Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 1.729.159
Filter
1.
Rev. SPAGESP ; 22(1): 83-97, ene.-jun. 2021.
Article in Portuguese | LILACS, Index Psychology - Scientific journals | ID: biblio-1155516

ABSTRACT

Partimos do trabalho em uma instituição de acolhimento para crianças e adolescentes propondo uma escuta orientada pela psicanálise. Considerando as tensões entre instituição e psicanálise, a questão que nos orienta é de que forma a transferência pode contribuir para uma instauração de escuta, que permitirá a elaboração da situação de vulnerabilidade desses sujeitos. Utilizamos como método de pesquisa a revisão bibliográfica associada à psicanálise aplicada e recorremos aos fragmentos de recordação das situações vividas no cotidiano institucional. Concluiu-se que há um lugar de escuta sob transferência a ser considerada na instituição e que o Plano Individual de Atendimento (PIA) necessita ser efetivado sob transferência, para que seja implementado como instrumento que valorize o surgimento das singularidades dos acolhidos.


We started from work at a host institution for children and adolescents, proposing a listening guided by psychoanalysis. Considering the tensions between institution and psychoanalysis, the question that guides us is how the transfer can contribute to establishing a listening that will allow the elaboration of the situation of vulnerability of these subjects. We used as a research method the bibliographic review associated with applied psychoanalysis and we also used fragments of remembrance of the situations experienced in the institutional daily life. It was concluded that there is a place of listening under the transfer to be considered in the institution and that the Individual Assistance Plan needs to be carried out under the transfer in order to be implemented as an instrument that values the emergence of the singularities of the sheltered.


Partimos desde el trabajo en una institución de acogida para niños y adolescentes proponiendo una escucha orientada por el psicoanálisis. Considerando las tensiones entre institución y psicoanálisis, la cuestión que nos orienta es de qué forma la transferencia puede contribuir al establecimiento de un escuchar que permitirá la elaboración de la situación de vulnerabilidad de esos sujetos. Utilizamos como método de investigación la revisión bibliográfica asociada al psicoanálisis aplicado y recurrimos a los fragmentos de recuerdos de las situaciones de la vida cotidiana institucional. Concluimos que hay un lugar de escucha bajo transferencia a ser considerado en la institución y que el Plan Individual de Atención necesita ser efectivado bajo transferencia para que sea implementado como un instrumento que valore el surgimiento de las singularidades de los acogidos.


Subject(s)
Humans , Male , Female , Child , Adolescent , Psychoanalysis , Attention , Orphanages , Disaster Vulnerability , Lodged , User Embracement , Child, Foster , Health Services Needs and Demand
3.
BMC Infect Dis ; 21(1): 405, 2021 May 01.
Article in English | MEDLINE | ID: mdl-33933008

ABSTRACT

BACKGROUND: Aseptic meningitis is most often caused by enteroviruses (EVs), but EVs associated with aseptic meningitis have not yet been reported in Liaocheng. The aim of this study was to determine the prevalence and genetic characteristics of EVs causing aseptic meningitis in children in Liaocheng. METHODS: We reviewed the epidemiological and clinical characteristics of 504 paediatric cases of aseptic meningitis in Liaocheng from 2018 to 2019 and analysed the phylogeny of the predominant EV types causing this disease. RESULTS: A total of 107 children were positive for EV in cerebrospinal fluid samples by nested PCR. Most of the positive patients were children 13 years old or younger and had symptoms such as fever, headache and vomiting (P < 0.05). The seasons with the highest prevalence of EV-positive cases were summer and autumn. The 107 EV sequences belonged to 8 serotypes, and echovirus types 18, 6 and 11 were the three dominant serotypes in Liaocheng during the 2-year study period. Phylogenetic analyses demonstrated that the E18 and E6 isolates belonged to subgenotype C2, while the E11 isolates belonged to subgenotype D5. VP1 analysis suggested that only one lineage of these three types was cocirculating in the Liaocheng region. CONCLUSIONS: This study demonstrated the diverse EV genotypes contributing to a large outbreak of aseptic meningitis in Liaocheng. Therefore, large-scale surveillance is required to assess the epidemiology of EVs associated with aseptic meningitis and is important for the diagnosis and treatment of aseptic meningitis in Liaocheng.


