Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 457
Filtrar
1.
N Engl J Med ; 383(20): 1932-1940, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33176083

RESUMO

BACKGROUND: A three-dose, oral rotavirus vaccine (Rotavac) was introduced in the universal immunization program in India in 2016. A prelicensure trial involving 6799 infants was not large enough to detect a small increased risk of intussusception. Postmarketing surveillance data would be useful in assessing whether the risk of intussusception would be similar to the risk seen with different rotavirus vaccines used in other countries. METHODS: We conducted a multicenter, hospital-based, active surveillance study at 27 hospitals in India. Infants meeting the Brighton level 1 criteria of radiologic or surgical confirmation of intussusception were enrolled, and rotavirus vaccination was ascertained by means of vaccination records. The relative incidence (incidence during the risk window vs. all other times) of intussusception among infants 28 to 365 days of age within risk windows of 1 to 7 days, 8 to 21 days, and 1 to 21 days after vaccination was evaluated by means of a self-controlled case-series analysis. For a subgroup of patients, a matched case-control analysis was performed, with matching for age, sex, and location. RESULTS: From April 2016 through June 2019, a total of 970 infants with intussusception were enrolled, and 589 infants who were 28 to 365 days of age were included in the self-controlled case-series analysis. The relative incidence of intussusception after the first dose was 0.83 (95% confidence interval [CI], 0.00 to 3.00) in the 1-to-7-day risk window and 0.35 (95% CI, 0.00 to 1.09) in the 8-to-21-day risk window. Similar results were observed after the second dose (relative incidence, 0.86 [95% CI, 0.20 to 2.15] and 1.23 [95% CI, 0.60 to 2.10] in the respective risk windows) and after the third dose (relative incidence, 1.65 [95% CI, 0.82 to 2.64] and 1.08 [95% CI, 0.69 to 1.73], respectively). No increase in intussusception risk was found in the case-control analysis. CONCLUSIONS: The rotavirus vaccine produced in India that we evaluated was not associated with intussusception in Indian infants. (Funded by the Bill and Melinda Gates Foundation and others.).


Assuntos
Intussuscepção/etiologia , Vacinas contra Rotavirus/efeitos adversos , Administração Oral , Estudos de Casos e Controles , Feminino , Humanos , Imunização Secundária/efeitos adversos , Incidência , Índia/epidemiologia , Lactente , Intussuscepção/epidemiologia , Masculino , Vigilância de Produtos Comercializados , Risco , Infecções por Rotavirus/prevenção & controle , Vacinação , Vacinas Atenuadas/efeitos adversos
2.
Euro Surveill ; 25(33)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32820718

RESUMO

Background Rotavirus is a major cause of severe gastroenteritis in children worldwide. The disease burden has been substantially reduced in countries where rotavirus vaccines are used. Given the risk of vaccine-induced intussusception, the benefit­risk balance of rotavirus vaccination has been assessed in several countries, however mostly without considering indirect protection effects. Aim We performed a benefit­risk analysis of rotavirus vaccination accounting for indirect protection in France among the 2018 population of children under the age of 5 years. Methods To incorporate indirect protection effects in the benefit formula, we adopted a pseudo-vaccine approach involving mathematical approximation and used a simulation design to provide uncertainty intervals. We derived background incidence distributions from quasi-exhaustive health claim data. We examined different coverage levels and assumptions regarding the waning effects and intussusception case fatality rate. Results With the current vaccination coverage of < 10%, the indirect effectiveness was estimated at 6.4% (+/− 0.4). For each hospitalisation for intussusception, 277.0 (95% uncertainty interval: (165.0­462.1)) hospitalisations for rotavirus gastroenteritis were prevented. Should 90% of infants be vaccinated, indirect effectiveness would reach 57.9% (+/− 3.7) and the benefit­risk ratio would be 192.4 (95% uncertainty interval: 116.4­321.3). At a coverage level of 50%, indirect protection accounted for 27% of the prevented rotavirus gastroenteritis cases. The balance remained in favour of the vaccine even in a scenario with a high assumption for intussusception case fatality. Conclusions These findings contribute to a better assessment of the rotavirus vaccine benefit­risk balance.


