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IgA vasculitis associated with renal and joint findings in children and correlation between patient’s compliance in treatment: A case series IgA血管炎与儿童肾脏和关节表现相关以及患者治疗依从性之间的相关性:一系列病例
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.37897/rjp.2023.2.2
Ana-Maria Roxana Koller, Alexandra Man, C. Muntean
Objectives. Evaluation and therapeutic management of pediatric patients having Henoch-Schönlein purpura with renal and joint involvement and the importance of their follow-up in preventing complications. Material and Methods: The present study follows cases of two patients, diagnosed with Henoch-Schönlein purpura, with different degrees of compliance, in which the therapeutic approach was determined by the severity of the patient’s conditions. Outcomes. Two male children with Henoch-Schönlein purpura, aged 11 and 9, shared the same clinical features, including skin lesions and joint involvement. The first case may be distinguished from the second one, due to renal injury, a significantly worsen general condition, more widespread purpura, and lower treatment conformity. Laboratory analyses revealed elevated D-Dimers between inflammatory markers, therefore corticotherapy and anticoagulants were initiated. Under the prescribed treatment, both children’s shapes improved, but the first one decided to be discharged on request before being fully recovered. Conclusions. In addition to symptomatic treatment, leisure, corticotherapy administration, and monitoring levels in blood pressure and renal function, patient compliance is highly important related to the prevention of chronic kidney disease at a later stage.
目标。儿童过敏性紫癜合并肾脏和关节受累患者的评估和治疗管理,以及随访对预防并发症的重要性。材料和方法:本研究随访了两例诊断为过敏性紫癜的患者,他们有不同程度的依从性,其中治疗方法由患者病情的严重程度决定。结果。两名患有过敏性紫癜的男性儿童,年龄分别为11岁和9岁,具有相同的临床特征,包括皮肤病变和关节受累。第一种情况可能与第二种情况不同,因为肾损伤、一般情况明显恶化、紫癜更广泛、治疗依从性较低。实验室分析显示,炎症标志物之间的D-二聚体升高,因此开始使用皮质类固醇治疗和抗凝剂。在规定的治疗下,两个孩子的体型都有所改善,但第一个孩子决定在完全康复前应要求出院。结论。除了症状治疗、休闲、皮质类固醇治疗以及监测血压和肾功能水平外,患者的依从性与后期慢性肾脏疾病的预防非常重要。
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引用次数: 0
Acute encephalopathy bilirubin in the first week of life: A case of G6PD-deficient neonate 出生后第一周急性脑病胆红素:一例G6PD缺陷新生儿
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.37897/rjp.2023.2.3
Debbie Rose Komala, Pricilia Gunawan Halim, A. Yunanto, Pudji Andayani
Background. Acute bilirubin encephalopathy is an acute neurological manifestation due to indirect bilirubin deposits in the basal ganglia and brainstem nuclei. In several developed countries, the incidence reaches 0.6-2.5 cases/100,000 births, while a recent study in 8 hospitals in Indonesia showed an incidence rate of 2%. In this paper, we describe an acute bilirubin encephalopathy in a neonate with G6PD deficiency. Case Presentation. A 5-day-old male neonate was admitted to the ER with recurrent generalized tonic seizures which started 6 hours prior to admission. Post seizure, the neonate cried then fell asleep. He had seemed less active and did not want to breastfeed for the last 12 hours. The neonate was born at full term (3160 grams) by a spontaneous vaginal delivery in the hospital, APGAR score 7/9, mother blood type AB+. He was exclusively breastfed with adequate intake. Physically examined, the neonate was lethargic with flat anterior fontanelle, Kramer V jaundice, fever, hypertonia, decreased sucking reflex, physiologic reflexes +2/+2, Babinski +/+, without cranial nerve paresis. Laboratory results of total bilirubin 44.79 mg/dL (indirect 43.04 mg/dL; direct 1.75 mg/dL), Hb 14.2 g/dL, WBC 15,000/μL, reticulocytes 124,500/μL, negative Coombs’s test, blood type A+, peripheral blood morphology within normal limits. The neonate was planned for exchange transfusion, intensive (triple) phototherapy was performed while waiting for the exchange transfusion. Bilirubin levels fell significantly within 12 hours after phototherapy initiation. Phototherapy was continued, the neonate was discharged on the seventh day of hospitalization in good condition. During treatment, etiology tracking was performed towards G6PD (G6PD level: 6.6 U/dL). Conclusion. Acute bilirubin encephalopathy is a rare morbidity found in newborns. ABE that occurs in the first week of life, prompt further investigations other than physiologic jaundice. Most frequent etiologies are ABO incompatibility, G6PD deficiency, sepsis and hereditary spherocytosis. In this case, we found G6PD as the cause of acute bilirubin encephalopathy in the first week of life.