Subject(s)
Enterovirus Infections/virology , Enterovirus/genetics , Meningitis, Aseptic/cerebrospinal fluid , Meningitis, Aseptic/epidemiology , Meningitis, Viral/cerebrospinal fluid , Adolescent , Child , Child, Preschool , China/epidemiology , Disease Outbreaks , Enterovirus/isolation & purification , Enterovirus Infections/cerebrospinal fluid , Enterovirus Infections/epidemiology , Enterovirus Infections/etiology , Female , Genotype , Humans , Infant , Male , Meningitis, Aseptic/etiology , Meningitis, Aseptic/virology , Meningitis, Viral/epidemiology , Meningitis, Viral/virology , Phylogeny , Seasons
4.
Acta Chir Orthop Traumatol Cech ; 88(2): 95-100, 2021.
Article in Czech | MEDLINE | ID: mdl-33960921

ABSTRACT

PURPOSE OF THE STUDY The study aimed to evaluate the intraoperative and early postoperative response to simultaneous bilateral femoral osteotomy usually accompanied by soft tissue release of hip joints, or open reduction, capsuloplasty, pelvic osteotomy or extraarticular shelf procedure. MATERIAL AND METHODS A bilateral surgery was performed in 16 children. Twelve children suffered from (spastic) cerebral palsy and there was one case of paralytic dislocation in a patient with myelomeningocele, while the remaining patients suffered from chromosome I aberrations, Dandy-Walker syndrome and merosin-deficient muscular dystrophy. GMFCS Level IV and V prevailed. The patients with femoral head deformity or severe adduction contracture were removed from the study group. In all cases the LCP Pediatric Hip Plate 3.5 or 5.0 (Synthes) was used for osteosynthesis. The postoperative fixation by a hip spica cast was applied for 6 weeks, after which in most cases SWASH orthosis was used at night. The age of the patient, the hip joint finding, the GMFCS level and the type of procedure were recorded. RESULTS The evaluation took into account the use of general anaesthesia only or a combination of general and epidural anaesthesia, most often through caudal block, duration of surgery, time when blood transfusion was necessary and the volumes of blood needed, duration of stay in the Anaesthesiology and Resuscitation Unit, or Intensive Care Unit. As a response to surgery, the changes in haemoglobin levels in g/l and VAS pain score were studied. In four patients only the operative time exceeded 3 hours. Blood transfusion was necessary in 13 patients, with one blood unit being always sufficient. Two patients were admitted to the Anaesthesiology and Resuscitation Unit, the remaining patients spent 1-3 days after surgery in the ICU. The average length of hospital stay did not exceed a week. The postoperative decrease in haemoglobin levels quickly improved. The pain intensity was regularly recorded postoperatively and on day 3-4 it was evaluated as moderate, with patients responding well to common analgesics (VAS 4-7). DISCUSSION The evaluation of duration of simultaneous bilateral procedure, postoperative recovery based on the need for blood transfusion, changes in blood count and VAS scores indicated that the procedure performed on both hip joints simultaneously does not significantly exceed the reasonable limits in terms of the patient s burden. In literature, we found only a single article on a topic of this sort, the conclusions of which are very similar. CONCLUSIONS The simultaneous bilateral femoral osteotomy can be considered a fairly safe procedure. Key words: hip joint instability, simultaneous femoral osteotomy, cerebral palsy.


Subject(s)
Cerebral Palsy , Hip Dislocation , Child , Feasibility Studies , Femur , Hip Dislocation/surgery , Hip Joint/surgery , Humans , Osteotomy , Retrospective Studies , Treatment Outcome
5.
Acta Chir Orthop Traumatol Cech ; 88(2): 101-106, 2021.
Article in Czech | MEDLINE | ID: mdl-33960922

