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Brackel CLH, Noij LCE, Vijverberg SJH, Legghe CL, Maitland-van der Zee AH, van Goudoever JB, Buonsenso D, Munblit D, Sigfrid L, McFarland S, Anmyr L, Ashkenazi-Hoffnung L, Bellinat APN, Dias NLS, Edwards A, Fashina T, Juraški RG, Gonçalves ALN, Hansted E, Herczeg V, Hertting O, Jankauskaite LN, Kaswandani N, Kevalas R, Krivácsy P, Lorenz M, Malone LA, McVoy M, Miller DW, Morrow AK, Nugawela MD, Oliveira CR, Oliveira PRS, Osmanov IM, Overmars IM, Paintsil E, Pinto Pereira SM, Prawira Y, Putri ND, Ramos RCF, Rasche M, Ryd-Rinder M, De Rose C, Samitova E, Jovanović TS, Say D, Scott JT, Shachar-Lavie I, Shafran R, Shmueli E, Snipaitiene A, Stephenson T, Ténai N, Tosif S, Turkalj M, Valentini P, Vasconcelos LRS, Villard L, Vilser D, Hashimoto S, Terheggen-Lagro SWJ. International Care programs for Pediatric Post-COVID Condition (Long COVID) and the way forward. Pediatr Res 2024:10.1038/s41390-023-03015-0. [PMID: 38287106 DOI: 10.1038/s41390-023-03015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/16/2023] [Accepted: 12/15/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Pediatric Post-COVID-Condition (PPCC) clinics treat children despite limited scientific substantiation. By exploring real-life management of children diagnosed with PPCC, the International Post-COVID-Condition in Children Collaboration (IP4C) aimed to provide guidance for future PPCC care. METHODS We performed a cross-sectional international, multicenter study on used PPCC definitions; the organization of PPCC care programs and patients characteristics. We compared aggregated data from PPCC cohorts and identified priorities to improve PPCC care. RESULTS Ten PPCC care programs and six COVID-19 follow-up research cohorts participated. Aggregated data from 584 PPCC patients was analyzed. The most common symptoms included fatigue (71%), headache (55%), concentration difficulties (53%), and brain fog (48%). Severe limitations in daily life were reported in 31% of patients. Most PPCC care programs organized in-person visits with multidisciplinary teams. Diagnostic testing for respiratory and cardiac morbidity was most frequently performed and seldom abnormal. Treatment was often limited to physical therapy and psychological support. CONCLUSIONS We found substantial heterogeneity in both the diagnostics and management of PPCC, possibly explained by scarce scientific evidence and lack of standardized care. We present a list of components which future guidelines should address, and outline priorities concerning PPCC care pathways, research and international collaboration. IMPACT Pediatric Post-COVID Condition (PPCC) Care programs have been initiated in many countries. Children with PPCC in different countries are affected by similar symptoms, limiting many to participate in daily life. There is substantial heterogeneity in diagnostic testing. Access to specific diagnostic tests is required to identify some long-term COVID-19 sequelae. Treatments provided were limited to physical therapy and psychological support. This study emphasizes the need for evidence-based diagnostics and treatment of PPCC. The International Post-COVID Collaboration for Children (IP4C) provides guidance for guideline development and introduces a framework of priorities for PPCC care and research, to improve PPCC outcomes.
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Affiliation(s)
- Caroline L H Brackel
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.
- Department of Pediatrics, Tergooi MC, Hilversum, the Netherlands.
| | - Lieke C E Noij
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Susanne J H Vijverberg
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Camille L Legghe
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Faculty of Pharmacy, University of Lille, Lille, France
| | - Anke H Maitland-van der Zee
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniel Munblit
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Louise Sigfrid
- ISARIC Global Support Centre, Pandemic Science Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sammie McFarland
- Long COVID Kids and Friends, Fletcher & Partners, Crown Chambers, Bridge Street, Salisbury, SP1 2LZ, UK
| | - Lena Anmyr
- Medical Unit Social Work, Function Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Liat Ashkenazi-Hoffnung
- Department of Day Hospitalization, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel
| | - Ana P N Bellinat
- Pediatric Intensive Care Unit, Hospital Martagão Gesteira - Children's Hospital, Salvador, Brazil
| | - Nathália L S Dias
- Pediatric Intensive Care Unit, Hospital Martagão Gesteira - Children's Hospital, Salvador, Brazil
| | - Amy Edwards
- Department of Infectious Disease, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Tomini Fashina
- Department of Global Health, Yale University School of Public Health, New Haven, CT, USA
| | - Romana Gjergja Juraški
- Department of Pediatric Neurology, Srebrnjak Children's Hospital, Srebrnjak, Zagreb, Croatia
- Medical School of Osijek, University of Osijek, Osijek, Zagreb, Croatia
| | | | - Edita Hansted
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Vivien Herczeg
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Budapest, Hungary
| | - Olof Hertting
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Lina N Jankauskaite
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Nastiti Kaswandani
- Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rimantas Kevalas
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Péter Krivácsy
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Budapest, Hungary
| | - Michael Lorenz
- Pediatric Pulmonology, Department of Paediatrics, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Laura A Malone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Molly McVoy
- Department of Pediatric Psychiatry, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - David W Miller
- Department of Pediatric Integrative Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Amanda K Morrow
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Carlos R Oliveira
- Department of Pediatrics, Division of Infectious Diseases & Global Health, Yale University School of Medicine, New Haven, CT, USA
| | | | - Ismael M Osmanov
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Isabella M Overmars
- Department of Infection and Immunity, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Elijah Paintsil
- Department of Pediatrics, Division of Infectious Diseases & Global Health, Yale University School of Medicine, New Haven, CT, USA
| | | | - Yogi Prawira
- Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nina Dwi Putri
- Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Marius Rasche
- Pediatric Pulmonology, Department of Paediatrics, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Malin Ryd-Rinder
- Pediatric Emergency Care, Astrid Lindgren Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Christina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elmira Samitova
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Daniela Say
- Department of Infection and Immunity, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Janet T Scott
- Department of Infectious Disease, MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Iris Shachar-Lavie
- Department of Psychological Medicine, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Einat Shmueli
- Pulmonary Institute, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel
| | - Ausra Snipaitiene
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Terence Stephenson
- UCL Great Ormond Street Institute of Child Health, University College Hospital & Great Ormond Street Hospital, London, UK
| | - Nikolett Ténai
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Budapest, Hungary
| | - Shidan Tosif
- Department of General Medicine, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Mirjana Turkalj
- Department of Pulmonology, Allergy and Immunology, Srebrnjak Children's Hospital, Zagreb, Croatia
- Medical School, Catholic University of Croatia, Zagreb, Croatia
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luydson R S Vasconcelos
- Hospital Universitário Oswaldo Cruz, Recife, Pernambuco, Brazil
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation, FIOCRUZ-PE, Recife, Brazil
| | - Li Villard
- Medical Unit Occupational Therapy and Physiotherapy, Function Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Vilser
- Clinic for Pediatric and Adolescent Medicine Neuberg/Ingolstadt AMEOS Hospital Association, Neuberg, Germany
| | - Simone Hashimoto
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne W J Terheggen-Lagro
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
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Pociute A, Kottilingal Farook MF, Dagys A, Kevalas R, Laucaityte G, Jankauskaite L. Platelet-Derived Biomarkers: Potential Role in Early Pediatric Serious Bacterial Infection and Sepsis Diagnostics. J Clin Med 2022; 11:jcm11216475. [PMID: 36362702 PMCID: PMC9658833 DOI: 10.3390/jcm11216475] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Fever is the most common complaint of children who are attending a pediatric emergency department (PED). Most of the fever cases are of viral origin; however, the most common markers, such as leucocyte, neutrophil count, or C-reactive protein, are not sensitive or specific enough to distinguish the etiology of fever, especially if children present at the early phase of infection. Currently, platelets have been attributed a role as important sentinels in viral and bacterial infection pathogenesis. Thus, our aim was to analyze different platelet indices, such as PNLR (platelet-to-neutrophil/lymphocyte ratio), PNR (platelet-to-neutrophil ratio) as well as specific secreted proteins, such as sP-selectin, CXCL4, CXCL7, and serotonin. We included 68 children who were referred to PED with the early onset of fever (<12 h). All children with comorbidities, older than five years, and psychiatric diseases, who refused to participate were excluded. All the participants were divided into viral, bacterial, or serious bacterial infection (SBI) groups. All the children underwent blood sampling, and an additional sample was collected for protein analysis. Our analysis revealed statistically significant differences between leucocyte, neutrophil, and CRP levels between SBI and other groups. However, leucocyte and neutrophil counts were within the age norms. A higher PNLR value was observed in a bacterial group, PNR-in viral. As we tested CXCL7 and sP-selectin, alone and together those markers were statistically significant to discriminate SBI and sepsis from other causes of infection. Together with tachypnoe and SpO2 < 94%, it improved the prediction value of sepsis as well as SBI. CXCL4 and serotonin did not differ between the groups. Concluding, CXCL7 and sP-selectin showed promising results in early SBI and sepsis diagnosis.
