RESUMEN
In this survey study of institutions across the US, marked variability in evaluation, treatment, and follow-up of adolescents 12 through 18 years of age with mRNA coronavirus disease 2019 (COVID-19) vaccine-associated myopericarditis was noted. Only one adolescent with life-threatening complications was reported, with no deaths at any of the participating institutions.
Asunto(s)
COVID-19 , Miocarditis , Adolescente , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Humanos , Miocarditis/epidemiología , Miocarditis/etiología , ARN MensajeroRESUMEN
BACKGROUND: A combination of parenteral medications (often referred to as standard combination therapy) is frequently used in the treatment of acute migraine in the pediatric emergency department (PED). The primary aim of this study was to evaluate the two-hour, 24-hour, and seven-day impact of one such regimen on pain in children who present to the PED. Standard combination therapy for purposes of our study is defined as a bolus of intravenous saline, and a combination of intravenous ketorolac, prochlorperazine, and diphenhydramine. METHODS: This prospective observational study included 120 children between the ages seven and 18 years who presented to the PED with migraine, whose parents could read and understand the consent form in English, and who were treated with standard combination therapy. The primary outcome measure for this study was the change in severity of pain as noted by the child using the Faces Pain Scale-Revised. We analyzed normally distributed continuous variables by mean and standard deviation, whereas non-normally distributed continuous variables are reported by median and interquartile range. RESULTS: Nonparametric Friedman testing on the entire cohort (n = 120) noted that there was a statistically significant change in the Faces pain scale from before administration of standard combination therapy to the two-hour, 24-hour, and one-week time point with a reduction in pain score of 87.5%, 100%, and 50%, respectively, at the three time points. CONCLUSIONS: This study noted moderate relief of pain after administration of standard combination therapy, which persisted at one-week after administration.
Asunto(s)
Antiinflamatorios no Esteroideos/farmacología , Difenhidramina/farmacología , Antagonistas de Dopamina/farmacología , Hipnóticos y Sedantes/farmacología , Ketorolaco/farmacología , Trastornos Migrañosos/tratamiento farmacológico , Proclorperazina/farmacología , Enfermedad Aguda , Adolescente , Antiinflamatorios no Esteroideos/administración & dosificación , Niño , Difenhidramina/administración & dosificación , Antagonistas de Dopamina/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Hipnóticos y Sedantes/administración & dosificación , Ketorolaco/administración & dosificación , Masculino , Evaluación de Resultado en la Atención de Salud , Proclorperazina/administración & dosificación , Estudios Prospectivos , Solución Salina/administración & dosificaciónRESUMEN
Paradoxical reactions (PRs) are exaggerated inflammatory responses owing to recovery of cellular immunity following initiation of anti-tuberculous therapy (ATT). The presentation is worsening of pre-existing symptoms or development of new lesions. A 14-year-old girl with multi-drug-resistant tuberculosis developed a recurrent asymptomatic retropharyngeal abscess while on ATT. She required multiple aspirations of the abscess. Xpert MTB/RIF detected Mycobacterium tuberculosis from the aspirate which was resistant to rifampicin; culture was negative. Following aspirations of the abscess, continued ATT and a 2-month course of corticosteroids, she remains well and has gained weight. A retropharyngeal abscess presenting in the form of a PR has not been reported previously in adults or children.