ABSTRACT

PURPOSE OF THE STUDY Diagnosis and treatment of fractures of the facial skeleton in children can be difficult due to the skeletal growth. MATERIAL AND METHODS The 9-year retrospective study included patients admitted with the orbital fracture diagnosis to the University Hospital Brno, Children s Hospital, Department of Paediatric ENT, Department of Paediatric Anaesthesiology and Resuscitation, and Department of Paediatric Surgery, Orthopaedics and Traumatology. We looked into the number of patients admitted to the hospital with the orbital fracture diagnosis and the cause of the injury, the age of patients, and the used treatment method - surgical or non-operative treatment were analysed. The following assumptions were applied: 1. Incidence of the injury (orbital fracture) increases with the age of the patient, 2. Incidence of the injury in individual years is constant. RESULTS In the followed-up period, between 2010 and 2018, a total of 47 patients, of whom 8 girls and 39 boys, with the orbital fracture diagnosis were treated. 12 patients underwent surgery, 35 patients were treated non-operatively. The study group included 47 patients with the age range of 1 to 18 years, with the median age 12 years. When the results were processed, a trend was revealed showing an increase in the number of injuries as well as an in the age of patients at the time of injury. The number of injuries increases with age and year. Both the correlations, however, are statistically insignificant and the trend can be considered statistically insignificant. DISCUSSION Both the non-operative and surgical treatment of patients lead to excellent results, even in the long-term follow-up. In paediatric patients, the surgical approach should be opted for only in cases when the non-operative approach is impossible due to the extent and characteristics of fracture and damage to soft tissues. CONCLUSIONS The surgical treatment aims at the best possible anatomical reconstruction of the orbit with no subsequent functional or cosmetic defects. If surgical treatment is necessary, then the transconjunctival approach is most appropriate in children, namely because of the good overview over the operating field, simple procedure as well as the cosmetic outcome. In most cases it is enough to reposition the orbital soft tissues. In complicated cases, with an orbital floor defect, it needs to be covered with a suitable material. Also, the non-operative approach has its place in therapy and the case-by-case approach must be applied. Orbital fractures should always be treated by experienced specialists (ENT, dental surgeon, traumatologist) specialising in paediatric patients. Key words: fracture, orbit, childhood, surgical, non-operative treatment.


Subject(s)
Orbital Fractures , Orthopedic Procedures , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Orbital Fractures/diagnosis , Orbital Fractures/epidemiology , Orbital Fractures/surgery , Postoperative Complications , Retrospective Studies , Treatment Outcome
6.
Acta Chir Orthop Traumatol Cech ; 88(2): 131-136, 2021.
Article in English | MEDLINE | ID: mdl-33960926

ABSTRACT

PURPOSE OF THE STUDY The aim of this study was to investigate the culture results of children undergoing debridement for suspected septic arthritis or acute osteomyelitis and to compare the laboratory parameters and clinical characteristics of culture-positive and culture-negative patients. MATERIAL AND METHODS Patients who underwent surgery in our hospital for septic arthritis and acute osteomyelitis between 2011 and 2019 were retrospectively analyzed. Seventy-two of 96 patients were included in the study. The patients had documented joint swelling, redness, pain with joint movement and weight-bearing failure. Fever was assessed preoperatively. Sedimentation rate, C-reactive protein level, white blood cell count and the leukocyte count in aspiration material as well as complications were evaluated preoperatively and 3 months postoperatively. RESULTS Twenty patients underwent surgery of the hip; 39 of the knee; 7 of the foot, ankle and distal tibia; 1 of the elbow; and 1 of the distal radius. Additionally, 4 patients had septic arthritis and acute osteomyelitis of the femur. The mean age of the patients was 7.8 years (1-16). The mean follow-up period was 16.2 months (3-42). Preoperative aspiration was performed in 44 of 72 patients. Thirty of 72 patients had positive cultures. No statistically significant difference in age, preoperative duration, C-reactive protein, sedimentation, white blood cell count, preoperative fever or complications was found when compared between patients with culture growth and those without reproduction (p > 0.05). There was a significant difference between the leukocyte count in the aspiration material (p < 0.05). CONCLUSIONS Prediagnosis of septic arthritis or acute osteomyelitis in pediatric patients is important in terms of future joint health and sepsis. According to our findings an inability to obtain bacteria does not exclude septic arthritis as a diagnosis. Empirical antibiotic therapy with a wide postoperative spectrum is important for joint health in these patients. Preoperative serum parameters cannot predict the agent needed for treatment. Key words: septic arthritis, osteomyelitis, pediatric septic arthritis, pediatric joint infection, pediatric infection.