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Affiliation(s)
- Aiste Pociute
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | | | - Algirdas Dagys
- Department of Pediatrics, Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Rimantas Kevalas
- Department of Pediatrics, Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Goda Laucaityte
- Department of Pediatrics, Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Lina Jankauskaite
- Department of Pediatrics, Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Institute of Physiology and Pharmacology, Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Correspondence:
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Burokiene S, Sutkus V, Vaideliene L, Urbonas V, Kevalas R, Labanauskas L, Usonis V, Jankauskiene A. Primary child health care services in Lithuania: Does it meet the needs of the children? Child Care Health Dev 2022; 48:435-442. [PMID: 34883527 DOI: 10.1111/cch.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary health care is the foundation of a health system and has a strong influence on the efficiency of the health system as a whole. For children in Europe, it is defined by three primary health care models: paediatric; mixed paediatrician and family physician; and family physician. There is much debate in Europe about which model is most appropriate for children. The Lithuanian model is mixed, although health policy is geared towards the promotion of family physicians, with a decline in the number of primary paediatricians in clinical practice. OBJECTIVES To review the children's primary health care system in Lithuania, compare the indicators of primary care by family physicians and paediatricians in Lithuania, and identify parents' perceptions of the primary health care model for children. METHODS A retrospective longitudinal study was performed of children's primary health care indicators for quantity and quality in 2014-2018. A representative opinion survey of 1000 adult respondents was conducted. RESULTS A total of 3.5 million children's visits to primary care physicians (6.7 ± 3 visits for each child) were registered in Lithuania in 2018. During a recent 5-year period (2014-2018), the number of visits did not change significantly. Visits to paediatricians accounted for 41% of all children's visits to primary care physicians in 2018. Visits to Emergency Departments increased by 20%. The results of the survey showed that 72.3% of the respondents would prefer their children be treated by a primary care paediatrician. CONCLUSION The mixed paediatrician and family physician health care model gives parents the right to choose. The results showed a decreased number of paediatricians in primary care; paediatric primary care is more frequent than family physician care; and parents tend to trust paediatricians more. The study also showed differences in the models of service used and patterns between regions in Lithuania.
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Affiliation(s)
- Sigita Burokiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Children's Hospital, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Viktoras Sutkus
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Children's Hospital, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Laimute Vaideliene
- Lithuanian University of Health Sciences, Kaunas, Lithuania.,Pediatric Clinic, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | - Vaidotas Urbonas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Children's Hospital, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rimantas Kevalas
- Lithuanian University of Health Sciences, Kaunas, Lithuania.,Pediatric Clinic, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | - Liutauras Labanauskas
- Lithuanian University of Health Sciences, Kaunas, Lithuania.,Pediatric Clinic, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | - Vytautas Usonis
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Children's Hospital, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Augustina Jankauskiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Children's Hospital, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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4
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Petraitiene B, Conejo PR, Jankauskaite L, Kevalas R, Trumpulyte G, Snipaitiene A, Vitkauskiene A, Gurskis V. Prevalence, clinical expression, invasiveness and outcome of Staphylococcus aureus containing Panton-Valentine leukocidin in children treated in a university hospital of Lithuania. Infect Dis (Lond) 2020; 52:464-472. [PMID: 32297537 DOI: 10.1080/23744235.2020.1752395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: There is a high prevalence of Staphylococcus aureus virulence factor Panton-Valentine leukocidin (PVL) in North-East parts of Europe. The aim was to evaluate data regarding the PVL occurrences in Lithuania, determine the relationship with Methicillin resistant Staphylococcus aureus (MRSA), association with demographic and clinical conditions, invasiveness and severity of the disease in children treated in hospital Kauno klinikos (KK).Methods: We performed a prospective case-cohort single-center study on paediatric patients hospitalized from 2012 to 2015 to KK. We compared characteristics in PVL positive [SA-PVL(+)] and PVL negative [SA-PVL(-)] groups among non-invasive and invasive infections. Logistic regression was performed to detect PVL predicting factors and Cox regression was presented to define factors associated with admission to intensive care unit (ICU).Results: PVL was detected in 51.5%, MRSA in 7.0% and MRSA-PVL(+) in 4.8% of cases. In general, PVL was associated with older age comparing with SA-PVL(-) (median 8.5 vs. 4.0 years, p < .001). Skin and soft tissue infections were presented in 87.9% of all SA-PVL(+) cases. Invasive infections (44.7% vs. 12.1%, p < .001) and co-morbidities (20.5% vs. 2.9%, p < .001) were associated with SA-PVL(-) infections compared to SA-PVL(+), but ICU admission number was higher in invasive SA-PVL(+) cases comparing to invasive SA-PVL(-) cases (41.2% vs. 10.2%, p = .007).Conclusions: There was a high prevalence of pvl gene in patients treated in KK. SA-PVL(+) infections were associated with SSTI and were not common in invasive infections, but the invasive infections caused by SA-PVL(+) were related to severe disease progression and admission to ICU.
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Affiliation(s)
- Birute Petraitiene
- Department of Pediatrics, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania.,Lithuanian University of Health Science, Medical Academy, Kaunas, Lithuania
| | | | - Lina Jankauskaite
- Department of Pediatrics, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania.,Lithuanian University of Health Science, Medical Academy, Kaunas, Lithuania
| | - Rimantas Kevalas
- Department of Pediatrics, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania.,Lithuanian University of Health Science, Medical Academy, Kaunas, Lithuania
| | - Giedre Trumpulyte
- Department of Pediatric Surgery, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania
| | - Ausra Snipaitiene
- Department of Pediatrics, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania.,Lithuanian University of Health Science, Medical Academy, Kaunas, Lithuania
| | - Astra Vitkauskiene
- Lithuanian University of Health Science, Medical Academy, Kaunas, Lithuania.,Department of Laboratory Medicine, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania
| | - Vaidotas Gurskis
- Department of Pediatrics, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania.,Lithuanian University of Health Science, Medical Academy, Kaunas, Lithuania
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5