Assuntos
Gastroenterite/prevenção & controle , Hospitalização/estatística & dados numéricos , Intussuscepção/epidemiologia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Rotavirus/imunologia , Vacinação/efeitos adversos , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Análise Custo-Benefício , França/epidemiologia , Gastroenterite/epidemiologia , Humanos , Incidência , Lactente , Masculino , Modelos Teóricos , Mortalidade , Medição de Risco/métodos , Vacinas contra Rotavirus/efeitos adversos , Vacinação/estatística & dados numéricos
3.
PLoS One ; 15(8): e0238185, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857776

RESUMO

BACKGROUND: Recent studies have reported that after the introduction of rotavirus vaccine the incidence of intussusception did not change among infants, or slightly increased at the age immediately after the first dose. The rotavirus vaccines were introduced in Korea for private market use in 2007-2008. We investigated the incidence of intussusception before (2002-2006) and after (2009-2015) the vaccine introduction in Korea. METHODS: We conducted an interrupted time series study that used data from the Korean National Health Insurance database to identify infants (<12 months of age) who were diagnosed with intussusception and underwent non-invasive or invasive reduction from 2002 to 2015. According to the recommended ages for immunization, the annual intussusception incidence and the incidence rate ratios were calculated among three age groups, 6-14, 15-24, and 25-34 weeks. RESULTS: The annual incidences in infants have decreased over time from 241.7 per 100,000 infants (pre-vaccine period) to 160.1-205.2 per 100,000 infants (post-vaccine period). The incidence rate ratio during the post-vaccine period ranged from 0.66 to 0.85. The incidences of intussusception in all three infant age groups have decreased in post-vaccine period compared to pre-vaccine period (incidence rate ratio range: 0.31-0.65, 0.47-0.75, and 0.68-0.94 in 6-14, 15-24, and 25-34 weeks, respectively). CONCLUSIONS: The incidence of intussusception in infants did not increase after the rotavirus vaccine introduction in Korea, but rather decreased over the past decades. Since the incidence of intussusception varies according to country or region, continuous monitoring the incidence of intussusception in infants is necessary in each county or region.


Assuntos
Intussuscepção/epidemiologia , Vacinas contra Rotavirus/administração & dosagem , Humanos , Incidência , Lactente , República da Coreia/epidemiologia , Infecções por Rotavirus/prevenção & controle
5.
J Pediatr Surg ; 55(6): 1023-1025, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32247601

RESUMO

BACKGROUND/PURPOSE: Recurrent intussusception following successful nonoperative reduction has previously been reported with a frequency of 8%-12% based on data from individual institutions. Meanwhile, the timing of discharge after successful reduction continues to be debated. Here, we evaluate readmissions for recurrent intussusception in young children using a large-scale national database. METHODS: The National Readmissions Database (2010-2014) was queried to identify young children (age < 5 years) diagnosed with intussusception. We compared procedures performed during the index admission and frequency of readmissions for recurrent intussusception. Results were weighted for national estimates. RESULTS: We identified 8289 children diagnosed with intussusception during an index admission. These patients received definitive treatment with nonoperative reduction alone (43%), surgical reduction (42%), or bowel resection (15%). Readmission for recurrent intussusception was required for 3.7% of patients managed with nonoperative reduction alone, 2.3% of patients that underwent surgical reduction, and 0% of those that underwent bowel resection. Median time to readmission was 4 days after nonoperative reduction, and only 1.5% of these patients experienced recurrence within 48 h of discharge. CONCLUSIONS: Recurrent intussusception may be substantially less common than previously reported. Our findings support the practice of discharge shortly after successful nonoperative reduction. TYPE OF STUDY: Retrospective, prognosis study. LEVEL OF EVIDENCE: III.


Assuntos
Intussuscepção/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Pré-Escolar , Humanos , Incidência , Lactente , Recém-Nascido , Intussuscepção/patologia , Intussuscepção/terapia , Recidiva , Estudos Retrospectivos
6.
J Pediatr Surg ; 55(8): 1562-1569, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32156425