Subject(s)
Arthritis, Infectious , Osteomyelitis , Adolescent , Arthritis, Infectious/diagnosis , Blood Sedimentation , Child , Child, Preschool , Humans , Infant , Leukocyte Count , Osteomyelitis/diagnosis , Retrospective Studies
7.
Soins ; 66(854): 19-22, 2021 Apr.
Article in French | MEDLINE | ID: mdl-33962726

ABSTRACT

Nursing education in Lebanon has integrated the academic world since 1979, but the profession is experiencing difficulties related to the retention of nurses at work and the lack of attraction to the profession. In this context, a study on the professional self-image was conducted among nurses working in hospitals. The results show that nurses have a positive professional self-image, but they find that their image in society is negative and only 20.4% would recommend this career to their children or their entourage.


Subject(s)
Education, Nursing , Self Concept , Child , Humans , Lebanon
8.
Soins ; 66(854): 49-52, 2021 Apr.
Article in French | MEDLINE | ID: mdl-33962734

ABSTRACT

When the only geno-identical donor is a minor child with autistic type disorders, the question of consent arises. Reflection on the decision to transplant bone marrow in this specific context.


Subject(s)
Bone Marrow Transplantation , Tissue Donors , Child , Family , Humans
9.
Soins ; 66(854): 46-48, 2021 Apr.
Article in French | MEDLINE | ID: mdl-33962733

ABSTRACT

In pediatric oncohematology, a hematopoietic stem cell transplant (HSC) may be offered depending on the pathology and the therapeutic objective. The transplant generates many repercussions, in particular related to the donation and the debt, on the physical and psychological identity of the donor and the recipient, with family changes. The multidisciplinary support of the families is essential so that everyone may find his right place.


Subject(s)
Hematopoietic Stem Cell Transplantation , Child , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Tissue Donors
10.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(4): 536-542, 2021 Apr 20.
Article in Chinese | MEDLINE | ID: mdl-33963712

ABSTRACT

OBJECTIVE: To explore the clinical phenotype and changes in joint structure and function in adolescent patients with severe hemophilia A under different doses of FVIII. OBJECTIVE: Forty- three adolescents with severe hemophilia A aged 4-18 years were divided into on-demand group (n=7), low-dose group (FVIII dose of 10-15 U/kg, 2-3 times a week, and ≤30 U/kg a week; n=17), and intermediate-dose group (FVIII dose of 15-20 U/kg, 2-3 times a week, and 45-60 U/kg a week (n=19). The 3 groups were compared for their clinical bleeding phenotype, annual bleeding rate (ABR), annual joint bleeding rate (AJBR), annual the most severe joint bleeding rate, joint imaging scores (ultrasound HEAD-US score and IPSG MRI score), Hemophilia Joint Health Score (HJHS) and Functional Independence Score in Hemophilia (FISH) within 24 months. OBJECTIVE: Compared with that in on-demand group, the ABR was significantly reduced in the low- and intermediate-dose groups (P=0.004 and 0.000, respectively), and was reduced by 32.87% in the intermediate-dose group as compared with the low-dose group. The AJBR (P < 0.01) and annual the most severe joint bleeding rate (P < 0.05) also differed significantly among the 3 groups. The number of bleeding episodes increased progressively with time in the on-demand group, remained stable in the low- dose group, and tended to decrease in the intermediate-dose group. The imaging scores of the most severe joints showed lesion progression in all the 3 groups. The ultrasound scores, which increased steadily in the on-demand group, showed significantly lowered increment rates in the low- and intermediate-dose groups (P=0.002 and 0.000, respectively). The MRI scores showed also delayed increment in the low- and intermediate-dose groups as compared with the on-demand group (P=0.041 and 0.000, respectively), and the increment was accelerated in the on-demand and low-dose group but remained stable in the intermediate-dose group. The increment of the HJHS scores was significantly higher in the on-demand group than in the lowand intermediate-dose groups (P=0.003 and 0.000, respectively), and the scores increased at a steady rate in the on-demand group but tended to decrease in the latter two groups. The FISH score was decreased by 0.29±3.09 in the on-demand group but was increased significantly in the low- and intermediate-dose groups compared with the on-demand group (P=0.000). OBJECTIVE: In Chinese adolescents with severe hemophilia A, low- and intermediate-dose FVIII prophylaxis, especially at the intermediate dose, is better than on- demand treatment for protecting joint structure and function.