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Rosenthal VD, Bat-Erdene I, Gupta D, Belkebir S, Rajhans P, Zand F, Myatra SN, Afeef M, Tanzi VL, Muralidharan S, Gurskis V, Al-Abdely HM, El-Kholy A, AlKhawaja SAA, Sen S, Mehta Y, Rai V, Hung NV, Sayed AF, Guerrero-Toapanta FM, Elahi N, Morfin-Otero MDR, Somabutr S, De-Carvalho BM, Magdarao MS, Velinova VA, Quesada-Mora AM, Anguseva T, Ikram A, Aguilar-de-Moros D, Duszynska W, Mejia N, Horhat FG, Belskiy V, Mioljevic V, Di-Silvestre G, Furova K, Gamar-Elanbya MO, Gupta U, Abidi K, Raka L, Guo X, Luque-Torres MT, Jayatilleke K, Ben-Jaballah N, Gikas A, Sandoval-Castillo HR, Trotter A, Valderrama-Beltrán SL, Leblebicioglu H, Riera F, López M, Maurizi D, Desse J, Pérez I, Silva G, Chaparro G, Golschmid D, Cabrera R, Montanini A, Bianchi A, Vimercati J, Rodríguez-del-Valle M, Domínguez C, Saul P, Chediack V, Piastrelini M, Cardena L, Ramasco L, Olivieri M, Gallardo P, Juarez P, Brito M, Botta P, Alvarez G, Benchetrit G, Caridi M, Stagnaro J, Bourlot I, García M, Arregui N, Saeed N, Abdul-Aziz S, ALSayegh S, Humood M, Mohamed-Ali K, Swar S, Magray T, Aguiar-Portela T, Sugette-de-Aguiar T, Serpa-Maia F, Fernandes-Alves-de-Lima L, Teixeira-Josino L, Sampaio-Bezerra M, Furtado-Maia R, Romário-Mendes A, Alves-De-Oliveira A, Vasconcelos-Carneiro A, Anjos-Lima JD, Pinto-Coelho K, Maciel-Canuto M, Rocha-Batista M, Moreira T, Rodrigues-Amarilo N, Lima-de-Barros T, Guimarães KA, Batista C, Santos C, de-Lima-Silva F, Santos-Mota E, Karla L, Ferreira-de-Souza M, Luzia N, de-Oliveira S, Takeda C, Azevedo-Ferreira-Lima D, Faheina J, Coelho-Oliveira L, do-Nascimento S, Machado-Silva V, Bento-Ferreira, Olszewski J, Tenorio M, Silva-Lemos A, Ramos-Feijó C, Cardoso D, Correa-Barbosa M, Assunção-Ponte G, Faheina J, da-Silva-Escudero D, Servolo-Medeiros E, Andrade-Oliveira-Reis M, Kostadinov E, Dicheva V, Petrov M, Guo C, Yu H, Liu T, Song G, Wang C, Cañas-Giraldo L, Marin-Tobar D, Trujillo-Ramirez E, Andrea-Rios P, Álvarez-Moreno C, Linares C, González-Rubio P, Ariza-Ayala B, Gamba-Moreno L, Gualtero-Trujill S, Segura-Sarmiento S, Rodriguez-Pena J, Ortega R, Olarte N, Pardo-Lopez Y, Luis Marino Otela-Baicue A, Vargas-Garcia A, Roncancio E, Gomez-Nieto K, Espinosa-Valencia M, Barahona-Guzman N, Avila-Acosta C, Raigoza-Martinez W, Villamil-Gomez W, Chapeta-Parada E, Mindiola-Rochel A, Corchuelo-Martinez A, Martinez A, Lagares-Guzman A, Rodriguez-Ferrer M, Yepes-Gomez D, Muñoz-Gutierrez G, Arguello-Ruiz A, Zuniga-Chavarria M, Maroto-Vargas L, Valverde-Hernández M, Solano-Chinchilla A, Calvo-Hernandez I, Chavarria-Ugalde O, Tolari G, Rojas-Fermin R, Diaz-Rodriguez C, Huascar S, Ortiz M, Bovera M, Alquinga N, Santacruz G, Jara E, Delgado V, Salgado-Yepez E, Valencia F, Pelaez C, Gonzalez-Flores H, Coello-Gordon E, Picoita F, Arboleda M, Garcia M, Velez J, Valle M, Unigarro L, Figueroa V, Marin K, Caballero-Narvaez H, Bayani V, Ahmed S, Alansary A, Hassan A, Abdel-Halim M, El-Fattah M, Abdelaziz-Yousef R, Hala A, Abdelhady K, Ahmed-Fouad H, Mounir-Agha H, Hamza H, Salah Z, Abdel-Aziz D, Ibrahim S, Helal A, AbdelMassih A, Mahmoud AR, Elawady B, El-sherif R, Fattah-Radwan Y, Abdel-Mawla T, Kamal-Elden N, Kartsonaki M, Rivera D, Mandal S, Mukherjee S, Navaneet P, Padmini B, Sorabjee J, Sakle A, Potdar M, Mane D, Sale H, Abdul-Gaffar M, Kazi M, Chabukswar S, Anju M, Gaikwad D, Harshe A, Blessymole S, Nair P, Khanna D, Chacko F, Rajalakshmi A, Mubarak A, Kharbanda M, Kumar S, Mathur P, Saranya S, Abubakar F, Sampat S, Raut V, Biswas S, Kelkar R, Divatia J, Chakravarthy M, Gokul B, Sukanya R, Pushparaj L, Thejasvini A, Rangaswamy S, Saini N, Bhattacharya C, Das S, Sanyal S, Chaudhury B, Rodrigues C, Khanna G, Dwivedy A, Binu S, Shetty S, Eappen J, Valsa T, Sriram A, Todi S, Bhattacharyya M, Bhakta A, Ramachandran B, Krupanandan R, Sahoo P, Mohanty N, Sahu S, Misra S, Ray B, Pattnaik S, Pillai H, Warrier A, Ranganathan L, Mani A, Rajagopal S, Abraham B, Venkatraman R, Ramakrishnan N, Devaprasad D, Siva K, Divekar D, Satish Kavathekar M, Suryawanshi M, Poojary A, Sheeba J, Patil P, Kukreja S, Varma K, Narayanan S, Sohanlal T, Agarwal A, Agarwal M, Nadimpalli G, Bhamare S, Thorat S, Sarda O, Nadimpalli P, Nirkhiwale S, Gehlot G, Bhattacharya S, Pandya N, Raphel A, Zala D, Mishra S, Patel M, Aggarwal D, Jawadwal B, Pawar N, Kardekar S, Manked A, Tamboli A, Manked A, Khety Z, Singhal T, Shah S, Kothari V, Naik R, Narain R, Sengupta S, Karmakar A, Mishra S, Pati B, Kantroo V, Kansal S, Modi N, Chawla R, Chawla A, Roy I, Mukherjee S, Bej M, Mukherjee P, Baidya S, Durell A, Vadi S, Saseedharan S, Anant P, Edwin J, Sen N, Sandhu K, Pandya N, Sharma S, Sengupta S, Palaniswamy V, Sharma P, Selvaraj M, Saurabh L, Agarwal M, Punia D, Soni D, Misra R, Harsvardhan R, Azim A, Kambam C, Garg A, Ekta S, Lakhe M, Sharma C, Singh G, Kaur A, Singhal S, Chhabra K, Ramakrishnan G, Kamboj H, Pillai S, Rani P, Singla D, Sanaei A, Maghsudi B, Sabetian G, Masjedi M, Shafiee E, Nikandish R, Paydar S, Khalili H, Moradi A, Sadeghi P, Bolandparvaz S, Mubarak S, Makhlouf M, Awwad M, Ayyad O, Shaweesh A, Khader M, Alghazawi A, Hussien N, Alruzzieh M, Mohamed Y, ALazhary M, Abdul Aziz O, Alazmi M, Mendoza J, De Vera P, Rillorta A, de Guzman M, Girvan M, Torres M, Alzahrani N, Alfaraj S, Gopal U, Manuel M, Alshehri R, Lessing L, Alzoman H, Abdrahiem J, Adballah H, Thankachan J, Gomaa H, Asad T, AL-Alawi M, Al-Abdullah N, Demaisip N, Laungayan-Cortez E, Cabato A, Gonzales J, Al Raey M, Al-Darani S, Aziz M, Al-Manea B, Samy E, AlDalaton M, Alaliany M, Alabdely H, Helali N, Sindayen G, Malificio A, Al-Dossari H, Kelany A, Algethami A, Mohamed D, Yanne L, Tan A, Babu S, Abduljabbar S, Al-Zaydani M, Ahmed H, Al Jarie A, Al-Qathani A, Al-Alkami H, AlDalaton M, Alih S, Alaliany M, Gasmin-Aromin R, Balon-Ubalde E, Diab H, Kader N, Hassan-Assiry I, Kelany A, Albeladi E, Aboushoushah S, Qushmaq N, Fernandez J, Hussain W, Rajavel R, Bukhari S, Rushdi H, Turkistani A, Mushtaq J, Bohlega E, Simon S, Damlig E, Elsherbini S, Abraham S, Kaid E, Al-Attas A, Hawsawi G, Hussein B, Esam B, Caminade Y, Santos A, Abdulwahab M, Aldossary A, Al-Suliman S, AlTalib A, Albaghly N, HaqlreMia M, Kaid E, Altowerqi R, Ghalilah K, Alradady M, Al-Qatri A, Chaouali M, Shyrine E, Philipose J, Raees M, AbdulKhalik N, Madco M, Acostan C, Safwat R, Halwani M, Abdul-Aal N, Thomas A, Abdulatif S, Ali-Karrar M, Al-Gosn N, Al-Hindi A, Jaha R, AlQahtani S, Ayugat E, Al-Hussain M, Aldossary A, Al-Suliman S, Al-Talib A, Albaghly N, Haqlre-Mia M, Briones S, Krishnan R, Tabassum K, Alharbi L, Madani A, Al-Hindi A, Al-Gethamy M, Alamri D, Spahija G, Gashi A, Kurian A, George S, Mohamed A, Ramapurath R, Varghese S, Abdo N, Foda-Salama M, Al-Mousa H, Omar A, Salama M, Toleb M, Khamis S, Kanj S, Zahreddine N, Kanafani Z, Kardas T, Ahmadieh R, Hammoud Z, Zeid I, Al-Souheil A, Ayash H, Mahfouz T, Kondratas T, Grinkeviciute D, Kevalas R, Dagys A, Mitrev Z, Bogoevska-Miteva Z, Jankovska K, Guroska S, Petrovska M, Popovska K, Ng C, Hoon Y, Hasan YM, Othman-Jailani M, Hadi-Jamaluddin M, Othman A, Zainol H, Wan-Yusoff W, Gan C, Lum L, Ling C, Aziz F, Zhazali R, Abud-Wahab M, Cheng T, Elghuwael I, Wan-Mat W, Abd-Rahman R, Perez-Gomez H, Kasten-Monges M, Esparza-Ahumada S, Rodriguez-Noriega E, Gonzalez-Diaz E, Mayoral-Pardo D, Cerero-Gudino A, Altuzar-Figueroa M, Perez-Cruz J, Escobar-Vazquez M, Aragon D, Coronado-Magana H, Mijangos-Mendez J, Corona-Jimenez F, Aguirre-Avalos G, Lopez-Mateos A, Martinez-Marroquin M, Montell-Garcia M, Martinez-Martinez A, Leon-Sanchez E, Gomez-Flores G, Ramirez M, Gomez M, Lozano M, Mercado V, Zamudio-Lugo I, Gomez-Gonzalez C, Miranda-Novales M, Villegas-Mota I, Reyes-Garcia C, Ramirez-Morales M, Sanchez-Rivas M, Cureno-Diaz M, Matias-Tellez B, Gonzalez-Martinez J, Juarez-Vargas R, Pastor-Salinas O, Gutierrez-Munoz V, Conde-Mercado J, Bruno-Carrasco G, Manrique M, Monroy-Colin V, Cruz-Rivera Z, Rodriguez-Pacheco J, Cruz N, Hernandez-Chena B, Guido-Ramirez O, Arteaga-Troncoso G, Guerra-Infante F, Lopez-Hurtado M, Caleco JD, Leyva-Medellin E, Salamanca-Meneses A, Cosio-Moran C, Ruiz-Rendon R, Aguilar-Angel L, Sanchez-Vargas M, Mares-Morales R, Fernandez-Alvarez L, Castillo-Cruz B, Gonzalez-Ma M, Zavala-Ramír M, Rivera-Reyna L, del-Moral-Rossete L, Lopez-Rubio C, Valadez-de-Alba M, Bat-Erdene A, Chuluunchimeg K, Baatar O, Batkhuu B, Ariyasuren Z, Bayasgalan G, Baigalmaa S, Uyanga T, Suvderdene P, Enkhtsetseg D, Suvd-Erdene D, Chimedtseye E, Bilguun G, Tuvshinbayar M, Dorj M, Khajidmaa T, Batjargal G, Naranpurev M, Bat-Erdene A, Bolormaa T, Battsetseg T, Batsuren C, Batsaikhan N, Tsolmon B, Saranbaatar A, Natsagnyam P, Nyamdawa O, Madani N, Abouqal R, Zeggwagh A, Berechid K, Dendane T, Koirala A, Giri R, Sainju S, Acharya S, Paul N, Parveen A, Raza A, Nizamuddin S, Sultan F, Imran X, Sajjad R, Khan M, Sana F, Tayyab N, Ahmed A, Zaman G, Khan I, Khurram F, Hussain A, Zahra F, Imtiaz A, Daud N, Sarwar M, Roop Z, Yusuf S, Hanif F, Shumaila X, Zeb J, Ali S, Demas S, Ariff S, Riaz A, Hussain A, Kanaan A, Jeetawi R, Castaño E, Moreno-Castillo L, García-Mayorca E, Prudencio-Leon W, Vivas-Pardo A, Changano-Rodriguez M, Castillo-Bravo