背景急性胆红素脑病是由基底节和脑干细胞核中的间接胆红素沉积引起的一种急性神经系统表现。在几个发达国家,发病率达到0.6-2.5例/10万新生儿,而最近在印度尼西亚8家医院进行的一项研究显示,发病率为2%。在本文中,我们描述了一例G6PD缺乏症新生儿的急性胆红素脑病。案例介绍。一名5天大的男性新生儿因在入院前6小时开始的复发性全身强直性癫痫发作而被送入急诊室。癫痫发作后,新生儿哭了,然后睡着了。在过去的12个小时里,他似乎没有那么活跃,也不想母乳喂养。新生儿在医院自然阴道分娩,足月出生(3160克),APGAR评分7/9,母亲血型AB+。他完全是母乳喂养,摄入量充足。经体格检查,新生儿嗜睡,前囟门平坦,Kramer V型黄疸,发烧,强直,吮吸反射减弱,生理反射+2/+2,Babinski+/+,无脑神经麻痹。总胆红素44.79 mg/dL(间接43.04 mg/dL;直接1.75 mg/dL)、Hb 14.2 g/dL、WBC 15000/μL、网织红细胞124500/μL的实验室结果,Coombs试验阴性,血型A+,外周血形态在正常范围内。新生儿计划进行换血,在等待换血时进行强化(三重)光疗。光疗开始后12小时内胆红素水平显著下降。继续进行光疗,新生儿在住院第七天出院,情况良好。治疗期间,对G6PD(G6PD水平:6.6 U/dL)进行病因追踪。结论急性胆红素脑病是一种罕见的新生儿发病率。ABE发生在生命的第一周,除了生理性黄疸外,还需要进一步的研究。最常见的病因是ABO血型不合、G6PD缺乏、败血症和遗传性球细胞增多症。在这种情况下,我们发现G6PD是生命第一周急性胆红素脑病的原因。
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引用次数: 0
LGI1 and CASPR2-related Morvan syndrome - diagnostic challenges in a pediatric case LGI1和caspr2相关的Morvan综合征——儿科病例的诊断挑战
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.37897/rjp.2023.2.5
Elena Catalina Petrov, Diana Anamaria Epure, Oana Aurelia Vladacenco, Daniela Dorina Vasile, Maria Lupu, Eugenia Roza, Raluca Ioana Teleanu
Morvan syndrome is a rare immune-mediated pathology involving the central, peripheral and autonomic nervous systems. Although it was described in adults, mostly as a paraneoplastic syndrome, it is rarely seen in pediatric patients. In this report, we present the case of a 15-year-old male patient who experienced insomnia, peripheral nerve hyperexcitability and autonomic signs, highly suggestive for Morvan syndrome, but prone to diagnostic dilemmas as well. The diagnosis was confirmed by the presence of antibodies against voltage-gated potassium channels (VGKC). This article aims to highlight the unique clinical picture of a rare syndrome, diagnostic pitfalls and treatment options in pediatric patients.