Subject(s)
Hemophilia A , Adolescent , Child , Child, Preschool , Factor VIII , Hemarthrosis , Hemophilia A/drug therapy , Hemorrhage , Humans , Prospective Studies
11.
Georgian Med News ; (312): 78-82, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33964832

ABSTRACT

In this study was to investigate the сoexistence of diabetes mellitus type 1 with other chronic pathology in children and adolescents and their impact on the course of diabetes mellitus type 1 (DM1). The 88 children from 3 to 17 years who had DM1 were observed. The study was conducted by survey with the aim of finding risk factors and associated comorbidties with a questionnaire-based, objective-subjective study. All patients had severe form of T1DM, with suboptimal and poor glycemic control. Comorbid pathologies observed in 71,6±4,8% of childrn included: thyroid pathology - 62,5±5,1%, disorders of the autonomic nervous system - 20,5±4,3%, gastro-pathology - 7,9±2,8%, atopic dermatitis - 6,8±2,6%, arthritis - 6,8±2,6%, bronchial asthma - 4,5±2,2%, allergic rhinitis - 3,4±1,9%, immune-deficient disorder - 2,3±1,5%. Conclusions. 1. The detected comorbid pathology in children with DM1 makes it necessary to collect an anamnesis and examination of children for the purpose of early finding a coexistence of chronic pathology. 2. The risk of development of the thyroid pathology enhances is 7,5 times, allergic pathology is 6,9 times in patients with DM1. 3. Coexistence of type 1 diabetes and other chronic diseases impairs glucose metabolism, impedes effective insulin therapy, and deteriorates diabetes control. 4. This accent the need for the improvement of the monitoring of patient with diabetes mellitus and comorbid pathology for the prognosis of the course and optimization of treatment and rehabilitation measures.


Subject(s)
Asthma , Diabetes Mellitus, Type 1 , Rhinitis, Allergic , Adolescent , Asthma/complications , Asthma/epidemiology , Child , Comorbidity , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Humans , Insulin
12.
Georgian Med News ; (312): 82-87, 2021 Mar.
Article in Russian | MEDLINE | ID: mdl-33964833

ABSTRACT

The purpose of this review is study of literature for the development of biological effect of Kalcipherol (D vitamin group) on children population. Different factors seem, that D- vitamin deficiency disbalance elevated, children specifically negative effect, which have a major impact on health, growth and development of infants, children and adolescents. Vitamin D and calcium deficiencies are preventable global public health problems in pediatric medicine. The laboratory assessment of vitamin D (calcidiol-25(OH)D), epidemiological studies assessing the prevalence of vitamin D deficiency, are performed to analyze the relationships between neuropsychological function and mechanisms of toxic effects in the setting of vitamin D.


Subject(s)
Vitamin D Deficiency , Adolescent , Adult , Child , Humans , Infant , Prevalence , Vitamin D , Vitamin D Deficiency/epidemiology , Vitamins
13.
Georgian Med News ; (312): 88-92, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33964834