L, Aibar-Yaranga K, Marquez-Mondalgo V, Mueras-Quevedo J, Meza-Borja C, Flor J, Fernandez-Camacho Y, Banda-Flores C, Pichilingue-Chagray J, Castaneda-Sabogal A, Caoili J, Mariano M, Maglente R, Santos S, de-Guzman G, Mendoza M, Javellana O, Tajanlangit A, Tapang A, Sg-Buenaflor M, Labro E, Carma R, Dy A, Fortin J, Navoa-Ng J, Cesar J, Bonifacio B, Llames M, Gata H, Tamayo A, Calupit H, Catcho V, Bergosa L, Abuy M, Barteczko-Grajek B, Rojek S, Szczesny A, Domanska M, Lipinska G, Jaroslaw J, Wieczoreka A, Szczykutowicza A, Gawor M, Piwoda M, Rydz-Lutrzykowska J, Grudzinska M, Kolat-Brodecka P, Smiechowicz K, Tamowicz B, Mikstacki A, Grams A, Sobczynski P, Nowicka M, Kretov V, Shalapuda V, Molkov A, Puzanov S, Utkin I, Tchekulaev A, Tulupova V, Vasiljevic S, Nikolic L, Ristic G, Eremija J, Kojovic J, Lekic D, Simic A, Hlinkova S, Lesnakova A, Kadankunnel S, Abdo-Ali M, Pimathai R, Wanitanukool S, Supa N, Prasan P, Luxsuwong M, Khuenkaew Y, Lamngamsupha J, Siriyakorn N, Prasanthai V, Apisarnthanarak A, Borgi A, Bouziri A, Cabadak H, Tuncer G, Bulut C, Hatipoglu C, Sebnem F, Demiroz A, Kaya A, Ersoz G, Kuyucu N, Karacorlu S, Oncul O, Gorenek L, Erdem H, Yildizdas D, Horoz O, Guclu E, Kaya G, Karabay O, Altindis M, Oztoprak N, Sahip Y, Uzun C, Erben N, Usluer G, Ozgunes I, Ozcelik M, Ceyda B, Oral M, Unal N, Cigdem Y, Bayar M, Bermede O, Saygili S, Yesiler I, Memikoglu O, Tekin R, Oncul A, Gunduz A, Ozdemir D, Geyik M, Erdogan S, Aygun C, Dilek A, Esen S, Turgut H, Sungurtekin H, Ugurcan D, Yarar V, Bilir Y, Bayram N, Devrim I, Agin H, Ceylan G, Yasar N, Oruc Y, Ramazanoglu A, Turhan O, Cengiz M, Yalcin A, Dursun O, Gunasan P, Kaya S, Senol G, Kocagoz A, Al-Rahma H, Annamma P, El-Houfi A, Vidal H, Perez F, D-Empaire G, Ruiz Y, Hernandez D, Aponte D, Salinas E, Vidal H, Navarrete N, Vargas R, Sanchez E, Ngo Quy C, Thu T, Nguyet L, Hang P, Hang T, Hanh T, Anh D. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module. Am J Infect Control 2020; 48:423-432. [PMID: 31676155 DOI: 10.1016/j.ajic.2019.08.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. METHODS During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied. RESULTS Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher. CONCLUSIONS Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.
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Miseviciene V, Liakaite G, Kevalas R. Short course of systemic corticosteroids in wheezy children: still an open question. Adv Respir Med 2020; 87:209-216. [PMID: 31476008 DOI: 10.5603/arm.a2019.0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/31/2019] [Accepted: 06/13/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We performed a real-life clinical study to identify the main indications for the prescription of short-course treatment with systemic glucocorticosteroids (GCS) for steroid naive children with acute virus-induced wheezing as well as to analyze the influence of such treatment on patients' serum cortisol level, other blood tests results and the length of stay in the hospital. MATERIAL AND METHODS The data of 44 patients who had acute wheezing, had no bacterial infection and were otherwise healthy were analyzed: 26 children received treatment with GCS and 18 children did not. Full blood count, biochemistry tests (Na, K, glucose) and blood cortisol levels of all patients were analyzed during treatment. RESULTS The main indications for the short-term administration of systemic GCS were increased work of breathing, recurrent wheezing, clinical signs of atopy and a family history of asthma. Systemic GCS increased a sodium concentration (p = 0.014), decreased a cortisol level (p = 0.038), leukocyte (p = 0.043), neutrophil (p = 0.045), and eosinophil (p < 0.001) count in blood serum. The major reduction in the eosinophil count was observed in allergic children (p = 0.023). Older age was a risk factor for cortisol suppression (p = 0.018). The average length of stay in the hospital was longer in the intervention group (p = 0.039). CONCLUSION Even short-course treatment with systemic GCS decreases the serum cortisol level and has a significant effect on other blood tests results. Systemic GCS used for acute virus-induced wheezing treatment did not prove to reduce the average length of stay in the hospital. Objective criteria for initiation of such treatment are still lacking, which might consequently lead to the overuse of corticosteroids.
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Affiliation(s)
- Valdone Miseviciene
- Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Gintare Liakaite
- Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Kevalas
- Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Henry O, Brzostek J, Czajka H, Leviniene G, Reshetko O, Gasparini R, Pazdiora P, Plesca D, Desole MG, Kevalas R, Gabutti G, Povey M, Innis B. Corrigendum to "One or two doses of live varicella virus-containing vaccines: Efficacy, persistence of immune responses, and safety six years after administration in healthy children during their second year of life" [Vaccine 36 (2018) 381-387]. Vaccine 2018; 36:6894. [PMID: 30244871 DOI: 10.1016/j.vaccine.2018.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ouzama Henry
- Vaccine Discovery and Development, GSK, Philadelphia, United States.
| | | | - Hanna Czajka
- Infectious Diseases Outpatient Clinic, The St. Luis Provincial Specialist Children's Hospital, Cracow, Poland.
| | - Giedra Leviniene
- Pediatric Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Olga Reshetko
- Pharmacology, Saratov Medical University, Saratov, Russia.
| | | | - Petr Pazdiora
- Department of Epidemiology, Medical Faculty Pilsen of Charles University, Czech Republic.
| | - Doina Plesca
- Pediatrics, University of Medicine and Pharmacy, Bucharest, Romania.
| | | | - Rimantas Kevalas
- Pediatric Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | | | - Bruce Innis
- Vaccine Discovery and Development, GSK, Philadelphia, United States.
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Henry O, Brzostek J, Czajka H, Leviniene G, Reshetko O, Gasparini R, Pazdiora P, Plesca D, Desole MG, Kevalas R, Gabutti G, Povey M, Innis B. One or two doses of live varicella virus-containing vaccines: Efficacy, persistence of immune responses, and safety six years after administration in healthy children during their second year of life. Vaccine 2017; 36:381-387. [PMID: 29224964 DOI: 10.1016/j.vaccine.2017.11.081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND This phase III B follow-up of an initial multicenter study (NCT00226499) will evaluate the ten-year efficacy of two doses of the combined measles-mumps-rubella-varicella vaccine (MMRV) and one dose of the live attenuated varicella vaccine (V) versus a measles-mumps-rubella control group (MMR) for the prevention of clinical varicella disease. Here we present efficacy results for six years post-vaccination. METHODS In phase A of the study, healthy children aged 12-22 months from ten European countries were randomized (3:3:1) and received either two doses of MMRV, or one dose of combined MMR and one dose of monovalent varicella vaccine (MMR+V), or two doses of the MMR vaccine (control), 42 days apart. Vaccine efficacy against all and against moderate or severe varicella (confirmed by detection of viral DNA or epidemiological link) was assessed from six weeks up to six years post-dose 2 for the MMRV and MMR+V groups, and was calculated with 95% confidence intervals (CI). The severity of varicella was calculated using the modified Vázquez scale (mild ≤ 7; moderately severe = 8-15; severe ≥ 16). Herpes zoster cases were also recorded. RESULTS 5289 children (MMRV = 2279, mean age = 14.2, standard deviation [SD] = 2.5; MMR+V = 2266, mean age = 14.2, SD = 2.4; MMR = 744, mean age = 14.2, SD = 2.5 months) were included in the efficacy cohort. 815 varicella cases were confirmed. Efficacy of two doses of MMRV against all and against moderate or severe varicella was 95.0% (95% CI: 93.6-96.2) and 99.0% (95% CI: 97.7-99.6), respectively. Efficacy of one dose of varicella vaccine against all and against moderate or severe varicella was 67.0% (95% CI: 61.8-71.4) and 90.3% (95% CI: 86.9-92.8), respectively. There were four confirmed herpes zoster cases (MMR+V = 2, MMR = 2), all were mild and three tested positive for the wild-type virus. CONCLUSIONS Two doses of the MMRV vaccine and one dose of the varicella vaccine remain efficacious through six years post-vaccination.