Morvan综合征是一种罕见的免疫介导的病理涉及中枢,外周和自主神经系统。虽然它在成人中被描述为一种副肿瘤综合征,但在儿科患者中很少见到。在本报告中,我们报告了一名15岁的男性患者,他经历了失眠,周围神经亢奋和自主神经体征,高度提示Morvan综合征,但也容易诊断困境。诊断被证实存在抗电压门控钾通道(VGKC)的抗体。这篇文章的目的是强调一个罕见的综合征,诊断陷阱和治疗方案的儿科患者独特的临床图片。
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引用次数: 0
Pediatric Meckel’s diverticulum: Experience from a tertiary center in Eastern India 儿科梅克尔憩室:来自印度东部三级医疗中心的经验
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.37897/rjp.2023.2.6
Debashree Priyadarshini, O.Y. Pavan K Reddy, Rachita Sarangi, Antaryami Pradhan
Background. Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, having a varied clinical presentation in the pediatric age group. It can manifest with life-threatening complications when symptomatic. However, very few studies have been reported from Eastern India. In this study, we aim to analyze the demographics, clinical presentation, associated characteristics, laboratory and histopathological features, various modalities of diagnosis, and treatment for pediatric Meckel’s diverticulum. Results. 18 children were diagnosed with Meckel’s diverticulum. Children below five years of age accounted for the majority of cases, with almost 50% presenting before age two. A male predominance was seen in the study with a male-to-female ratio of 4:1. The presentation was usually acute with lower gastrointestinal bleeding being the most common symptom in our study. Open diverticulectomy was the most common surgical procedure performed. MD was found on the mesenteric surface of the distal ileum in two cases. Simultaneous endo colon (upper GI endoscopy & colonoscopy) followed by laparoscopic surgery was done in a single setup in two actively bleeding cases with negative Meckel’s scan. There was no mortality, and no complications were noted on follow-up. Conclusion. MD had an acute presentation with lower GI bleeding being the commonest presenting symptom. It can be found on the mesenteric surface of the distal ileum. Open diverticulectomy was the treatment of choice for symptomatic patients. Surgical removal of incidentally detected MD was not associated with adverse outcomes.
背景。梅克尔憩室(MD)是最常见的胃肠道先天性异常,在儿童年龄组有不同的临床表现。出现症状时可出现危及生命的并发症。然而,很少有来自东印度的研究报告。在本研究中,我们旨在分析儿童梅克尔憩室的人口学特征、临床表现、相关特征、实验室和组织病理学特征、各种诊断方式和治疗方法。结果:18例患儿被诊断为梅克尔憩室。5岁以下儿童占大多数病例,近50%在2岁之前出现。在研究中,男性占主导地位,男女比例为4:1。表现通常是急性的,下消化道出血是我们研究中最常见的症状。开腹憩室切除术是最常见的手术方式。2例在回肠远端肠系膜表面发现MD。同步结肠内腔内镜(上消化道内镜)结肠镜检查),随后进行腹腔镜手术,在一个单一的设置在两个活跃出血病例阴性梅克尔扫描。随访无死亡,无并发症发生。结论。MD有急性表现,下消化道出血是最常见的表现症状。它可以在回肠远端肠系膜表面发现。开放性憩室切除术是有症状患者的首选治疗方法。手术切除偶然发现的MD与不良后果无关。
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引用次数: 0
Children would taste anything: foreign body ingestion – a multidisciplinary perspective and clinical practice algorithm 儿童会尝到任何东西:异物摄入-多学科视角和临床实践算法
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.37897/rjp.2023.2.4
Raluca Maria Vlad, Ruxandra Dobritoiu, Irina Gabriela Ionita, Miorita Toader
Foreign body ingestion is a frequent issue among the pediatric population, children under 4 years old being at high risk. The authors reviewed the literature considering the importance of a quick diagnosis and prompt distinction between various types of foreign bodies, thus resulting in the best therapeutic approach. The most common foreign bodies ingested are cited to be coins, button batteries, magnets and food bits. As for therapeutic approaches, references don’t place upper endoscopy as key curative method, in some cases outpatient follow-up is a better choice. Foreign body ingestion complications are usually rare, but sometimes life threatening (coins generate aorto-esophageal fistulas, fish bones cause intestinal perforation, magnets lead to intestinal obstructions and erosions). After carefully consulting the latest guidelines regarding management of foreign body ingestion, we put together an instructive diagram outlining curative procedures in these cases. This review summarizes diagnostic and therapeutic methods for the most common swallowed objects and provides a brief, concise, easy to use clinical practice algorithm, thus giving clinicians an excellent tool to manage these cases.