ABSTRACT

Epilepsy is one of the most common neurological disorder affecting up to 1% of the world population. It is a heterogeneous disorder and includes genetic, structural, metabolic causes, sometimes reason is unknown. In recent 20 years inflammation has been considered as a possible etiologic factor in angiogenesis and epileptogenesis in experimental models but there is still lack of evidence if inflammation could be seen in clinical cases of children with different forms of epilepsy. Epileptic encephalopathies are the group of epilepsies when seizure itself can cause severe cognitive and behavioral abnormalities. Besides seizures occurring in epileptic encephalopathies prone to be highly resistant to medication. Thus any etiological factor contributing to epileptogenesis could have high clinical relevance in modern epileptology. The aim of our research was to study the pro-inflammatory cytokines in different forms of epilepsy in children. We have assessed 56 children from 0-16 years of age. 20 were included in control group (Group 1), 20 children with resolved seizures were involved in study group (Group 2a) and 16 children with resistant seizures were identified as group 2b. The concentration of the following pro-inflammatory cytokines was assessed in blood serum: VCAM-1, CCL2, CCL3, CCL11 as well as a correlation between concentration and seizure repetition rate was also studied. All pro-inflammatory markers were within normal range in controls as well as in both study groups except CCL11. The concentration of CCL11 was elevated in group 2b. Thus we could hypothesize that inflammation could contribute to etiology of resistant epilepsies including epileptic encephalopathies. This evidence could serve as very significant information for pharmaceutical industry for future development of anti-inflammatory medicines as add on therapy with antiepileptic drugs for treatment of drug resistant epilepsies.


Subject(s)
Drug Resistant Epilepsy , Epilepsy , Epileptic Syndromes , Anticonvulsants/therapeutic use , Child , Drug Resistant Epilepsy/drug therapy , Epilepsy/complications , Epilepsy/drug therapy , Epileptic Syndromes/drug therapy , Humans , Inflammation/complications , Inflammation/drug therapy
14.
Georgian Med News ; (312): 172-180, 2021 Mar.
Article in Russian | MEDLINE | ID: mdl-33964848

ABSTRACT

The purpose of our study is to carry out a comprehensive analysis of the phenomenon of pedophilia in the context of child protection from sexual abuse, as well as to substantiate the need for treatment of persons with sexual perversions as a way to prevent sexual violence against children. Despite the normative consolidation of the inadmissibility of violence against children, including sexual violence, and the current system of preventive measures, today minors are the most victimized group of people. Of particular concern is not only the physical harm caused to a child as a result of sexual violence, but also the negative effects on mental health, which further contributes to the emergence of various psychosomatic illnesses, depressed psycho-emotional state, mental health disorders, suicidal behavior. Analysis of domestic and foreign studies cited in the article shows that the number of criminal attacks on the sexual inviolability of the child is steadily increasing. Most of the victims of such crimes are young children, and the perpetrator is often a close relative or someone known to the child. The use of the digital environment and modern methods of communication by pedophiles in order to harass and coerce children into sexual intercourse contributes to the increase in the number of such crimes. The methodology of the study is based on the dialectical method of knowledge, legal and organizational foundations of preventive activity concerning crimes against sexual freedom and sexual inviolability of the child, interrelation and interdependence of domestic and international experience. The results of the study show that, in order to reduce the number of infringements on the sexual inviolability of the child, a set of legal and medical measures aimed at preventing real and potential threats, primarily at identifying and treating persons with sexual perversions, in particular pedophilia, is necessary. This is especially necessary during and after serving a sentence for relevant crimes.


Subject(s)
Child Abuse, Sexual , Crime Victims , Criminals , Pedophilia , Child , Child, Preschool , Humans , Sexual Behavior
15.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(4): 432-437, 2021 Apr 28.
Article in English, Chinese | MEDLINE | ID: mdl-33967092

ABSTRACT

Cardio-facio-cutaneous (CFC) syndrome is an extremely rare autosomal dominant genetic disease due to BRAF and other gene mutations. The main characteristics of the patients are craniofacial deformities, cardiac malformations, skin abnormalities, delay of language and motor development, gastrointestinal dysfunction, intellectual disability, and epilepsy. In this case, the child has a typical CFC syndrome face and developmental delay. The gene results of the second-generation sequencing technology showed that there was a mutation site c.1741A>G (p. Asn581Asp) (heterozygous) in exon 14 of the BRAF (NM_004333.5) gene. The mutation was not observed in the child's parents. The above-mentioned mutation may be a de novo mutation. There is no effective therapy for this disease so far.