RESUMO

OBJECTIVES: Describe changes in the diagnostic approach and treatment for pediatric intussusception over two decades. STUDY DESIGN: Administrative universal healthcare data were used to conduct a population-based cohort study of intussusception between January 1997 and December 2016 in Ontario, Canada. A validated case definition was used to identify all patients (<18 years) treated for intussusception in the province at community or tertiary care centers. Treatment modality was determined using physician billing data and databases linked at ICES; it was categorized as nonoperative alone, surgical alone, or failed nonoperative. Descriptive statistics, Cochrane-Armitage for trend analyses, and graphical and multinomial logistic regression were performed. RESULTS: Over 20 years, 1895 pediatric patients were treated for intussusception. Pretreatment imaging use rose from 57.5% to 99.3%. Nonoperative management increased from 23.4% to 75.2%. However, 43% of children who presented to a community hospital underwent immediate surgical management, compared with just 11% of children at tertiary centers (RR 0.39, 95% CI: 0.25-0.62). Among children who underwent surgery, there was an increase in bowel resection over time (41.7% to 57.6%). CONCLUSIONS: Over the 20 year period of study, pretreatment imaging became universal, and management shifted from predominantly surgical to nonoperative reduction in Ontario. The rate of surgical intervention remains higher in community versus tertiary centers. LEVEL OF EVIDENCE: Treatment study, III.


Assuntos
Intussuscepção , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Intussuscepção/diagnóstico , Intussuscepção/epidemiologia , Intussuscepção/terapia , Masculino , Ontário/epidemiologia
7.
J Pediatr Surg ; 55(3): 530-534, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31351705

RESUMO

PURPOSE: In high-income countries the presentation and treatment of intussusception is relatively rapid, and most cases are correctable with radiographically-guided reduction. In low-income countries, many delays affect outcomes and surgical intervention is required. This study characterizes the burden and outcome of pediatric intussusception in Uganda. METHODS: Prospective case series of intussusception cases from May 2015 to July 2016 at a tertiary referral hospital in Uganda. RESULTS: Forty patients were included in the study. Male to female ratio was 3:2. Average duration of symptoms before presentation was 4.5 days. Median duration of symptoms in referred patients was 4 days and 2 days in non-referred patients (P value 0.0009). All 40 patients underwent surgical treatment: 25% had resection and enterostomy, 15% had resection and primary anastomosis, 2.5% had resection, primary anastomosis and enterostomy and 57.5% underwent manual reduction. Mortality was 32% and febrile patients on admission were 20 times more likely to die (P value 0.040). CONCLUSION: Intussusception carries a high operative and mortality rate in Uganda. Referred patients presented later than non-referred patients to health facilities. Fever on examination at admission was positively associated with mortality. This disease remains a target for quality metrics in global pediatric surgery. TYPE OF STUDY: Diagnostic study. LEVEL OF EVIDENCE: III.


Assuntos
Intussuscepção , Feminino , Humanos , Lactente , Intussuscepção/epidemiologia , Intussuscepção/mortalidade , Intussuscepção/fisiopatologia , Intussuscepção/terapia , Masculino , Estudos Prospectivos , Uganda/epidemiologia
8.
Pediatr Emerg Care ; 36(4): e189-e191, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29337838

RESUMO

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to serious sequelae. The objective of this study was to determine the prevalence of ileoileal intussusception and to document and compare clinical outcomes with ileocolic intussusception. METHODS: A retrospective cohort study of children with an abdominal ultrasound that diagnosed intussusception. Clinical data and diagnostic studies were retrieved, to compare ileoileal with ileocolic intussusception. RESULTS: A total of 488 patients were evaluated with an abdominal ultrasound on suspicion of intussusception; 54 (11%) had ileoileal intussusception and 30 (6%) ileocolic intussusception. The significant features distinguishing the 2 conditions were fever, more common in patients with ileoileal intussusception, and an abdominal mass, which was papable more commonly in ileocolic intussusception. None of the ileoileal intussusception patients required surgical intervention, and all were discharged without complication. CONCLUSIONS: With recent advances in abdominal ultrasound, the diagnosis of ileoileal intussusception has become easier than before. Patients presenting with small bowel intussusception may not need any immediate intervention. The presence of fever supports the diagnosis of ileoileal intussusception.