异物摄入是儿科人群中常见的问题,4岁以下儿童是高危人群。作者回顾了文献,考虑到快速诊断和迅速区分各种类型的异物的重要性,从而产生最佳的治疗方法。最常见的异物被认为是硬币、纽扣电池、磁铁和食物碎片。至于治疗方式,文献并未将上内镜作为主要治疗方法,部分病例门诊随访是更好的选择。异物摄入并发症通常很少见,但有时会危及生命(硬币会导致主动脉-食管瘘,鱼骨会导致肠道穿孔,磁铁会导致肠道阻塞和侵蚀)。在仔细查阅了有关异物摄入管理的最新指南后,我们整理了一个指导性的图表,概述了这些病例的治疗程序。本文综述了最常见的吞咽物的诊断和治疗方法,并提供了一个简短、简洁、易于使用的临床实践算法,从而为临床医生管理这些病例提供了一个很好的工具。
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引用次数: 0
Comprehensive review of EEG data classification techniques for ADHD detection using machine learning and deep learning 利用机器学习和深度学习检测ADHD的脑电图数据分类技术综述
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.37897/rjp.2023.2.1
Nitin Ahire, R. Awale, Abhay Wagh
Children who have Attention-Deficit/Hyperactivity Disorder (ADHD) have a chronic behavioral disease. Children with ADHD have a hard time focusing and controlling their actions. One of the most difficult problems in controlling and treating this condition is early detection. There is yet to be discovered a reliable professional procedure for early detection of this condition. The electroencephalogram (EEG) is a useful neuroimaging technique for researching ADHD; one of the key goals is to define the EEG of ADHD youngsters. Numerous methods based on EEG signals have been put out in the literature to address this issue since they are an effective neuroimaging approach for studying ADHD. The best recording formats and channels for diagnosing ADHD, however, have not been the subject of many research. Machine learning (ML) and Artificial Intelligence (AI) strategies for identifying ADHD using EEG-based tools are discussed in this paper. Although, in the case of ADHD, the utilization of ML and AI approaches is restricted. However, the data clearly imply that combining EEG technologies with ML/AI may be utilized to detect ADHD. For categorizing adult ADHD subtypes based on EEG power spectra, ML algorithms that incorporate several classifiers are presented. A widely used deep learning (DL) method is the convolutional neural network (CNN). The use of DL approaches in ADHD research, on the other hand, is currently restricted. EEG has been used in studies to look for ADHD neurological connections. Recent advances in deep learning algorithms, particularly CNN, are anticipated to overcome the issue.
患有注意力缺陷/多动障碍(ADHD)的儿童患有慢性行为疾病。患有多动症的儿童很难集中注意力和控制自己的行为。控制和治疗这种疾病最困难的问题之一是早期发现。目前还没有发现一种可靠的专业程序来早期发现这种情况。脑电图(EEG)是研究多动症的一种有用的神经成像技术;其中一个关键目标是定义ADHD青少年的脑电图。文献中已经提出了许多基于EEG信号的方法来解决这个问题,因为它们是研究ADHD的有效神经成像方法。然而,诊断多动症的最佳记录格式和渠道并不是许多研究的主题。本文讨论了使用基于脑电图的工具识别ADHD的机器学习(ML)和人工智能(AI)策略。尽管在多动症的情况下,ML和AI方法的使用受到限制。然而,这些数据清楚地表明,将脑电图技术与ML/AI相结合可以用于检测多动症。为了根据脑电图功率谱对成人ADHD亚型进行分类,提出了包含多个分类器的ML算法。一种广泛使用的深度学习(DL)方法是卷积神经网络(CNN)。另一方面,DL方法在ADHD研究中的使用目前受到限制。脑电图已被用于研究多动症的神经联系。深度学习算法的最新进展,特别是CNN,有望克服这一问题。
{"title":"Comprehensive review of EEG data classification techniques for ADHD detection using machine learning and deep learning","authors":"Nitin Ahire, R. Awale, Abhay Wagh","doi":"10.37897/rjp.2023.2.1","DOIUrl":"https://doi.org/10.37897/rjp.2023.2.1","url":null,"abstract":"Children who have Attention-Deficit/Hyperactivity Disorder (ADHD) have a chronic behavioral disease. Children with ADHD have a hard time focusing and controlling their actions. One of the most difficult problems in controlling and treating this condition is early detection. There is yet to be discovered a reliable professional procedure for early detection of this condition. The electroencephalogram (EEG) is a useful neuroimaging technique for researching ADHD; one of the key goals is to define the EEG of ADHD youngsters. Numerous methods based on EEG signals have been put out in the literature to address this issue since they are an effective neuroimaging approach for studying ADHD. The best recording formats and channels for diagnosing ADHD, however, have not been the subject of many research. Machine learning (ML) and