Subject(s)
Abnormalities, Multiple , Ectodermal Dysplasia , Heart Defects, Congenital , Child , Ectodermal Dysplasia/genetics , Facies , Failure to Thrive , Heart Defects, Congenital/genetics , Humans , Mutation , Proto-Oncogene Proteins B-raf/genetics
16.
Nihon Shokakibyo Gakkai Zasshi ; 118(5): 445-454, 2021.
Article in Japanese | MEDLINE | ID: mdl-33967129

ABSTRACT

We conducted a questionnaire survey on voluntary inoculation of hepatitis B (HB) vaccine to children at 79 pediatric clinics. The voluntary vaccination rate was 65.2%, the desired vaccination target was "all infants" at 84.8% of clinics, the recommended method was "only when the patient wishes" at a rate of 80.0%, and "actively recommended" at 20.0%. If there was a request, 71.7% of clinics answered that they would like to recommend it in the future, and 38.9% said that it was difficult to recommend it because of the voluntary nature of vaccination. The requests were "expansion of the scope of regular vaccination" at 60.9% of clinics and "enlightenment activities and information provision" at 54.3%. Since it was suggested that voluntary vaccination is difficult to recommend, it is necessary to proactively provide information and public relations activities regarding its necessity to medical personnel and parents.


Subject(s)
Hepatitis B Vaccines , Hepatitis B , Child , Hepatitis B/prevention & control , Humans , Infant , Surveys and Questionnaires , Vaccination
17.
Rinsho Ketsueki ; 62(4): 229-238, 2021.
Article in Japanese | MEDLINE | ID: mdl-33967145

ABSTRACT

Myelodysplastic syndrome (MDS) is a group of clonal hematopoietic disorders characterized by peripheral cytopenia and morphological abnormalities in hematopoietic cells, i.e., myelodysplasia. Aging-related somatic variants acquired in the hematopoietic cells are associated with MDS pathogenesis in adults. However, pediatric MDS often occurs because of germline predispositions. Myelodysplasia can be observed in not only MDS but also other hematopoietic and non-hematopoietic disorders, such as infections and primary immunodeficiencies. Therefore, careful differential diagnosis between MDS and other diseases is necessary. The bone marrow histopathology should be evaluated for accurate differentiation of MDS without excess blasts from aplastic anemia and MDS with excess blasts from acute myeloid leukemia. The treatment strategy for childhood MDS differs based on disease subtypes. The clinical courses of pediatric MDS without excess blasts are heterogeneous; therefore, it is crucial to assess the prognostic values of clinical and cytogenetic findings. In contrast, allogeneic hematopoietic cell transplantation should be considered as the only curative option for pediatric MDS with excess blasts.


Subject(s)
Anemia, Aplastic , Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute , Myelodysplastic Syndromes , Adult , Bone Marrow , Child , Humans , Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/therapy
18.
Rinsho Ketsueki ; 62(4): 278-288, 2021.
Article in Japanese | MEDLINE | ID: mdl-33967153

ABSTRACT

Recent advances in sequencing technologies have increased the detection rate for identifying germline mutations that predispose an individual to various myeloid neoplasms and somatic mutations acquired during progression from myelodysplastic syndromes (MDS) to acute myeloid leukemia (AML). In addition to pediatric subjects, adult patients were analyzed in order to obtain a complete spectrum of driver mutations in germline cells and/or somatic tumor samples. As shown in several recent studies, such driver mutations are acquired in a gene-specific fashion. DDX41 mutations are observed in germline cells long before MDS presentation. SAMD9/SAMD9L germline mutations associated with defective hematopoiesis account for recurrent and familial -7/del (7q) lesions, which result in the removal of the disadvantageous allele. Additionally, MDS cases in younger population display compound heterozygous germline mutations in the Shwachman-Diamond syndrome-associated SBDS gene. In peripheral blood samples from healthy elderly individuals, DNMT3A, TET2, and ASXL1 somatic mutations are usually detected due to age-related clonal hematopoiesis and are considered to be a risk factor for hematological neoplasms. In MDS, mutations of genes, such as NRAS and FLT3, designated as type-1 genes, are significantly associated with leukemic evolution. On the other hand, mutations in type-2 genes, including RUNX1 and GATA2, are related to progression from low risk MDS to high risk MDS.