Assuntos
Doenças do Íleo/epidemiologia , Intussuscepção/epidemiologia , Abdome/diagnóstico por imagem , Pré-Escolar , Feminino , Febre/epidemiologia , Hospitais Pediátricos , Humanos , Doenças do Íleo/diagnóstico , Lactente , Obstrução Intestinal/epidemiologia , Intestino Grosso/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Intussuscepção/diagnóstico , Masculino , Prevalência , Estudos Retrospectivos , Atenção Terciária à Saúde , Ultrassonografia
9.
Medicine (Baltimore) ; 98(44): e17783, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689848

RESUMO

RATIONALE: Postoperative intussusception in adults is a rare but serious complication after gastrointestinal anastomosis surgery. Postoperative intussusception in adults caused by tube feeding was rarely been reported before. The aim of the current study was to summarize the clinical data on a group of patients with tube feeding associated postoperative intussusceptions. The possible etiology and preventive measures will also be discussed. PATIENT CONCERNS: During the period from May 2013 to January 2018, patients who received gastrointestinal anastomosis in our center were retrospectively reviewed. Preoperative variables including standard demographic and pathological characteristics as well as the treatment and prognosis were also analyzed. DIAGNOSES: Tube feeding associated postoperative intussusceptions. INTERVENTIONS: 7 patients were identified with tube feeding associated postoperative intussusceptions with a prevalence of 0.38%. Intussusceptions occurred from 10 to 69 days (median 25.7 days) postoperatively in an acute form. OUTCOMES: None of the patients had spontaneous reduction and all patients underwent surgery. Antegrade efferent limb intussusceptions were found in all the cases. Intussusception occurred at efferent loop at 23.6 cm (range 15-60) from the gastrointestinal or Braun anastomosis. None of the patients was found recurrence throughout the follow-up period. LESSONS: In contrast with other postoperative intussusceptions, the tube feeding associated postoperative intussusceptions have special clinical manifestations. It is more likely to occur in early period of time after the surgery and in an acute form. Surgical correction is recommended for most of patients. Several measures have been proposed to prevent such complications after gastrointestinal surgery, however more research and information are still needed.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Nutrição Enteral/efeitos adversos , Enteropatias/epidemiologia , Intussuscepção/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Enteropatias/etiologia , Intussuscepção/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Prevalência , Estudos Retrospectivos
10.
Pan Afr Med J ; 33: 113, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489091

RESUMO

Meckel's diverticulum (MD) is a remnant of omphalomesenteric channel. It is often asymptomatic but it can be responsible for various clinical complications and variable clinical status especially in children. We conducted a retrospective study on complications of MD among children hospitalized in the division of Paediatric Surgery at the University Hospital Hassan II, Fez, Morocco. The study aimed to describe the clinical, radiological and therapeutic features of MD. The study was conducted over a period of 10 years (January 2009 - December 2018) and involved 18 children (15 boys and 3 girls) aged 1 day - 15 years (with an average age of 5 years) who had undergone surgery for complications of MD. Acute intussusception and intestinal occlusion were the most frequent complications. Other complications included: infection of the MD (1 case) and digestive hemorrhage (2 cases). Two rare types of neonatal Meckel's diverticulum were described (neonatal occlusion and fistula associated with omphalocele). In no case, abdominal X-ray without treatment, ultrasound and CT scan showed MD. Scintigraphy was performed in 2 patients with hematochezia and it helped to make the diagnosis of MD in one case. Three patients underwent laparoscopic surgery with resection of the MD and intestinal anastomosis with laparoscopy. The other patients underwent laparotomy. Ileostomy was performed in one case, followed by secondary recovery. Patient's outcome was good, except for one case of anastomotic leakage. Anatomopathological examination showed two cases of heterotopia.


Assuntos
Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/métodos , Divertículo Ileal/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Lactente , Recém-Nascido , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intussuscepção/epidemiologia , Intussuscepção/etiologia , Intussuscepção/cirurgia , Laparotomia/métodos , Masculino , Divertículo Ileal/diagnóstico , Divertículo Ileal/cirurgia , Marrocos , Estudos Retrospectivos
11.
Arab J Gastroenterol ; 20(2): 69-73, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155426