Artificial Intelligence (AI) strategies for identifying ADHD using EEG-based tools are discussed in this paper. Although, in the case of ADHD, the utilization of ML and AI approaches is restricted. However, the data clearly imply that combining EEG technologies with ML/AI may be utilized to detect ADHD. For categorizing adult ADHD subtypes based on EEG power spectra, ML algorithms that incorporate several classifiers are presented. A widely used deep learning (DL) method is the convolutional neural network (CNN). The use of DL approaches in ADHD research, on the other hand, is currently restricted. EEG has been used in studies to look for ADHD neurological connections. Recent advances in deep learning algorithms, particularly CNN, are anticipated to overcome the issue.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47999761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical-evolutionary considerations in Duchenne Dystrophy 杜氏营养不良症的临床-进化考虑
Q4 Medicine Pub Date : 2023-03-31 DOI: 10.37897/rjp.2023.1.1
C. Singer, S. Coşoveanu, I. Petrescu, M. Singer, A. Dobrescu, M. Popescu, A. Popescu
Duchenne muscular dystrophy (DMD) is a severe, progressive and incurable X-linked genetic disorder. The article presents 18 children with DMD admitted between 2016-2022 in the Pediatric Clinic II, Emergency County Hospital in Craiova. The study looked at: the distribution according to residence, the average age when they walked, when they were diagnosed and when they walked in a wheelchair, heredocollateral and pathological antecedents, clinical manifestations, nutritional status, genetic tests and the evolution of these patients.
杜兴肌营养不良(DMD)是一种严重的、进行性的、无法治愈的X连锁遗传病。这篇文章介绍了2016-2022年间在克雷奥瓦县急诊县医院第二儿科诊所收治的18名DMD儿童。这项研究着眼于:根据居住地的分布、他们走路时的平均年龄、被诊断时和坐在轮椅上走路时的年龄、先天性和病理性前因、临床表现、营养状况、基因测试和这些患者的进化。
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引用次数: 0
Diagnostic challenges in children with celiac disease. A five-year experience with new guidelines in a General Pediatrics Department 乳糜泻患儿的诊断挑战在普通儿科新指南的五年经验
Q4 Medicine Pub Date : 2023-03-31 DOI: 10.37897/rjp.2023.1.8
D. Pop, Radu Samuel Pop, C. Schnell, Valentina Tarau-Sas, Edita-Gabriela Ichim, P. Cherecheș-Panța, D. Iacob, D. Gheban, S. Man, D. Farcău
Background. The clinical characteristics of patients with celiac disease cover a wide range of signs and symptoms. Our study aimed to describe the main clinical features and investigations performed on our celiac patients diagnosed in the past five years. Material and methods. We collected data from medical records of patients aged 0 to 18 years diagnosed with celiac disease. We included in the analysis patients newly diagnosed with celiac disease, in our department, between January 2017 and August 2022. Results. In this period, 30 children were diagnosed with celiac disease in our general pediatrics department. The mean age at diagnosis ± standard deviation was 6.3±4.2 years (median age=4.3 years). The period between onset of symptoms ranged between 3 months to 5 years (median=6 months). Twenty children (66%) had features of classical celiac disease. Thirteen/30 patients (43.3%) were found to have iron deficiency anemia at diagnosis. In 23/30 (76%) of the children, the values of the IgA-TGA were more than 10 times the upper limit of the normal values. Nineteen children were diagnosed between 2017 and 2019. Fifteen of these 19 patients (79%) were diagnosed based on positive levels of antibodies and duodenal biopsy samples showing Marsh 2 or 3 features, and 4/19 (21%) based on positive IgA-TGA and AEM and a genetic test showing HLA DQ2 and/or DQ8. Conclusions. Classical celiac disease remains the predominant phenotype in our patients. Adherence to new guidelines allowed in the past 2 years a diagnosis without histological examination of biopsy fragments in most of the patients.