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Affiliation(s)
- Ouzama Henry
- Vaccine Discovery and Development, GSK, Philadelphia, United States.
| | | | - Hanna Czajka
- Infectious Diseases Outpatient Clinic, The St. Luis Provincial Specialist Children's Hospital, Cracow, Poland.
| | - Giedra Leviniene
- Pediatric Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Olga Reshetko
- Pharmacology, Saratov Medical University, Saratov, Russia.
| | | | - Petr Pazdiora
- Department of Epidemiology, Medical Faculty Pilsen of Charles University, Czech Republic.
| | - Doina Plesca
- Pediatrics, University of Medicine and Pharmacy, Bucharest, Romania.
| | | | - Rimantas Kevalas
- Pediatric Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | | | - Bruce Innis
- Vaccine Discovery and Development, GSK, Philadelphia, United States.
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Rosenthal VD, Al-Abdely HM, El-Kholy AA, AlKhawaja SAA, Leblebicioglu H, Mehta Y, Rai V, Hung NV, Kanj SS, Salama MF, Salgado-Yepez E, Elahi N, Morfin Otero R, Apisarnthanarak A, De Carvalho BM, Ider BE, Fisher D, Buenaflor MCS, Petrov MM, Quesada-Mora AM, Zand F, Gurskis V, Anguseva T, Ikram A, Aguilar de Moros D, Duszynska W, Mejia N, Horhat FG, Belskiy V, Mioljevic V, Di Silvestre G, Furova K, Ramos-Ortiz GY, Gamar Elanbya MO, Satari HI, Gupta U, Dendane T, Raka L, Guanche-Garcell H, Hu B, Padgett D, Jayatilleke K, Ben Jaballah N, Apostolopoulou E, Prudencio Leon WE, Sepulveda-Chavez A, Telechea HM, Trotter A, Alvarez-Moreno C, Kushner-Davalos L, Desse J, Maurizi D, Montanini A, Chaparro G, Stagnaro J, Romani A, Bianchi A, Álvarez G, Palaoro A, Bernan M, Cabrera-Montesino R, Domínguez C, Rodríguez C, Silva C, Bogdanowicz E, Riera F, Benchetrit G, Perez I, Vimercati J, Marcos L, Ramasco L, Caridi M, Oyola M, Rodríguez M, Spadaro M, Olivieri M, Saul P, Juarez P, Pérez R, Botta P, Quintana D, Ríos A, Stagnaro J, Chediack V, Chilon W, Alsayegh AI, Yaseen FH, Hani LF, Sowar SF, Magray TA, Medeiros E, Alves De Oliveira A, Romario-Mendes A, Fernandes-Valente C, Santos C, Escudeiro D, Azevedo-Ferreira Lima D, Azevedo-Pereira D, Onzi-Siliprandi E, Serpa-Maia F, Aguiar-Leitao F, Assuncao-Ponte G, Dos Anjos-Lima J, Olszewski J, Harten Pinto Coelho K, Alves De Lima L, Mendonca M, Maciel-Canuto Amaral M, Tenorio M, Gerah S, Andrade-Oliveira-Reis M, Moreira M, Ximenes-Rocha Batista M, Campos-Uchoa R, Rocha-Vasconcelos Carneiro R, Amaral De Moraes R, Do Nascimento S, Moreira-Matos T, Lima-De Barros Araujo T, De Jesus Pinheiro-Bandeira T, Machado-Silva V, Santos Monteiro W, Hristozova E, Kostadinov E, Angelova K, Velinova V, Dicheva V, Guo X, Ye G, Li R, Song L, Liu K, Liu T, Song G, Wang C, Yang X, Yu H, Yang Y, Martínez A, Vargas-García A, Lagares-Guzmán A, González A, Linares C, Ávila-Acosta C, Santofimio D, Yepes-Gomez D, Marin-Tobar D, Mazo-Elorza D, Chapeta-Parada E, Camacho-Moreno G, Roncancio-Vill G, Valderrama-Marquez I, Ruiz-Gallardo J, Ospina-Martínez J, Osorio J, Marín-Uribe J, López J, Gualtero S, Rojas J, Gomez-Nieto K, Rincon L, Meneses-Ovallos L, Canas-Giraldo L, Burgos-Florez L, Amaral-Almeida Costa M, Rodriguez M, Barahona-Guzmán N, Mancera-Paez O, Rios-Arana P, Ortega R, Romero-Torres S, Pulido-Leon S, Valderrama S, Moreno-Mejia V, Raigoza-Martinez W, Villamil-Gomez W, Pardo-Lopez Y, Argüello-Ruiz A, Solano-Chinchilla A, Muñoz-Gutierrez G, Calvo-Hernández I, Maroto-Vargas L, Zuniga M, Valverde-Hernandez M, Chavarria-Ugalde O, Herrera B, Díaz C, Bovera M, Cevallos C, Pelaez C, Jara E, Delgado V, Coello-Gordon E, Picoita F, Guerrero-Toapant F, Valencia F, Santacruz G, Gonzalez H, Pazmino L, Garcia M, Arboleda M, Lascano M, Alquinga N, Ramírez V, Yousef RH, Moustafa AEM, Ahmed A, Elansary A, Ali AM, Hasanin A, Messih AA, Ramadan A, El Awady B, Hassan D, Abd El Aziz D, Hamza H, Agha HM, Ghazi IA, ElKholy J, Fattah MA, Elanany M, Mansour M, 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International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module. Am J Infect Control 2016; 44:1495-1504. [PMID: 27742143 DOI: 10.1016/j.ajic.2016.08.007] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. METHODS During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. RESULTS Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. CONCLUSIONS Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.