RESUMO

BACKGROUND AND STUDY AIMS: Intussusception is a life-threatening illness, with incompletely understood aetiology, although some predisposing factors are known. Intussusception frequently occurs in well-nourished chubby infants. We aimed to determine whether patients presenting with intussusception have a high prevalence of obesity. PATIENTS AND METHODS: This cross sectional study was conducted in 100 infants presenting with intussusception aged ≤2 years at the Paediatric Surgery Department. Anthropometric measures, history of recent upper respiratory tract infection, timing and type of intervention were recorded. A near median split divided the population into younger (aged < 8 months, N = 47) and older (8-24 months, N = 53) groups. Obesity was defined as having a body weight for length ≥ 97.7th centile on WHO growth charts. RESULTS: The study comprised 58 boys and 42 girls, 31% of whom had upper respiratory infection in the preceding month. Obesity was present in 18% of patients, based on WHO growth charts. There was a trend towards higher percentage of obese infants within the younger (25%) compared to older age groups (12%, P = 0.085), but no gender difference. Obesity did not influence the rate of success of hydrostatic reduction. Based on Egypt-specific growth charts, the percentage of infants with a weight-for-age centile ≥ 85th was 42%, of whom 7% were ≥ 97.7th centile. The corresponding percentages for the weight-for-length were 29% and 15% of patients respectively. CONCLUSION: There is a high prevalence of obesity in infants presenting with intussusception, particularly under 8 months of age. The mechanistic link between obesity and the pathogenesis of intussusception deserves investigation.


Assuntos
Intussuscepção/epidemiologia , Obesidade/epidemiologia , Fatores Etários , Estatura , Peso Corporal , Comorbidade , Estudos Transversais , Egito/epidemiologia , Feminino , Gráficos de Crescimento , Humanos , Lactente , Intussuscepção/terapia , Masculino , Prevalência
12.
Int J Epidemiol ; 48(4): 1316-1326, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30879038

RESUMO

BACKGROUND: In some countries that have introduced oral rotavirus vaccines, a small but elevated risk of intussusception-a rare bowel disorder-has been reported. Updated estimates on the global epidemiology of intussusception are needed to help predict the potential number of intussusception cases that could be caused by the vaccine in different settings. METHODS: We estimated incidence rates, age distributions and case-fatality ratios (CFRs) for intussusception hospital admissions among children aged <5 years, before the introduction of rotavirus vaccines. We included all articles identified in a systematic review between January 2002 and January 2018, and contacted authors for more granular unpublished data on age distributions. RESULTS: We identified 128 articles containing 227 country datasets (61 age distributions, 71 incidence rates and 95 CFRs). The median age of intussusception ranged from 29 weeks in Africa (83% of cases in the first year of life) to 70 weeks in the Western Pacific region (35% of cases in the first year of life). The median (range) annual incidence of intussusception hospital admissions per 100 000 aged <1 year ranged from 34 (13-56) in Africa to 90 (9-380) in the Western Pacific region. We found extreme differences between the CFRs in Africa (1 death in every 10 hospital admissions) and the rest of the world (fewer than 1 death in every 100-2000 hospital admissions). CONCLUSION: Intussusception epidemiology varies by country and region. Understanding and recognizing these differences will be important when assessing the potential number of intussusception cases associated with rotavirus vaccines.


Assuntos
Intussuscepção/epidemiologia , Intussuscepção/etiologia , Vacinas contra Rotavirus/efeitos adversos , Distribuição por Idade , Pré-Escolar , Hospitalização , Humanos , Incidência , Lactente , Intussuscepção/mortalidade , Infecções por Rotavirus/prevenção & controle , Vacinação/métodos
13.
Indian Pediatr ; 56(1): 29-32, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30806357

RESUMO

OBJECTIVE: To analyze the association between the clinical presentation, clinical course, management and outcome in intussusception with emphasis on safety of saline hydrostatic reduction. METHODS: This retrospective study included 375 patients of intussusception diagnosed between March 2007 to February 2017. Symptoms at presentation, mode of reduction of intussusception and associated complications were recorded. RESULTS: 336 (89.6%) patients were aged below 3 years. Classical triad of abdominal pain, vomiting and red stools was present in 111 (29.6%) patients. While 64 (17.1 %) patients had spontaneous resolution, hydrostatic reduction and surgery cured 283 (75.5 %) and 28 (7.4 %) patients, respectively; overall recurrence rate was 13.1%. Among the patients who underwent operative reduction, blood in stools was present in 15 (53.6%) patients. CONCLUSIONS: Hydrostatic reduction of intussusception is effective irrespective of duration of symptoms and number of recurrences.