背景。乳糜泻患者的临床特征包括广泛的体征和症状。我们的研究旨在描述过去五年中诊断为乳糜泻的患者的主要临床特征和调查。材料和方法。我们收集了0 - 18岁被诊断为乳糜泻的患者的医疗记录数据。我们纳入了2017年1月至2022年8月期间在我科新诊断为乳糜泻的患者。结果。在此期间,30名儿童在我们的普通儿科被诊断为乳糜泻。平均诊断年龄±标准差为6.3±4.2岁(中位年龄=4.3岁)。出现症状的时间间隔为3个月至5年(中位数=6个月)。20名儿童(66%)具有典型乳糜泻的特征。诊断时发现缺铁性贫血13 /30例(43.3%)。23/30(76%)患儿IgA-TGA值超过正常值上限10倍以上。2017年至2019年期间,有19名儿童被确诊。这19例患者中有15例(79%)是基于抗体阳性水平和十二指肠活检样本显示Marsh 2或3特征而诊断的,4/19(21%)是基于IgA-TGA和AEM阳性以及HLA DQ2和/或DQ8基因检测而诊断的。结论。经典乳糜泻仍然是我们患者的主要表型。在过去的两年中,新指南允许大多数患者在没有活检碎片的组织学检查的情况下进行诊断。
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引用次数: 0
The utility of leukergy test in gastroenteritis with Campylobacter in children 白血病试验在儿童弯曲杆菌性肠胃炎中的应用
Q4 Medicine Pub Date : 2023-03-31 DOI: 10.37897/rjp.2023.1.6
S. Vlaic, L. Ion, Ionela Alina Ganta, S. Diaconescu, C. Tanase
Gastroenteritis with Campylobacter has proven in the last decade to be one of the most common causes of bacterial enteritis in children. Objectives. The objective of the current study was to highlight the usefulness of using the leukergy test, a test characterized by the aggregation capacity and increased adhesiveness of leukocytes in the case of bacterial infections, in order to establish as early as possible, the bacterial etiology of campylobacteriosis compared to the time it takes to gather other bacteriological evidence. Materials and methods. This paper was based on a single center prospective case-control study conducted between June 2020 and May 2021 at Ponderas Academic Hospital, which involved 45 children hospitalized with medium and severe forms of gastroenteritis with Campylobacter jejuni, and a control group of 40 children who are clinically and biologically healthy. The property of aggregation, adhesiveness of leukocytes in peripheral blood of the 85 children included in the research was studied using the leukergia test. The results of the leukergia test were subsequently compared with other acute phase reactants, collected from the same blood sample: total leukocyte count (WBCC), total neutrophil count (NEUT), C-reactive protein (CRP). Results. Sensitivity, Specificity and Positive Predictive Value had values of: 93.3%, 82.50%, 85.71% for leukergy (%); 93.3%, 85%, 87.5% for WBCC with normal values; 88.89%, 82.5%, 85.11% NEUT and 95.56%, 97.5%, 97.7% for CRP. Conclusions. The leukergy test is a good predictor in the early establishment of bacterial etiology in the case of gastroenteritis with Campylobacter jejuni, being a quick and effective test price quality ratio. The leukergy test can be of real help through the additional information that it brings also in medical centers that do not have advanced investigative capabilities.
弯曲杆菌引起的肠胃炎在过去十年中已被证明是儿童细菌性肠炎最常见的原因之一。目标。当前研究的目的是强调使用白细胞试验的有用性,该试验的特点是在细菌感染的情况下白细胞的聚集能力和黏附性增加,以便尽早确定弯曲杆菌病的细菌病因,而不是收集其他细菌学证据所需的时间。材料和方法。本论文基于2020年6月至2021年5月在庞德拉斯学术医院进行的一项单中心前瞻性病例对照研究,该研究涉及45名因中重度肠胃炎合并空肠弯曲杆菌住院的儿童,以及40名临床和生物学健康的儿童作为对照组。本文采用白斑试验对85例儿童外周血白细胞的聚集性、黏附性进行了研究。随后将白血病试验结果与从同一血样中收集的其他急性期反应物进行比较:白细胞总计数(WBCC)、中性粒细胞总计数(NEUT)、c反应蛋白(CRP)。结果。白血病的敏感性、特异性和阳性预测值分别为93.3%、82.50%、85.71% (%);WBCC正常值为93.3%、85%、87.5%;NEUT为88.89%、82.5%、85.11%,CRP为95.56%、97.5%、97.7%。结论。白细胞检测是一种快速有效的检测方法,能较好地预测空肠弯曲杆菌性肠胃炎细菌病因的早期确定。白血病测试可以通过它带来的额外信息提供真正的帮助,也可以为没有先进调查能力的医疗中心提供帮助。
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引用次数: 0
Socio-economic issues in the diagnostic approach and decision to treat of a child with familial cholestasis 家庭性胆汁淤积症患儿的诊断方法和治疗决策中的社会经济问题