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Esparza-Ahumada S, Morfin-Otero R, Rodriguez-Noriega E, Gutierrez-Martinez S, Perez-Gomez HR, León-Garnica G, Mendoza-Mujica C, Cecilia Culebro Burguet M, Portillo-Gallo JH, Almazán FA, Miramontes GI, Olivas MDRV, Aguilar Angel LA, Vargas MS, Orlando Flores Alvarado A, Carlos Mares Morales R, Carlos Fernandez Alvarez L, Armando Rincon Leon H, Navarro Fuentes KR, Mariela Perez Hernandez Y, Falcon GM, Vargas AG, Trujillo Juarez MA, Mulia AM, Alma Ulloa Camacho P, Martinez-Marroquin MY, Garcia MM, Martinez AM, Sanchez EL, Flores GG, Martínez MDRG, Alfonso Galindo Olmeda J, Olivarez G, Rodriguez EB, Magdalena Gutierrez Castillo M, Guadalupe Villa González M, Beatriz Sauceda Castañeda I, Rodriguez JM, Baatar O, Batkhuu B, Meryem K, Amina B, Abouqal R, Zeggwagh AA, Dendane T, Abidi K, Madani N, Mahmood SF, Memon BA, Bhutto GH, Paul N, Parveen A, Raza A, Mahboob A, Nizamuddin S, Sultan F, Nazeer H, Khan AA, Hafeez A, Lara L, Mapp T, Alvarez B, Rojas-Bonilla MI, Castano E, De Moros DA, Atarama RE, Calisto Pazos ME, Paucar A, Ramos MT, Jurado J, Moreno D, Cruz Saldarriaga ME, Ramirez E, La Hoz Vergara CE, Enrique Prudencio Leon W, Isidro Castillo Bravo L, Fernanda Aibar Yaranga K, Pichilingue Chagray JE, Marquez Mondalgo VA, Zegarra ST, Astete NS, Guevara FC, Pastrana JS, Enrique Prudencio Leon W, Linares Calderon CF, Jesus Mayorga Espichan M, Martin Santivanez Monge L, Changano Rodriguez MV, Rosa Diaz Tavera Z, Martin Ramirez Wong F, Chavez SM, Rosa Diaz Tavera Z, Martin Ramirez Wong F, Atencio-Espinoza T, Villanueva VD, Blanco-Abuy MT, Tamayo AS, Bergosa LD, Llames CMJP, Trajano MF, Bunsay SA, Amor JC, Berba R, Sg Buenaflor MC, Labro E, Mendoza MT, Javellana OP, Salvio LG, Rayco RG, Bermudez V, Kubler A, Zielinska M, Kosmider-Zurawska M, Barteczko-Grajek B, Szewczyk E, Dragan B, Mikaszewska-Sokolewicz MA, Lazowski T, Cancel E, Licker MS, Dragomirescu LA, Dumitrascu V, Sandesc D, Bedreag O, Papurica M, Muntean D, Kotkov I, Kretov V, Shalapuda V, Molkov A, Puzanov S, Utkin I, Tchekulaev A, Tulupova V, Nikolic L, Ristic G, Eremija J, Kojovic J, Lekic D, Vasiljevic S, Lesnakova A, Marcekova A, Furova K, Gamar Elanbya MO, Ali MA, Kadankunnel SK, Somabutr S, Pimathai R, Wanitanukool S, Luxsuwong M, Supa N, Prasan P, Thamlikitkul V, Jamulitrat S, Suwalak N, Phainuphong P, Asma B, Aida B, Sarra BH, Ammar K, Ertem GT, Bulut C, Hatipoglu CA, Erdinc FS, Demiroz AP, Ozcelik M, Meco BC, Oral M, Unal N, Guclu CY, Kendirli T, İnce E, Çiftçi E, Yaman A, Ödek Ç, Karbuz A, Kocabaş BA, Altın N, Cesur S, Atasay B, Erdeve O, Akduman H, Kahvecioglu D, Cakir U, Yildiz D, Kilic A, Arsan S, Arman D, Unal S, Gelebek Y, Zengin H, Sen S, Cabadak H, Erbay A, Yalcin AN, Turhan O, Cengiz M, Dursun O, Gunasan P, Kaya S, Ramazanoglu A, Ustun C, Yasayacak A, Akdeniz H, Sirmatel F, Otkun AM, Sacar S, Sener A, Turgut H, Sungurtekin H, Ugurcan D, Necan C, Yilmaz C, Ozdemir D, Geyik MF, Ince N, Danis A, Erdogan SY, Erben N, Usluer G, Ozgunes I, Uzun C, Oncul O, Gorenek L, Erdem H, Baylan O, Ozgultekin A, Inan A, Bolukcu S, Senol G, Ozdemir H, Gokmen Z, Ozdemir SI, Kaya A, Ersoz G, Kuyucu N, Karacorlu S, Kaya Z, Guclu E, Kaya G, Karabay O, Esen S, Aygun C, Ulger F, Dilek A, Yilmaz H, Sunbul M, Engin A, Bakir M, Elaldi N, Koksal I, Yildizdas D, Horoz OO, Willke A, Koç MM, Azak E, Elahi N, Annamma P, El Houfi A, Pirez Garcia MC, Vidal H, Perez F, Empaire GD, Ruiz Y, Hernandez D, Aponte D, Salinas E, Diaz C, Guzmán Siritt ME, Gil De Añez ZD, Bravo LM, Orozco N, Mejías E, Hung NV, Anh NQ, Chau NQ, Thu TA, Phuong DM, Binh NG, Thi Diem Tuyet L, Thi Van Trang D, Hong Thoa VT, Tien NP, Anh Thu LT, Hang PT, My Hanh TT, Thuy Hang TT, Phuong Anh DP. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. Am J Infect Control 2014; 42:942-56. [PMID: 25179325 DOI: 10.1016/j.ajic.2014.05.029] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 12/14/2022]
Abstract
We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN.
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Sileikiene R, Vaskelyte J, Mizariene V, Nedzelskiene I, Verseckaite R, Jurkevicius R, Baksiene D, Sileikyte V, Kevalas R. Heart rate variability and atria function in children at late follow-up evaluation after atrioventricular node slow-pathway radiofrequency ablation. Pediatr Cardiol 2011; 32:792-800. [PMID: 21479908 PMCID: PMC3139060 DOI: 10.1007/s00246-011-9983-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/22/2011] [Indexed: 11/17/2022]
Abstract
This study was designed to assess the changes in the conductive system, autonomic dysfunction, and global and regional function of the atria and ventricles in children late after slow-pathway radiofrequency ablation (RFA). The study enrolled 22 children, who has successfully undergone RFA 2 to 5 years previously (RFA group) and 20 healthy children (control group). Electrophysiologic study was performed for the RFA group. Holter monitoring and echocardiography were performed for all the children. At a late follow-up assessment, the RFA children were free of paroxysms, whereas 8 of the 22 children (36%) reported transient palpitations. Both mean and maximal heart rates (HR) were significantly increased, whereas indices of HR variability (% of successive normal sinus RR intervals exceeding 50 ms [pNN50], root mean square of the successive normal sinus RR interval difference [rMSSD], high-frequency component [HFC]) were significantly decreased in the RFA group compared with preablation and control data. Left atrial (LA) and right atrial (RA) volumes were significantly higher, and atria deformation indices were significantly lower in the RFA group. Correlations were found between the mean HR and the volumes of LA (r = 0.477; p < 0.001) and RA (r = 0.512; p < 0.001). A negative correlation between the maximal LA volume and the longitudinal strain rate (SR) during relaxation (r = -0.476; p = 0.03) and a positive correlation between the minimal LA volume and both longitudinal SR (r = 0.361; p = 0.03) and strain (ε) (r = 0.375; p = 0.024) during contraction were shown. These data suggest a possible link between atrial dysfunction and the hyperadrenergic state after RFA.
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Affiliation(s)
- Rima Sileikiene
- Department of Children Diseases, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT, 50009, Lithuania.
| | - Jolanta Vaskelyte
- Department of Children Diseases, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009 Lithuania
| | - Vaida Mizariene
- Department of Children Diseases, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009 Lithuania
| | - Irena Nedzelskiene
- Department of Children Diseases, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009 Lithuania
| | - Raimonda Verseckaite
- Department of Children Diseases, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009 Lithuania
| | - Renaldas Jurkevicius
- Department of Children Diseases, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009 Lithuania
| | - Dalia Baksiene
- Department of Children Diseases, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009 Lithuania
| | - Viktorija Sileikyte
- Department of Children Diseases, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009 Lithuania
| | - Rimantas Kevalas
- Department of Children Diseases, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009 Lithuania
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Sileikiene R, Vaskelyte J, Mizariene V, Nedzelskiene I, Jurkevicius R, Sileikyte V, Kevalas R. Speckle tracking derived left and right ventricular strain, strain rate and. J Clin Exp Invest 2011. [DOI: 10.5799/ahinjs.01.2011.01.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sileikiene R, Baksiene D, Sileikis V, Kazakavicius T, Vaskelyte J, Kevalas R. Changes in electrophysiologic properties of the conductive system of the heart in children with atrioventricular nodal reentrant tachycardia after 2-8 years following radiofrequency catheter ablation of the slow pathway. Medicina (Kaunas) 2009; 45:632-638. [PMID: 19773622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Radiofrequency ablation of the slow pathway is an effective method of treatment in children with atrioventricular nodal reentrant tachycardia. The aim of our study was to evaluate anterograde conduction properties in children before and after radiofrequency ablation of the slow pathway and to determine the efficacy and safety of this method. MATERIAL AND METHODS Noninvasive transesophageal electrophysiological examination was performed in 30 patients at the follow-up period (mean duration, 3.24 years) after radiofrequency ablation of the slow pathway. RESULTS The slow pathway function was observed in 13 patients one day after ablation, in 26 patients during the follow-up period, and in 28 patients after administration of atropine sulfate. Atrioventricular node conduction was significantly decreased the following day after ablation and at the follow-up versus the preablation (165.2 [30.2] bmp and 146.3 [28.5] bpm versus 190.9 [31.4] bpm; P<0.001). The atrioventricular node effective refractory period prolonged significantly the following day after ablation and at the follow-up versus the preablation (319.3 [55.3] ms and 351.0 [82.1] ms versus 248.3 [36.6] ms; P<0.001). Effective refractory period of the fast pathway prolonged significantly as compared with the preablation (from 408.0 [60.4] ms to 481.2 [132.9] ms; P=0.005). The prolongation of effective refractory period of the slow pathway was more significant than effective refractory period of the fast pathway at the follow-up (P<0.001). Two late recurrences occurred; one patient had atrial tachycardia. CONCLUSION Children with atrioventricular nodal reentrant tachycardia can be effectively and safety cured by ablative therapy. The end-point during slow pathway ablation should be the abolition of tachycardia with preservation of dual atrioventricular nodal physiology.
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Affiliation(s)
- Rima Sileikiene
- Department of Children Diseases, Eiveniu 2, Kaunas 50009, Lithuania.