Assuntos
Intussuscepção , Dor Abdominal , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Intussuscepção/diagnóstico , Intussuscepção/epidemiologia , Intussuscepção/terapia , Masculino , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Vômito
14.
BMJ Open ; 9(1): e024712, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30782741

RESUMO

OBJECTIVE: The aims of this study were to highlight some epidemiological aspects of intussusception cases younger than 48 months and to develop a forecasting model for the occurrence of intussusception in children younger than 48 months in Suzhou. DESIGN: A retrospective study of intussusception cases that occurred between January 2007 and December 2017. SETTING: Retrospective chart reviews of intussusception paediatric patients in a large Children's hospital in South-East China were performed. PARTICIPANTS: The hospital records of 13 887 intussusception cases in patients younger than 48 months were included in this study. INTERVENTIONS: The modelling process was conducted using the appropriate module in SPSS V.23.0. METHODS: The Box-Jenkins approach was used to fit a seasonal autoregressive integrated moving average (ARIMA) model to the monthly recorded intussusception cases in patients younger than 48 months in Suzhou from 2007 to 2016. RESULTS: Epidemiological analysis revealed that intussusception younger than 48 months was reported continuously throughout the year, with peaks in the late spring and early summer months. The most affected age group was younger than 36 months. The time-series analysis showed that an ARIMA (1,0,1 1,1,1)12 model offered the best fit for surveillance data of intussusception younger than 48 months. This model was used to predict intussusception younger than 48 months for the year 2017, and the fitted data showed considerable agreement with the actual data. CONCLUSION: ARIMA models are useful for monitoring intussusception in patients younger than 48 months and provide an estimate of the variability to be expected in future cases in Suzhou. The models are helpful for predicting intussusception cases in Suzhou and could be useful for developing early warning systems. They may also play a key role in early detection, timely treatment and prevention of serious complications in cases of intussusception.


Assuntos
Intussuscepção/epidemiologia , Modelos Estatísticos , Estações do Ano , Pré-Escolar , China/epidemiologia , Feminino , Previsões , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
15.
Clin Rheumatol ; 38(6): 1707-1714, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30734116

RESUMO

OBJECTIVES: Henoch-Schönlein purpura (HSP) is the most common vasculitis of children. The aim of this study is to evaluate the demographic and clinic findings of patients with HSP and also to determine predictive factors for assessing the development of gastrointestinal system (GIS) and renal involvement. METHODS: This study was performed prospectively among children with HSP who are under 18 years of age and being followed-up in the Pediatric Rheumatology Unit of Health Sciences University Kanuni Sultan Süleyman Training and Research Hospital between January 2016 and January 2018. RESULTS: A total of 265 patients, 137 boys (51.7%) and 128 girls (48.3%), were involved to the study. The mean ± standard deviation of age at the diagnosis was 7.5 ± 3.2. The most common disease onset season was spring (31.7%). The rate of arthritis, GIS involvement, and renal involvement were 54%, 51.3%, and 29.1%, respectively. GIS bleeding was more frequent in males than females (p = 0.007). Boys over 7 years of age had significantly more common GIS bleeding (p = 0.04). Intussusception, relapse, and serious GIS involvement requiring hospitalization and steroid treatment were highly associated with severe renal involvement. CONCLUSIONS: We demonstrated that patients suffering intussusception, relapse, and serious GIS involvement or requiring hospitalization and steroid treatment had tendency to present with severe renal involvement. Therefore, these patients should be followed up carefully for not overlooking renal involvement of HSP.


Assuntos
Hemorragia Gastrointestinal/epidemiologia , Intussuscepção/epidemiologia , Nefropatias/epidemiologia , Púrpura de Schoenlein-Henoch/complicações , Púrpura de Schoenlein-Henoch/terapia , Dor Abdominal/etiologia , Artrite/epidemiologia , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Masculino , Estudos Prospectivos , Recidiva , Esteroides/uso terapêutico , Turquia
16.
Pediatr Emerg Care ; 35(8): 533-538, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28146013