Subject(s)
Leukemia, Myeloid, Acute , Myelodysplastic Syndromes , Myeloproliferative Disorders , Adult , Aged , Child , Germ-Line Mutation , Humans , Intracellular Signaling Peptides and Proteins , Leukemia, Myeloid, Acute/genetics , Mutation , Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/genetics
19.
Endocr Pract ; 27(5): 419-425, 2021 May.
Article in English | MEDLINE | ID: mdl-33934752

ABSTRACT

OBJECTIVE: To explore the body composition of pediatric patients referred for endocrine evaluation. METHODS: This real-life observational study conducted between January 2018 and January 2020 included 10 001 clinic visits of 3500 children and adolescents; first visits of 5 to 18-year-old patients were included. Anthropometric data, blood pressure levels, pubertal status, and bioelectrical impedance analysis (BIA, Tanita MC-780 MA) were extracted from medical files. Excluded from the analysis were patients participating in other studies. RESULTS: A total of 1001 patients (48% boys, mean age 11.3 ± 3.4 years, 33.5% prepubertal) were included. Mean anthropometric z-scores were normal and similar for boys and girls. Sex differences in body composition were as follows: boys had lower fat percentage, lower truncal fat percentage, higher appendicular skeletal muscle mass, and a higher muscle-to-fat ratio (MFR) than girls (P < .001 for all). MFR correlated with body mass index-standard deviation scores (BMI-SDS) in overweight/obese patients (r = -0.558, P < .001), although not in underweight patients. Systolic blood pressure (SBP) correlated with BMI-SDS in overweight/obese patients (r = 0.262, P < .001), although not in underweight patients. Diastolic blood pressure (DBP) did not correlate with BMI-SDS in either group of extreme weight status. MFR correlated with SBP and DBP in overweight/obese patients (r = -0.230, P < .001 and r = -0.141, P = .018, respectively) as well as in underweight patients (r = 0.331, P < .001 and r = 0.264, P = .005, respectively). CONCLUSIONS: Our findings support BIA for a more refined characterization of patients referred for endocrine evaluation than BMI-SDS. MFR may be a better surrogate marker of blood pressure levels than BMI-SDS in both underweight and overweight/obese pediatric patients.


Subject(s)
Body Composition , Obesity , Adolescent , Anthropometry , Body Mass Index , Body Weight , Child , Child, Preschool , Electric Impedance , Female , Humans , Male , Obesity/epidemiology
20.
Curr Opin Anaesthesiol ; 34(3): 271-275, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-33935174

ABSTRACT

PURPOSE OF REVIEW: Despite real advances in paediatric anaesthesia management, such as a growing awareness of the relevance of anaesthesia conduct as well as of the lack of evidence for neurotoxicity of anaesthetic agents, it must be said that there are still important questions in our specialty that remain unanswered. Standardization and harmonization of airway management, analgesia techniques and outcome measures are the important issues we are facing at the beginning of this decade. RECENT FINDINGS: Major improvements in airway management of neonates and infants resulted from the introduction of videolaryngoscopes and the systematic use of nasal oxygenation during endotracheal intubation. Similarly, the increasing popularity of dexmedetomidine has led to the generalization of its use, which, considering that it may produce undesirable effects, poses a challenge for the future. Moreover, recent systematic reviews have confirmed a lack of evidence for the efficacy of many techniques used in clinical practice. SUMMARY: The shift in research from the neurotoxicity of anaesthetic agents to factors related to anaesthetic conduct are discussed. Examples for an improvement in anaesthesia management are highlighted with advocacy for including these evidence-based findings in routine clinical practice. Finally, the impact of using clinically relevant age-related and patient-centred perioperative outcomes is essential for comparing and/or interpreting the safety and efficacy of anaesthesia and analgesia management in children.


Subject(s)
Anesthesia , Airway Management , Anesthesia/adverse effects , Child , Humans , Infant , Infant, Newborn , Intubation, Intratracheal/adverse effects
SELECTION OF CITATIONS
SEARCH DETAIL
...