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Asembergiene J, Gurskis V, Kevalas R, Valinteliene R. Nosocomial infections in the pediatric intensive care units in Lithuania. Medicina (Kaunas) 2009; 45:29-36. [PMID: 19223703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of the study was to collect the data on incidence rates, pathogens of nosocomial infections, and antimicrobials for treatment of nosocomial infections. MATERIAL AND METHODS Data were collected between March 2003 and December 2005 in five pediatric intensive care units using a modified patient-based HELICS protocol. Nosocomial infection was identified using the Centers for Disease Control definitions. All patients aged between 1 month and 18 years that stayed in the units for more than 48 hours were eligible for inclusion in this study. RESULTS A total of 1239 patient admissions and 7601 patient-days were evaluated. In 169 children (13.6%), 186 nosocomial infections occurred. The incidence density was 24.5 per 1000 patient-days, the incidence rate--15.0 per 100 admissions. The highest incidence density was observed in the 6-12-year age group (31.2 per 1000 bed-days). Nosocomial infection rates per 1000 device-days were 28.8 for ventilator-associated pneumonia, 7.7--for bloodstream infection, and 3.4--for urinary tract infection. The most common site of infection was respiratory tract (58.8%). Secondary bacteremia developed in 18 (10.6%) patients. Haemophilus influenzae (20.1%), Acinetobacter spp. (14.2%), and Staphylococcus aureus (17.6%) were the most frequently isolated microorganisms. The most common antimicrobials used were first- and second-generation cephalosporins 74 (31.0%) and broad-spectrum penicillins 70 (29.3%). CONCLUSIONS In Lithuanian pediatric intensive care units, the incidence rates of nosocomial infections were comparable to the available data from other countries, except for the ventilator-associated pneumonia rate, which was relatively high. H. influenzae, Acinetobacter spp., and S. aureus were the most prevalent pathogens. The first- and second-generation cephalosporins and broad-spectrum penicillins were the most common antimicrobials in the treatment of nosocomial infections.
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Affiliation(s)
- Jolanta Asembergiene
- Unit of Pediatric Intensive Care, Clinic of Children's Diseases, Hospital of Kaunas University of Medicine, Eiveniu 2, Kaunas, Lithuania
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Kanapeckiene V, Valinteliene R, Berzanskyte A, Kevalas R, Supranowicz P. Health of Roma children in Vilnius and Ventspils. Medicina (Kaunas) 2009; 45:153-161. [PMID: 19289906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
According to the literature data, Roma health and living conditions in Central and Eastern Europe are poorer than of the rest of population. However, the more detailed information about Roma health is lacking. The aim of the study was to evaluate morbidity, health self-assessment, and prevalence of addictions among Roma children in Vilnius and Ventspils and to compare with health indicators of non-Roma children. PARTICIPANTS AND METHODS. A descriptive epidemiological study was carried out, anonymously questioning all volunteer Roma children - 59 in Vilnius (Lithuania) and 31 in Ventspils (Latvia) schools. Results were compared with identical study, carried out in five Vilnius schools (reference group, 640). RESULTS. The appliance rate of Roma children to doctor did not differ from reference group - half of all questioned children visited doctor 1-3 times during the last year. However, more Roma children (74.6% from Vilnius and 64.6% from Ventspils) considered their health as poor and very poor as compared to reference group (4.3%). The proportion of children indicating somatic symptoms often and very often did not differ statistically significantly among groups with exception of vomiting and nausea, which was most prevalent among Vilnius Roma and Ventspils Roma. The proportion of children indicating emotional symptoms often and very often differed significantly in all groups and was the biggest in Ventspils Roma group. The proportion of daily alcohol, drug users, and smokers was higher in Vilnius Roma and Ventspils Roma groups, although the differences among all three groups were not statistically significant. CONCLUSION. Although the morbidity of Vilnius Roma and Ventspils Roma groups did not differ from reference group, essential discrepancy was found in health self-assessment - more Roma children considered their health as poor and very poor.
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Affiliation(s)
- Virginija Kanapeckiene
- Institute of Hygiene, Kaunas University of Medicine, Didzioji 22, 01128 Vilnius, Lithuania.
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Gurskis V, Asembergiene J, Kevalas R, Miciuleviciene J, Pavilonis A, Valinteliene R, Dagys A. Reduction of nosocomial infections and mortality attributable to nosocomial infections in pediatric intensive care units in Lithuania. Medicina (Kaunas) 2009; 45:203-213. [PMID: 19357450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of the study was to identify the most important risk factors for nosocomial infections, evaluate the incidence rates and risk changes after the multimodal intervention, and to assess mortality attributable to nosocomial infections. MATERIAL AND METHODS This was a prospective surveillance study. Data were collected from January 2005 until December 2007 in three pediatric intensive care units. All patients aged between 1 month and 18 years hospitalized in units for more than 48 hours were included in the study. The patients were divided into preintervention (2006) and postintervention (2007) groups. The multimodal intervention included education of the staff and implementation of evidence-based infection control measures. RESULTS A total of 755 children were included in the study. Major risk factors for nosocomial infections were identified: mechanical ventilation, central line, intracranial pressure device, and tracheostomy. Overall, the incidence rate (15.6 vs. 7.5 cases per 100 patients, P=0.002), incidence density (19.1 vs. 10.4 cases per 1000 patient-days, P=0.015), and the incidence of pneumonia (5.6 vs. 1.9 per 100 patients, P=0.016) have decreased in the postintervention as compared with the preintervention group. The relative risk reduction, absolute risk reduction, and number needed to treat were statistically significant for ventilator-associated pneumonia (66.5%, 3.7%, 27, respectively; P=0.016). There was no significant difference in survival time by the presence of nosocomial infection (83.67 patient-days without vs. 74.33 patient-days with infection, P>0.05) CONCLUSIONS The most important risk factors for nosocomial infections were mechanical ventilation, central line, intracranial pressure device, and tracheostomy. After the multimodal intervention, there was a statistically significant decrease in the incidence rates of nosocomial infections and the risk reduction for ventilator-associated pneumonia. No significant impact of nosocomial infections on mortality was determined.
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Affiliation(s)
- Vaidotas Gurskis
- Unit of Pediatric Intensive Care, Clinic of Children's Diseases, Hospital of Kaunas University of Medicine, Eiveniu 2, Kaunas, Lithuania.
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Baksiene ND, Sileikiene R, Sileikis V, Kevalas R, Gurskis V. Atrial tachyarrhythmias in infants. Turk J Pediatr 2008; 50:143-148. [PMID: 18664078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This report describes clinical features and tactics of treatment of atrial tachyarrhythmias in infancy. Electrophysiologic study was performed in all 20 infants (2 weeks - 12 months old) in order to determine the mechanism of arrhythmia and to predict the clinical efficacy of management. Reciprocating mechanism was revealed in 12 infants. Atrial flutter was diagnosed for 10 infants among whom only 2 patients were older than two months. Six infants were found to have flutter conduction with a rate of 1:1. Four infants had congestive heart failure, 3 of them with a structurally normal heart. Half of the infants with atrial flutter needed long-term antiarrhythmic therapy. Electrotherapy for termination of atrial flutter was effective in all of them. Automatic atrial tachycardia in eight infants presented no major problems unless it became incessant and resistant to pharmacological treatment. The average tachycardia rate reached 171+/-7 beats/min. Atrial reciprocating tachycardia usually affects patients with diseased myocardium.
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Liesiene R, Kevalas R, Uloziene I, Gradauskiene E. Search for clinical and neurophysiological prognostic patterns of brain coma outcomes in children. Medicina (Kaunas) 2008; 44:273-279. [PMID: 18469503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the possible predictive values of clinical examinations combined with the recordings of electroencephalography and brainstem auditory-evoked potentials in traumatic coma of pediatric patients. MATERIAL AND METHODS A total of 43 children in coma with severe acute head trauma were included in the study. They were investigated and treated in pediatric intensive care unit using standard evaluation and treatment protocol. Evaluation of coma was performed using Glasgow Coma Scale. Electroencephalography for 35 patients and brainstem auditory-evoked potentials for 24 patients were recorded. RESULTS Glasgow coma scale statistic pool median was equal to 4 points as measured in presence of brain edema, meanwhile it was 6 as measured in absence of edema. In case of supratentorial damage, median duration of consciousness recovery was 10 days. In absence of above-mentioned supratentorial damage, recovery of the consciousness was earlier - median was 5 days. Determined duration of artificial lung ventilation was statistically significantly shorter for those who had edema (P=0.048). In 20 patients (57% of all cases), constant or alternating slow wave activity was observed during the first electroencephalographic recording. In other cases, "alpha coma" or low amplitude of arrhythmic activity and local slowing activity corresponding to brain damage seen on computerized tomography were recorded. For 24 patients, brainstem auditory-evoked potentials were recorded. In 9 cases, they were abnormal; in these cases, the consciousness of the patients recovered after 44 days or did not recover. CONCLUSIONS Glasgow coma scale results alone may have limited prognostic value in absence of other objective neurophysiologic investigation data concerning the coma outcome in children. Prognosis may be worse if pathological brainstem auditory-evoked potentials correlate with pathological dynamic changes in electroencephalography and brain lesions, diagnosed during computerized tomography scan.
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Affiliation(s)
- Rūta Liesiene
- Department of Children Diseases, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania.