RESUMO

OBJECTIVES: The aim of this study was to evaluate the effects of a practice guideline of postreduction management of intussusception in children on the length of stay (LOS) from reduction in the pediatric emergency department (PED) and on the incidence of recurrence. METHODS: We developed a practice guideline of postreduction management of intussusception in the PED. The practice guideline involved feeding 2 hours after reduction and discharge 2 hours after successful feeding. The guideline was implemented on October 1, 2012. Retrospective quasi-experimental study was conducted for evaluation of the difference in LOS in the PED after reduction of intussusceptions, and the recurrence rate of intussusceptions between the preimplementation and postimplementation periods. Piecewise regression was performed to determine the differences between groups. RESULTS: In total, 45 and 52 patients were included in the preimplementation and postimplementation periods, respectively. The median LOS in the postimplementation period was significantly shorter than that in the preimplementation period (289 vs 532 minutes, respectively; P = 0.001). The slope of the LOS changed from 0.68 to -0.29. The slope decreased by 0.97 after practice guideline implementation. This difference was not statistically significant (P = 0.123), but it changed from a positive to negative gradient. The recurrence rate was not significantly different between the 2 periods (P = 0.605). CONCLUSIONS: Implementation of a practice guideline involving early feeding and discharge after reduction of intussusception resulted in a reduced LOS from reduction of intussusception in the PED and was not associated with recurrence of intussusception.


Assuntos
Intussuscepção/epidemiologia , Intussuscepção/terapia , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Adolescente , Adulto , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Incidência , Tempo de Internação/tendências , Masculino , Alta do Paciente/tendências , Guias de Prática Clínica como Assunto , Recidiva , Estudos Retrospectivos , Adulto Jovem
17.
Pediatr Emerg Care ; 35(10): 684-686, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28742637

RESUMO

OBJECTIVES: Intussusception is the most common abdominal emergency in pediatric patients aged 6 months to 3 years. There is often a delay in diagnosis, as the presentation can be confused for viral gastroenteritis. Given this scenario, we questioned the practice of performing emergency reductions in children during the night when minimal support staff are available. Pneumatic reduction is not a benign procedure, with the most significant risk being bowel perforation. We performed this analysis to determine whether it would be safe to delay reduction in these patients until normal working hours when more support staff are available. METHODS: We performed a retrospective review of intussusceptions occurring between January 2010 and May 2015 at 2 tertiary care institutions. The medical record for each patient was evaluated for age at presentation, sex, time of presentation to clinician or the emergency department, and time to reduction. The outcomes of attempted reduction were documented, as well as time to surgery and surgical findings in applicable cases. A Wilcoxon rank test was used to compare the median time with nonsurgical intervention among those who did not undergo surgery to the median time to nonsurgical intervention among those who ultimately underwent surgery for reduction. Multivariable logistic regression was used to test the association between surgical intervention and time to nonsurgical reduction, adjusting for the age of patients. RESULTS: The median time to nonsurgical intervention was higher among patients who ultimately underwent surgery than among those who did not require surgery (17.9 vs 7.0 hours; P < 0.0001). The time to nonsurgical intervention was positively associated with a higher probability of surgical intervention (P = 0.002). CONCLUSIONS: Intussusception should continue to be considered an emergency, with nonsurgical reduction attempted promptly as standard of care.


Assuntos
Dor Abdominal/etiologia , Serviço Hospitalar de Emergência/normas , Gastroenterite/diagnóstico , Perfuração Intestinal/etiologia , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Dor Abdominal/diagnóstico , Pré-Escolar , Diagnóstico Tardio , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fluoroscopia/métodos , Gastroenterite/virologia , Humanos , Lactente , Obstrução Intestinal/etiologia , Perfuração Intestinal/prevenção & controle , Intussuscepção/complicações , Intussuscepção/epidemiologia , Masculino , Pneumorradiografia/métodos , Estudos Retrospectivos , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento , Ultrassonografia
18.
Pediatr Surg Int ; 35(3): 373-381, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30478702

RESUMO

PURPOSE: Intussusception has been associated with rotavirus vaccine. The rotavirus vaccine will soon be introduced in the Swedish national immunization program. A validation of the diagnosis of intussusception among Swedish children in the Swedish National Patient Register is needed, as a basis for future vaccine safety surveillance by Swedish registers. METHODS: This diagnostic study reviewed the medical admission records of 392 Swedish children with intussusception from 1987 to 2013. The records were randomly selected by The National Board of Health and Welfare from all Sweden and from both pediatric and pediatric surgery care. Positive predictive values (PPV) were calculated to study the concordance between the diagnosis coded in the Swedish Patient Register and the accepted international criteria of case definitions. RESULTS: The PPV for a definitive diagnosis, based on certain radiology findings or surgery, was 84%. When clinically probable cases were added the PPV was 87%. When cases of possible intussusception were added the PPV was 89%. The PPV for the 240 children under 1 year was 88%. CONCLUSION: Swedish health care registers can be used in the evaluation of incidences of intussusception when rotavirus vaccine will be introduced, due to a high validity of the diagnosis of intussusception in the registers.


