prikazati seriju slučajeva anti-SARS-CoV-2 IgG pozitivnih pedijatrijskih pacijenata koji su razvili multisistemski upalni sindrom koji se javio kao posljedica bolesti COVID-19, a u svojoj ...definiciji objedinjuje povišenu tjelesnu temperaturu, znakove zahvaćanja dvaju ili više organskih sustava, pozitivan kontakt s koronavirusom i isključivanje drugih uzročnika, kao i opisati učinkovitost primijenjene imunosupresivne terapije. Prikaz slučaja: Četiri pedijatrijska pacijenta u dobi od 18 mjeseci, 9, 10 i 15 godina bila su upućena u hitnu pedijatrijsku ambulantu zbog perzistentnog febriliteta i simptoma različitih organskih sustava. Kod troje pacijenata glavni su simptomi bili povraćanje, proljev, osip i konjunktivitis, a u jednog se pacijenta isticao otežan hod i oslabljeni tetivni refleksi nogu. U svih pacijenata laboratorijski su nalazi potvrdili akutnu upalu, a zbog povišenog moždanog natriuretskog peptida učinjena je kardiološka obrada. Ultrazvuk srca je kod dvaju pacijenata pokazao mitralnu insuficijenciju, a kod jednog perikardijalni izljev. Nakon postavljene dijagnoze multisistemskog upalnog odgovora terapija je u slučaju naših pacijenata bila u skladu s neslužbenim svjetskim i europskim smjernicama. Primijenjeni su intravenski imunoglobulini i kortikosteroidi te nadoknada tekućine i vazoaktivni lijekovi. Budući da se na ovaj način može prezentirati bakterijska sepsa do dolaska hemokultura, primijenjeni su antibiotici širokog spektra. Sva su četiri pacijenta ozdravila te su puštena kući. Zaključak: Pravovremeno otkrivanje i liječenje multisistemskog upalnog odgovora ujedno znači i bolji ishod za pacijenta. Potencijalna buduća istraživanja mogla bi se usmjeriti na razjašnjavanje ovog stanja i mogućih dugoročnih posljedica, a na taj način i spriječiti teške kliničke slike.
Aim: To present a series of cases of pediatric patients who have been tested positively to anti-SARS-CoV-2 IgG and who have developed multisystem inflammatory syndrome that occurred because of COVID19 infection. In its definition, it implies symptoms such as fever, signs affecting two or more organ systems, positive contact with the COVID19 virus while excluding other causes and describing the efficacy of applied immunosuppressive therapy. Case report: Four pediatric patients aged 18 months, 9, 10 and 15 years were referred to an emergency pediatric clinic because of the persistent fever and symptoms of various organ systems. In the case of four patients, three out of the four patients had vomiting, diarrhea, rash and conjunctivitis as their main symptoms, and in the case of the remaining patient, their symptoms were the impaired gait and weakened tendon reflexes of the legs. In all patients the laboratory findings confirmed acute inflammation, and due to elevated brain natriuretic peptide they underwent the cardiac processing. The ultrasound of the heart showed mitral regurgitation in two patients, and in one pericardial effusion. After the diagnoses — the multisystem inflammatory response, the therapy in the case of our patients was in line with the unofficial world 1 European guidelines. They were administered intravenously immunoglobulins 1 corticosteroids and fluid replacement as well as the vasoactive drugs. Given the fact, that in this way it is possible for the bacterial sepsis to present itself upon arrival — hemoculture broad-spectrum antibiotics were administered. All four patients have recovered and were released home. Conclusion: Timely detection and treatment of the multisystem inflammatory response also means a better outcome for the patient. Potential future research could focus on elucidating this condition and possible Ik long-term consequences, and thus prevent severe clinical images.
Cistična fibroza (CF) najčešća je nasljedna smrtonosna bolest u ljudi bijele rase. Uzrokovana je odsutnošću ili poremećajem funkcije multifunkcionalnog proteina CFTR-a (engl. Cystic Fibrosis ...Transmembrane Conductance Regulator). Do sada je otkriveno više od 1000 mutacija CFTR-gena podijeljenih u šest klasa. Terapijski pristup u CF-u temelji se na liječenju komplikacija i simptoma, a ne na liječenju uzroka bolesti. Međutim, istražuje se više oralno aktivnih supstancija – modifikatora CFTR-a – koje modificiraju funkciju CFTR-proteina. Time se pokušava korigirati podliježući genski defekt koji uzrokuje CF. S obzirom na to da terapijski učinak modi(katora CFTR-a ovisi o individualnom defektu proteina, za odabir prikladnih bolesnika nužno je poznavanje genotipa na oba alela CFTR-gena. Trenutačno je samo nekoliko modi(katora CFTR-a završilo treću fazu kliničkih ispitivanja i registrirano je za upotrebu. Nažalost, njihova je klinička učinkovitost skromna. Zbog izrazito nepovoljnog omjera troška i koristi kombinacija lumakaftor-ivakaftor za sada se ne može preporučiti pri liječenju bolesnika homozigota za mutaciju F508del CFTR-a. Potrebno je uložiti daljnje napore u razvoj učinkovitijih modifikatora CFTR-a.
Povrh poznatog bakteriostatskog učinka makrolidi, uključujući azitromicin, mogu ublažiti kroničnu upalu i modulirati imunosni odgovor domaćina, a da ne utječu na njegovu sposobnost obrane od ...infekcija. Ovakva imunomodulacijska svojstva makrolida sve se više rabe u liječenju kroničnih upalnih bolesti dišnih putova u djece i odraslih. Danas je dugotrajna niskodozna primjena azitromicina široko prihvaćena i preporučuje se u liječenju cistične fibroze i bronhiektazija. Makrolidi se ispituju i rabe u liječenju kronične neutrofilne upale dišnih putova koja se često viđa u bolesnika s astmom rezistentnom na kortikosteroide i kroničnom opstruktivnom plućnom bolesti. Međutim potrebna su daljnja klinička ispitivanja koja trebaju prepoznati grupe bolesnika za koje je izgledno da će reagirati na takvo imunomodulacijsko liječenje.