Q4 Medicine Pub Date : 2023-03-31 DOI: 10.37897/rjp.2023.1.2
R. Vlad, Alexandra Coroleucă, Irina Dijmărescu, D. Păcurar
Objectives. The diagnostic approach in familial cholestasis cases involves using expensive investigations. The need for complex therapeutic resources is predictable. Material and methods. We present the case of a 3 years 5 months old boy diagnosed with cholestasis and liver cirrhosis, admitted in the Pediatrics Department of “Grigore Alexandrescu” Children’s Hospital for evaluation in order to check the criteria for liver transplantation. Outcomes. The patient is known to our clinic since he was 1 year 3 months; he was admitted at that time for green jaundice. He comes from a family with nine children, low socio-economic status and low education. The first four children have a different father, two of them were stillborn. The next five come from a consanguineous union (the father is maternal uncle of the mother): three (the patient included) presented with the same symptoms, two of them died before 3 years of age with liver cirrhosis. In time, infectious causes, autoimmune, neoplastic and metabolic disease were excluded. The liver biopsy describes cholestasis and fibrosis. Alagille syndrome and progressive familial intrahepatic cholestasis are still debated, but the genetic testing necessary for a positive diagnosis are not financially available to the family. The patient presents with failure to thrive, developmental delay, intense jaundice and pruritus, hippocratic fingers, dyspnea, enlarged abdomen with visible collateral circulation, significant hepatosplenomegaly. The lab tests show anemia, thrombocytopenia, liver cytolysis, normal gamma-glutamyl transferase, low prothrombin activity, normal renal function, no inflammatory syndrome, increased ammonia level, very high bile acids level. The upper endoscopy describes first degree esophageal varices and portal hypertensive gastropathy. A PELD (Pediatric End-Stage Liver Disease) score is calculated – 13.6 (76.3% one year survival rate on the transplant list, 90.9% one year survival rate after liver transplantation). The patient is enrolled on the transplant waiting list provided we would expect suboptimal results considering the developmental delay and difficult post-transplant monitoring. Conclusions. The low education level of the family correlated with a postponed positive diagnosis due to financial reasons and the lack of genetic advice already lead to the demise of four brothers. In this setting, the prognosis of the patient is very likely to be poor.
目标。家族性胆汁淤积症的诊断方法包括使用昂贵的调查。对复杂治疗资源的需求是可以预测的。材料和方法。我们报告了一例3岁5个月大的男孩,他被诊断为胆汁淤积症和肝硬化,入住“Grigore Alexandrescu”儿童医院儿科进行评估,以检查肝移植的标准。结果。该患者自1岁3个月起为我们诊所所知;当时他因绿色黄疸入院。他来自一个有九个孩子的家庭,社会经济地位低,教育程度低。前四个孩子有一个不同的父亲,其中两个是死胎。接下来的五个来自血缘结合(父亲是母亲的叔叔):三个(包括患者)出现了同样的症状,其中两个在3岁前死于肝硬化。随着时间的推移,传染病、自身免疫性疾病、肿瘤性疾病和代谢性疾病被排除在外。肝活检描述胆汁淤积和纤维化。Alagille综合征和进行性家族性肝内胆汁淤积症仍有争议,但阳性诊断所需的基因检测对该家族来说在经济上是不可用的。患者表现为发育不全、发育迟缓、强烈黄疸和瘙痒、希波克拉底手指、呼吸困难、腹部肿大伴可见侧支循环、明显肝脾肿大。实验室测试显示贫血、血小板减少、肝细胞溶解、γ-谷氨酰转移酶正常、凝血酶原活性低、肾功能正常、无炎症综合征、氨水平升高、胆汁酸水平极高。上内窥镜检查描述了一级食管静脉曲张和门脉高压性胃病。计算PELD(儿科终末期肝病)评分–13.6(移植名单上的一年生存率为76.3%,肝移植后的一年存活率为90.9%)。如果考虑到发育迟缓和移植后监测困难,我们预计会出现次优结果,则患者被列入移植等待名单。结论。这个家庭的低教育水平与由于经济原因和缺乏基因咨询而推迟的阳性诊断有关,这已经导致了四个兄弟的死亡。在这种情况下,患者的预后很可能很差。
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Revista Romana de Pediatrie
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