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Grinkeviciūte DE, Kevalas R, Matukevicius A, Ragaisis V, Tamasauskas A. Significance of intracranial pressure and cerebral perfusion pressure in severe pediatric traumatic brain injury. Medicina (Kaunas) 2008; 44:119-125. [PMID: 18344664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of the study was to evaluate outcome of children after severe traumatic brain injury treated according to intracranial pressure (ICP)-targeted protocol, to define threshold values of peak ICP and minimal cerebral perfusion pressure (CPP) for decompressive osteoplastic craniotomy, and to determine the relationship between ICP, CPP and long-term outcome in these children. All children admitted to Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital after severe head injury from January 2004 to June 2006 and treated according to ICP-targeted protocol for the management of severe head trauma were prospectively included in the study. Raised ICP was defined as a level higher than 20 mmHg. Minimal CPP was considered to be at a level of 40 mmHg. Outcome was defined using Glasgow Outcome Scale (GOS) at discharge from the hospital and after 6 months. Forty-eight patients (32 boys and 16 girls) were included into the study. Favorable outcome (GOS score of 4 and 5) after 6 months was achieved in 43 (89.6%) cases. Mean peak ICP was 24.2+/-7.2 mmHg and mean minimal CPP - 53.1+/-14.7 mmHg. Decompressive craniotomy was performed in 13 cases. Threshold values of peak ICP and minimal CPP for decompressive craniotomy were 22.5 mmHg (area under the curve, 0.880) and 46.5 mmHg (area under the curve, 0.898), respectively. The differences in peak ICP and minimal CPP in groups of favorable and unfavorable outcomes were not statistically significant. Treating children after severe traumatic brain injury according to the ICP-targeted protocol for the management of severe pediatric traumatic brain injury resulted in a favorable long-term outcome.
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Hansted E, Sitkauskiene B, Kevalas R, Tattersall A, Day T. Research for practice: a new in vitro test for identification of tuberculosis infection. Medicina (Kaunas) 2007; 43:519-22. [PMID: 17768365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Tuberculosis is one of the biggest global health problems. One-third of the world's population (2 billion) is latently infected with tuberculosis. The tuberculin skin test is commonly used to diagnose tuberculosis infection. This test has poor specificity and sensitivity, cross-reactivity with bacille Calmette-Guérin vaccination and many environmental mycobacteria, and poor sensitivity (only 75-90% in active tuberculosis). Mycobacterium tuberculosis activates a strong T cell-mediated immune response. That is why, a better marker for tuberculosis infection could be the presence of mycobacteria specific interferon-gamma-secreting T cells. These cells can be identified in blood or any other sample, which contains T cells. The test specificity is 99.9% (in low-risk control groups), and the sensitivity is 97.2% (in subjects with culture-confirmed active disease). New in vitro diagnostic test of tuberculosis, based on tuberculosis-induced immunological mechanisms, seems to be more specific and useful as previous methods.
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Affiliation(s)
- Edita Hansted
- Department of Pediatric Diseases, Kaunas University of Medicine, Eiveniu 2, Kaunas, Lithuania.
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Grinkeviciūte DE, Kevalas R, Saferis V, Matukevicius A, Ragaisis V, Tamasauskas A. Predictive value of scoring system in severe pediatric head injury. Medicina (Kaunas) 2007; 43:861-869. [PMID: 18084143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To determine the threshold values of Pediatric Index of Mortality 2 (PIM 2) score, Pediatric Trauma Score (PTS), and Glasgow Coma Scale (GCS) score for mortality in children after severe head injury and to evaluate changes in outcomes of children after severe head injury on discharge and after 6 months. MATERIAL AND METHODS All children with severe head injury admitted to the Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital, Lithuania, from January 2004 to June 2006 were prospectively included in the study. The severity of head injury was categorized according to the GCS score < or =8. As initial assessment tools, the PTS, postresuscitation GCS, and PIM 2 scores were calculated for each patient. Outcome was assessed according to Glasgow Outcome Scale on discharge and after 6 months. RESULTS The study population consisted of 59 children with severe head injury. The group consisted of 37 (62.7%) boys and 22 (37.3%) girls; the mean age was 10.6+/-6.02. The mean GCS, PTS, and PIM 2 scores were 5.9+/-1.8, 4.8+/-2.7, and 14.0+/-19.5, respectively. In terms of overall outcome, 46 (78.0%) patients survived and 13 (22.0%) died. All three scales appeared to be significant predictors of death. Threshold values for which potential mortality in children after severe head injury increased were 10.75 for PIM 2, 3 for PTS and 5 for GCS. PIM 2 score provided the best discrimination between survivors and nonsurvivors. CONCLUSIONS The threshold values for mortality in children after severe head trauma were PIM 2> or =10.75%, PTS< or =3 and GCS< or =5, and these values were significant risk factors of death in severely head injured children. The changes in outcome for survivals on discharge and after 6 months were statistically significant.
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Grinkeviciūte D, Kevalas R, Tamasauskas A, Matukevicius A, Gurskis V, Liesiene R. [Severe pediatric head injury: is there any optimal solution?]. Medicina (Kaunas) 2006; 42:278-87. [PMID: 16687899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Traumatic brain injury in children is a worldwide problem. The incidence of trauma cases is increasing over the world, and in Lithuania it is several times higher than in the most developed European countries. The article reviews data about the most modern means of managing pediatric traumatic brain injury. The role of prehospital care, emphasizing on airway management, adequate ventilation, oxygenation, and perfusion in order to preclude secondary brain injury, which begins straight after trauma, is being noted. Establishing trauma system and patient's treatment in pediatric trauma centers, where child gets urgent and sufficient help, reduces mortality and improves outcomes. Pediatric patient's triage using patient's status scoring and trauma scoring systems is recommended. The role of intracranial pressure and cerebral perfusion pressure is crucial. Immediate management of intracranial pressure reduces mortality and improves outcomes. Techniques of intracranial pressure monitoring and management strategies of intracranial hypertension, their advantages and possible disadvantages are described.
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Affiliation(s)
- Dovile Grinkeviciūte
- Clinic of Children's Diseases, Kaunas University of Medicine, Kaunas, Lithuania.
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Liesiene R, Uloziene I, Kevalas R, Grinkeviciūte D. [Evaluation of the functional brain state in comatose children]. Medicina (Kaunas) 2006; 42:355-61. [PMID: 16778462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This article reviews scientific literature data of the last decade and analyses the possibilities to evaluate functional brain state in comatose children. Observations after the development of coma, its short-term and long-term outcomes show that when duration of coma is over 30 days, the chances to regain consciousness and autonomy are decreased. Coma of hypoxic origin has more complicated course, and its prognosis is worse compared to the one of a traumatic origin. Vegetative condition is observed more frequently as a consequence of hypoxic brain damage. Survival in vegetative condition without recovery of consciousness raises medical, psychological, social, and patient care problems. The article reviews different methodical approaches for the evaluation of functional brain state. Various methods of brain bioelectric evaluation are analyzed, including routine and qualitative methods of electroencephalography, possibilities of its spectral analysis and evoked potentials of various types. The results of the observation that evaluate the changes of brain structure and neurophysiological parameters are reviewed. The analysis of 48 articles draws a conclusion that the most objective criteria for evaluation the prognosis of coma can be achieved while following the clinical condition of the patient in parallel with the brain neuroimaging studies and evaluation of neurophysiological parameters, such as electroencephalography spectral analysis and evoked potentials of brainstem and cortex. The best evaluation of the functional brain state and prognosis of coma can be achieved with repeatable investigations during coma development and comparison of the results of several parameters.
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Affiliation(s)
- Rūta Liesiene
- Department of Intensive Care, Clinic of Children's Diseases, Kaunas University of Medicine Hospital, Eiveniu 2, 50009 Kaunas, Lithuania.
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Sakalauskas R, Bagdonas A, Blaziene A, Bojarskas J, Danila E, Dubakiene R, Kevalas R, Kiziela A, Kudzyte J, Leisyte P, Macinskas S, Malakauskas K, Miseviciene V, Nargela R, Sitkauskiene B, Valavicius A, Valius L, Vaideliene L. [Consensus on asthma diagnosis and treatment in children and adults]. Medicina (Kaunas) 2005; 41:251-77. [PMID: 15827394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Asthma is a chronic airway disease that is a growing problem of public health. The current consensus is based on the Global Initiative for Asthma (GINA) and other guidelines for asthma, and adapted for Lithuania. This Consensus provides physicians with recommendations for asthma management in children and adults.
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Kevalas R. [Febrile infant and small child: what solution could be rational?]. Medicina (Kaunas) 2005; 41:974-87. [PMID: 16333221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Fever of infant and small child is one of the greatest parental concerns. Mostly the source of fever is viral infection, but sometimes it can be serious bacterial infection: meningitis, sepsis, osteomyelitis, urinary tract infection, pneumonia and enteritis. Non-identified bacterial infection may be a cause of disablement or even death. Infant and younger children up to 36 months of age are in the highest risk period for invasive bacterial infection. After the examination of febrile infant the practitioner has to take a wise decision, especially if febrile infant looks well enough and there is no focus of infection. It is not reasonable to admit all febrile infants and do tests to all of them or start empiric antibiotic therapy. In order to protect infants from no identification of serious bacterial infection it is important for a physician to know the evaluation and management tactics of febrile infants. Thus, the salient question for any physician is: "When can a febrile infant be safely discharged from the emergency room?" Most often proposed recommendations for the management of febrile infants in the literature come predominantly from Boston, Philadelphia and Rochester prospective studies. Criteria introduced in these recommendations demonstrate a safe and effective way of screening febrile infants for a serious bacterial infection. Each management strategy involves criteria such as child's age, temperature, clinical appearance, white blood cell count, urinalysis, cerebrospinal fluid test, stool screening, chest radiography. The purpose of this article is to review the data and to validate optimal recommendation regarding the management of febrile infant and child 3 to 36 months of age.
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Affiliation(s)
- Rimantas Kevalas
- Clinic of Children's Diseases, Kaunas University of Medicine, 50009 Kaunas, Lithuania.
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