Abstract Background Long-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children. Aims We aimed to investigate the perinatal and maternal risk factors ...involved in the development of chronic respiratory morbidity in preterm infants, with an emphasis on the importance of Foetal Inflammatory Response Syndrome (FIRS). Study design Prospective cohort study. Subjects Demographic, antenatal, delivery and outcomes data were collected from 262 infants with less than 32 completed weeks of gestational age, over a 10-year period. Outcome measures Presence of chronic lung disease of prematurity and early childhood wheezing. Results In multivariate logistic regression analysis the presence of FIRS appears to be the most important risk factor for both, chronic lung disease of prematurity (OR 31.05, 95% CI 10.7–87.75, p < 0.001) and early childhood wheezing (OR 5.63, 95% CI 2.42–13.05, p = 0.01). In the alternative regression model for early childhood wheezing, with chronic lung disease included as a variable, the statistical significance of FIRS completely vanished (OR 1.15, 95% CI 0.39–3.34, p = 0.79), whilst chronic lung disease became the most important risk factor (OR 23.45, 95% CI 8.5–63.25, p < 0.001). Conclusions Prenatal and early neonatal events are of utmost importance in the development of chronic respiratory symptoms in children. The influence of FIRS on the development of chronic respiratory symptoms goes far beyond its impact on gestational age and may be related to direct inflammation-mediated lung tissue damage. CLD appears to be an intermittent step on the way from FIRS to ECW.
Cilj: Utvrditi metode liječenja bolesnika koji su zaprimljeni na Odjel intenzivnog liječenja djece (OILD) zbog patološkog sadržaja u prsištu. Cilj je također utvrditi indikacije za postavljanje ...pleuralne drenaže, tehnike postavljanja, analizirati dodatne specifične terapijske postupke koji su se provodili tijekom pleuralne drenaže, trajanje liječenja te komplikacije. Ispitanici i metode: Ispitanici su sva djeca od rođenja do 18. godine života zaprimljena zbog patološkog sadržaja u prsištu na OILD Kliničkog bolničkog centra Rijeka, u razdoblju od 1. siječnja 2014. do 31. prosinca 2018. Podatci su prikupljeni iz arhivirane medicinske dokumentacije, integriranog bolničkog informacijskog sustava i protokola za prijam bolesnika te zatim analizirani i statistički obrađeni. Rezultati: U ispitivanom su razdoblju na OILD zaprimljena 1044 djeteta – od toga je 114 bolesnika zaprimljeno zbog patološkog sadržaja u prsištu (10,9 %). Pleuralni dren postavljen je u 93 djeteta (95,6 %), 53 djevojčice i 40 dječaka. Indikacije za postavljanje pleuralnog drena bile su parapneumonični izljev (N=44, 47,3 %), pneumotoraks (N=37, 39,7 %), hilotoraks (N=11, 11,8 %) i maligni izljev (N=1, 1,1 %). Najčešća tehnika postavljanja pleuralnog drena u OILD-u bila je putem troakara, potom Seldingerova tehnika. U osmero djece s organiziranim izljevima provodila se fibrinolitička terapija. Nije bilo akutnih komplikacija tijekom postupka postavljanja pleuralnog drena. Najčešća kasnije utvrđena komplikacija, u 23 djeteta, bila je malpozicija drena. Zaključci: Većina djece zaprimljene na OILD zbog patološkog sadržaja u prsištu liječi se pleuralnom drenažom. Najčešća indikacija za postavljanje pleuralnog drena u našem je istraživanju parapneumonični izljev. Pleuralna je drenaža sigurna i učinkovita metoda liječenja patološkog sadržaja u prsištu djece, s niskim postotkom komplikacija.
Objective: To determine the treatment methods and complications in children admitted to Pediatric Intensive Care Unit (PICU) due to pathological contents in the chest. The aim is also to determine the indications for pleural drainage placement, placement techniques, to analyze additional specific therapeutic procedures performed during pleural drainage, the duration of treatment and complications. Subjects and methods: Subjects are all children from birth to 18 years of age with pathological contents in the chest admitted to Pediatric Intensive Care Unit (PICU), Clinical Hospital Center Rijeka, in the period from January 1, 2014 – December 31, 2018. Data were collected and analyzed from archived medical records, integrated hospital information system, and patient admission protocols, and then statistically processed. Results: In the examined period, 1044 children were admitted to PICU; of these, 114 children had pathological contents in the chest (10.9%). The pleural drain was placed in 93 children (95.6%) 53 girls and 40 boys. Indications for pleural drainage were parapneumonic effusion (N = 44, 47.3%), pneumothorax (N = 37, 39.7%), chylothorax (N = 11, 11.8%) and malignant effusion (N = 1, 1.1%) The most common pleural drainage placement technique in the PICU was via the troacar, followed by Seldinger technique. Fibrinolytic therapy was given to eight children with loculated effusion. There were no acute complications during drain insertion. The most common later complication, in 23 children, was drain malposition. Conclusion: Most children admitted to PICU due to pathological contents in the chest are treated with pleural drainage The most common indication for pleural drainage placement in our institution was parapneumonic effusion. Pleural drainage is a safe and effective method for treating pathological contents in the chest in children, with a low percentage of complications.
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