Assuntos
Intussuscepção/diagnóstico , Radiografia Abdominal/métodos , Sistema de Registros , Criança , Pré-Escolar , Feminino , Hospitalização/tendências , Humanos , Incidência , Lactente , Intussuscepção/epidemiologia , Masculino , Estudos Retrospectivos , Suécia/epidemiologia
19.
Expert Rev Vaccines ; 17(12): 1135-1141, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30407079

RESUMO

BACKGROUND: Intussusception represents the most common cause of abdominal emergency among young children but nearly 75% of cases are still considered idiopathic. RESEARCH DESIGN AND METHODS: A case-control study was conducted among Sicilian children aged 0-59 months with a hospital admission for intussusception between 2009 and 2015 to identify factors associated with intussusception onset. RESULTS: Overall, 125 cases and 190 controls were recruited for the study. Birth order (OR 1.49, 95%CI: 1.10, 2.02, P = 0.02) and having had gastroenteritis or having taken antibiotics during the 30 days prior to hospitalization (OR 11.55, 95%CI: 3.23, 41.23, P < 0.001; 3.09, 95%CI: 1.17, 8.12, P = 0.009, respectively) were significantly associated with intussusception. On the other hand, exclusive breastfeeding for at least two months was a protective factor (OR 0.48, 95%CI: 0.23, 0.99, P = 0.009). Anti-rotavirus vaccination did not correlate with risk of intussusception (OR 0.96, 95% CI: 0.41, 2.25, P = 0.92). CONCLUSIONS: These findings increase the awareness of intussusception among clinical and public health service providers to obtain a better susceptibility profile. Moreover, identifying children at higher risk of intussusception could be useful in vaccination counselling to intercept early symptoms and to reduce the number of serious cases.


Assuntos
Hospitalização/estatística & dados numéricos , Intussuscepção/epidemiologia , Vacinas contra Rotavirus/administração & dosagem , Antibacterianos/efeitos adversos , Ordem de Nascimento , Aleitamento Materno/estatística & dados numéricos , Estudos de Casos e Controles , Pré-Escolar , Feminino , Gastroenterite/complicações , Gastroenterite/epidemiologia , Humanos , Lactente , Recém-Nascido , Intussuscepção/etiologia , Masculino , Fatores de Proteção , Fatores de Risco , Vacinas contra Rotavirus/efeitos adversos , Sicília/epidemiologia
20.
Vaccine ; 36(50): 7593-7598, 2018 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-30414781

RESUMO

Intussusception is the invagination of one segment of the bowel into a distal segment, characterized by symptoms of bloody stool, vomiting, and abdominal pain. Previous studies have found regional differences in incidence but the etiology of most intussusception cases is unknown. Rotavirus vaccines were associated with a slightly of increased risk of intussusception in post-licensure evaluations in high- and middle-income countries, but not in low income African countries. To describe the baseline epidemiology of intussusception in young children prior to rotavirus vaccine implementation, active sentinel hospital surveillance for intussusception in children < 2 years of age was conducted in 4 low income Asian countries (Bangladesh, Nepal, Pakistan and Vietnam). Over a 24-month period, 15 sites enrolled 1,415 intussusception cases, of which 70% were enrolled in Vietnam. Overall, 61% of cases were male and 1% (n = 16) died, ranging from 8% in Pakistan to 0% in Vietnam. The median age of cases enrolled ranged from 6 months in Bangladesh and Pakistan to 12 months in Vietnam. The proportion of cases receiving surgical management was 100% in Bangladesh, 88% in Pakistan, 61% in Nepal, and 1% in Vietnam. The high proportion of males and median age of cases around 6 months of age found in this regional surveillance network are consistent with previous descriptions of the epidemiology of intussusception in these countries and elsewhere. Differences in management and the fatality rate of cases between the countries likely reflect differences in access to healthcare and availability of diagnostic modalities. These baseline data will be useful for post-rotavirus vaccine introduction safety monitoring.


Assuntos
Intussuscepção/epidemiologia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/efeitos adversos , Inquéritos e Questionários , Ásia , Monitoramento Epidemiológico , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Intussuscepção/mortalidade , Masculino , Vacinas contra Rotavirus/administração & dosagem , Análise de Sobrevida
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA