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Endoscopic Management of a Double Duodenal Web: A Case Report of a Rare Alimentary Anomaly. 内镜下治疗双十二指肠网:一例罕见的消化道异常。
IF 1.5 Pub Date : 2023-01-01 DOI: 10.1177/11795565231186895
Andrew Sundin, Carlos T Huerta, Jennifer Nguyen, Ann-Christina Brady, Anthony R Hogan, Eduardo A Perez

Duodenal webs are a rare clinical entity with the presentation of a double duodenal web being exceedingly uncommon. Management of duodenal webs traditionally involves duodenal web excision with duodenoduodenostomy, which is usually performed via a laparoscopic or an open approach. We report the case of a 6-month-old child who presented with progressively worsening bilious emesis with imaging findings concerning for a duodenal web. Endoscopic evaluation was performed that identified 2 webs in the fourth portion of the duodenum. These were managed completely endoscopically with balloon dilation. Although surgery is the mainstay of treatment of duodenal webs, this patient was successfully managed by endoscopic intervention without the need for open or laparoscopic excision, which has not been previously described for double duodenal webs. This work demonstrates the safety and efficacy of endoscopic management for infants with this anomaly.

十二指肠网是一种罕见的临床实体,双十二指肠网的表现是非常罕见的。传统上,十二指肠网的处理包括十二指肠网切除术和十二指肠吻合术,通常通过腹腔镜或开放方法进行。我们报告的情况下,一个6个月大的孩子谁提出了渐进式恶化胆汁呕吐与影像学发现有关的十二指肠网。内镜检查发现在十二指肠第四部分有2个腹膜。这些都是在内窥镜下用球囊扩张处理的。虽然手术是治疗十二指肠网的主要方法,但该患者通过内窥镜干预成功治疗,而无需开放或腹腔镜切除,这在以前的双十二指肠网治疗中尚未见报道。这项工作证明了内窥镜治疗婴儿这种异常的安全性和有效性。
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引用次数: 0
Gram-negative Late Onset Neonatal Sepsis in a Tertiary Care Center From Central India: A Retrospective Analysis. 革兰氏阴性迟发新生儿败血症在三级保健中心从印度中部:回顾性分析。
IF 1.5 Pub Date : 2023-01-01 DOI: 10.1177/11795565231189595
Akangksha Pataskar, Anuragsingh Chandel, Varsha Chauhan, Manish Jain

Background: Neonatal sepsis has been a major cause of neonatal mortality and morbidity globally. Late onset sepsis is on the rise mostly due to better health care services and improved survival of premature neonates. Gram-negative sepsis has emerged as a major public health problem constituting significant morbidity and mortality. There is limited data on gram-negative late onset sepsis from the central part of India, therefore this study was conducted at a tertiary care center from rural part of India.

Objectives: To determine the clinical profile and outcome among neonates with gram-negative late onset sepsis.

Design: It is a retrospective analysis conducted among neonates with gram-negative late onset sepsis at a tertiary care center from central India.

Methods: All neonates below 28 days of age suspected to have late onset sepsis were enrolled in the study. The data for the period of January 2019 to December 2021 was collected and analyzed using software SPSS version 29. The outcome variables studied were discharge (good outcome) and death (poor outcome).

Results: In the present study, overall prevalence of gram-negative late onset sepsis was 4.8%. Respiratory distress (52.2%), seizure (18.9%), jaundice (15.6%), and lethargy (15.6%) were common clinical symptoms among neonates with sepsis. The most common organism isolated was Klebsiella spp. (36.7%) followed by Acinetobacter spp. (31.1%) and E. coli (17.8%). Low gestational age (n = 20 vs n = 7, P = .002) and low birth weight (n = 33 vs n = 4, P = .02) were associated with poor outcomes in neonates with gram negative LOS. The overall mortality rate was found to be 30% among neonates with gram negative sepsis.

Conclusion: The prevalence of gram-negative sepsis was found to be 4.8%. Factors associated with poor outcome in gram-negative sepsis were low birth weight, and prematurity. Klebsiella spp. was found to be a common cause of gram-negative LOS, therefore, the empiric antibiotic policy must provide coverage against these micro-organisms.

背景:新生儿败血症已成为全球新生儿死亡和发病的主要原因。由于卫生保健服务的改善和早产儿存活率的提高,迟发性败血症正在上升。革兰氏阴性败血症已成为一个主要的公共卫生问题,造成了严重的发病率和死亡率。关于印度中部地区革兰氏阴性晚发败血症的数据有限,因此本研究是在印度农村地区的三级保健中心进行的。目的:探讨革兰氏阴性晚发型脓毒症新生儿的临床特点和预后。设计:对印度中部一家三级保健中心的革兰氏阴性迟发性败血症新生儿进行回顾性分析。方法:所有28日龄以下疑为晚发型脓毒症的新生儿均被纳入研究。收集2019年1月至2021年12月的数据,使用SPSS 29版软件进行分析。研究的结果变量为出院(好结果)和死亡(差结果)。结果:在本研究中,革兰氏阴性晚发型脓毒症的总体患病率为4.8%。呼吸窘迫(52.2%)、癫痫发作(18.9%)、黄疸(15.6%)和嗜睡(15.6%)是新生儿败血症的常见临床症状。检出最多的细菌是克雷伯氏菌(36.7%),其次是不动杆菌(31.1%)和大肠杆菌(17.8%)。低胎龄(n = 20 vs n = 7, P = 0.002)和低出生体重(n = 33 vs n = 4, P = 0.02)与革兰氏阴性LOS新生儿预后不良相关。发现革兰氏阴性脓毒症新生儿的总死亡率为30%。结论:革兰氏阴性脓毒症患病率为4.8%。与革兰氏阴性脓毒症预后不良相关的因素是低出生体重和早产。克雷伯氏杆菌被发现是革兰氏阴性LOS的常见原因,因此,经验性抗生素政策必须提供针对这些微生物的覆盖。
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引用次数: 0
Determinants of Adverse Birth Outcomes in Public Hospitals of the Somali Region, Eastern Ethiopia: A Multicenter Unmatched Case-Control Study. 埃塞俄比亚东部索马里地区公立医院不良分娩结局的决定因素:一项多中心不匹配病例对照研究
IF 1.5 Pub Date : 2023-01-01 DOI: 10.1177/11795565231195253
Abdurahman Kedir Roble, Raghu Gundappa, Fahima Sheik Abdirahman, Abdurehman Mohamed Abdi

Background: Pregnancy outcomes that differ from normal live births are known as adverse pregnancy outcomes. Adverse pregnancy outcomes also have significant effects on the infant's family and society. There is limited data on adverse outcomes in eastern Ethiopia, particularly in the Somali region.

Objectives: This study aimed to assess the determinants of adverse birth outcomes in the Somali Region Hospitals.

Design: A hospital-based unmatched case-control study was conducted to conduct this study.

Methods: A hospital-based unmatched case-control study was conducted between June and July 2021 in pregnant women who attended public hospitals in the Somali region. A total of 327 (109 cases and 218 controls) participants were included in this study. Women who gave birth with at least 1 adverse birth outcome were considered cases, and those who gave birth with normal birth outcomes were considered controls. Cases were recruited consecutively, and controls were selected using systematic sampling methods. Data was gathered using interviews, record reviews, using the pretested standard tools. The data were entered into EpiData version 3.1 and analyzed with SPSS version 22. Multivariable regression analysis with an adjusted odds ratio and a 95% confidence interval was used to identify the factors associated with adverse birth outcomes. Finally, P-values less than .05 were used to identify significantly associated predictors.

Results: In the current study, rural residency [AOR = 2.80; 95%CI:(1.61-4.87)] lack of ANC follow-up [AOR = 3.27; 95%CI: (1.77-6.02)], pregnancy-induced hypertension [AOR = 3.28; 95%CI: (1.74-6.17)] being anemic mothers [AOR = 3.51; 95%CI: (2.02-6.07)] and khat chewing [AOR = 4.54; 95%CI: (2.12-9.70)] were identified as determinants of adverse birth outcome.

Conclusions: In the current study, rural residency, lack of ANC, being anemic in indexed pregnancies, pregnancy-induced hypertension, and khat chewing were determinants of adverse birth outcomes. Therefore, efforts should be made to enhance ANC follow-up, iron and folic acid supplementation, early treatments of pregnancy-induced hypertension, and information on the risk of chewing khat.

背景:不同于正常活产的妊娠结局被称为不良妊娠结局。不良妊娠结局对婴儿的家庭和社会也有显著影响。关于埃塞俄比亚东部,特别是索马里地区的不良后果的数据有限。目的:本研究旨在评估索马里地区医院不良分娩结果的决定因素。设计:本研究采用医院为基础的非匹配病例对照研究。方法:在2021年6月至7月期间,在索马里地区公立医院就诊的孕妇中进行了一项基于医院的非匹配病例对照研究。本研究共纳入327名参与者(109例病例和218例对照组)。分娩时至少有一种不良结局的妇女被认为是病例,而正常分娩结局的妇女被认为是对照组。连续招募病例,采用系统抽样方法选取对照。数据是通过访谈、记录审查和预先测试的标准工具收集的。数据录入EpiData 3.1版本,使用SPSS 22版本进行分析。采用校正优势比和95%置信区间的多变量回归分析来确定与不良出生结局相关的因素。最后,使用小于0.05的p值来识别显著相关的预测因子。结果:本研究中,农村居民[AOR = 2.80;95%CI:(1.61-4.87)]缺乏ANC随访[AOR = 3.27;95%CI:(1.77 ~ 6.02)],妊娠高血压[AOR = 3.28;95%CI:(1.74-6.17)]为贫血母亲[AOR = 3.51;95%CI:(2.02-6.07)]和阿拉伯茶咀嚼[AOR = 4.54;95%CI:(2.12-9.70)]被确定为不良出生结局的决定因素。结论:在目前的研究中,农村居住、缺乏ANC、在索引妊娠中贫血、妊娠引起的高血压和咀嚼阿拉伯茶是不良出生结局的决定因素。因此,应努力加强ANC的随访,铁和叶酸的补充,妊娠高血压的早期治疗,以及咀嚼阿拉伯茶的风险信息。
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引用次数: 0
Hyperbilirubinemia and Associated Factors Among Neonates Admitted to the Neonatal Care Unit in Jimma Medical Center. 吉马医疗中心新生儿护理部收治的新生儿高胆红素血症及其相关因素
IF 1.5 Pub Date : 2023-01-01 DOI: 10.1177/11795565231193910
Sintayehu Asaye, Misgana Bekele, Aklilu Getachew, Diriba Fufa, Tesfaye Adugna, Edosa Tadese

Background: Neonatal hyperbilirubinemia is a widespread and significant clinical problem among neonates worldwide. Globally, every year about 1.1 million babies develop it and the vast majority reside in South Asia and sub-Saharan Africa. Studies on the magnitude and factors associated with neonatal hyperbilirubinemia are limited in Ethiopia. So this study was aimed at assessing the prevalence and associated factors of neonatal hyperbilirubinemia among hospitalized neonates in the neonatal intensive care unit of Jimma Medical Center (JMC), Jimma, South West Ethiopia.

Design: Hospital-based cross-sectional study was conducted at JMC from July 24 to October 19, 2020.

Methods: A total of 222 neonates with their mothers were included and conveniently selected. Data was collected by interviewing mothers through structured questionnaires and reviewing neonates' medical records using a checklist. Multivariable binary logistic regression analyses were employed to identify factors associated with neonatal hyperbilirubinemia.

Results: from a total of neo-maternal pairs included in the studies; the proportion of Neonatal hyperbilirubinemia was found to be 94 (42.3%). Neo-maternal ABO incompatibility 33 (35.1%), prematurity 41 (43.6%), sepsis 35 (37.2%), Neonatal birth asphyxia 20 (21.2%), and Rh isoimmunization 10 (10.6%) was significantly associated with neonatal hyperbilirubinemia.

Conclusion: The prevalence of neonatal hyperbilirubinemia in the study setting was high. Antenatal care (including both mother and fetus detail examination and follow-ups) as well as cautions during labor need to focus on since Neonatal hyperbilirubinemia-associated factors were maternal and neonatal. Hence, further assessment, early intervention, and timely treatment are important to mitigate the burdens in neonates due to hyperbilirubinemia.

背景:新生儿高胆红素血症是世界范围内新生儿普遍存在的重要临床问题。在全球范围内,每年约有110万婴儿患有这种疾病,其中绝大多数生活在南亚和撒哈拉以南非洲。在埃塞俄比亚,关于新生儿高胆红素血症的程度和相关因素的研究是有限的。因此,本研究旨在评估埃塞俄比亚西南部吉马医疗中心(JMC)新生儿重症监护病房住院新生儿高胆红素血症的患病率及其相关因素。设计:以医院为基础的横断面研究于2020年7月24日至10月19日在JMC进行。方法:随机抽取222例新生儿及其母亲。通过结构化问卷采访母亲,并使用检查表查看新生儿的医疗记录来收集数据。采用多变量二元logistic回归分析确定与新生儿高胆红素血症相关的因素。结果:从纳入研究的新母亲对总数中;新生儿高胆红素血症比例为94(42.3%)。新生儿ABO血型不合33(35.1%)、早产41(43.6%)、败血症35(37.2%)、新生儿窒息20(21.2%)、Rh等免疫10(10.6%)与新生儿高胆红素血症显著相关。结论:研究区新生儿高胆红素血症的发生率较高。由于新生儿高胆红素血症相关因素存在于母体和新生儿,因此产前护理(包括母胎详细检查和随访)以及分娩时的注意事项都需要关注。因此,进一步评估、早期干预和及时治疗对于减轻新生儿高胆红素血症的负担非常重要。
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引用次数: 2
Positive Newborn Screening for Severe Combined Immunodeficiency: What Should the Pediatrician Do? 新生儿严重联合免疫缺陷阳性筛查:儿科医生该怎么做?
IF 1.5 Pub Date : 2023-01-01 DOI: 10.1177/11795565231162839
Wimwipa Mongkonsritragoon, Jenny Huang, Mary Fredrickson, Divya Seth, Pavadee Poowuttikul

Severe combined immunodeficiency (SCID) is a group of diseases characterized by low T-cell count and impaired T-cell function, resulting in severe cellular and humoral immune defects. If not diagnosed and treated promptly, infants affected by this condition can develop severe infections which will result in death. Delayed treatment can markedly reduce the survival outcome of infants with SCID. T-cell receptor excision circle (TREC) levels are measured on newborn screening to promptly identify infants with SCID. It is important for primary care providers and pediatricians to understand the approach to managing infants with positive TREC-based newborn screening as they may be the first contact for infants with SCID. Primary care providers should be familiar with providing anticipatory guidance to the family in regard to protective isolation, measures to minimize the risk of infection, and the coordination of care with the SCID coordinating center team of specialists. In this article, we use case-based scenarios to review the principles of TREC-based newborn screening, the genetics and subtypes of SCID, and management for an infant with a positive TREC-based newborn screen.

严重联合免疫缺陷(SCID)是一组以t细胞计数低和t细胞功能受损为特征的疾病,导致严重的细胞和体液免疫缺陷。如果不及时诊断和治疗,受这种情况影响的婴儿可能会发展成严重感染,从而导致死亡。延迟治疗可显著降低SCID患儿的生存结局。在新生儿筛查中测量t细胞受体切除环(TREC)水平,以及时识别SCID婴儿。对于初级保健提供者和儿科医生来说,了解处理基于trec的新生儿筛查阳性婴儿的方法很重要,因为他们可能是SCID婴儿的第一次接触者。初级保健提供者应熟悉为家庭提供有关保护性隔离、将感染风险降至最低的措施以及与SCID协调中心专家团队协调护理的预期指导。在这篇文章中,我们使用基于案例的场景来回顾基于trec的新生儿筛查的原则,SCID的遗传学和亚型,以及基于trec的新生儿筛查阳性婴儿的管理。
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引用次数: 0
Evaluation of Patients With Congenital Anal Stenosis, Single Center Study. 先天性肛管狭窄患者的评价,单中心研究。
IF 1.5 Pub Date : 2023-01-01 DOI: 10.1177/11795565221150193
Şafak Karaçay, Duygu Yılmaz, Meltem Ugras
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Clinical Medicine Insights: Pediatrics Volume 17: 1–2 © The Author(s) 2023 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1 795565221150 93
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引用次数: 0
The Effect of Clofibrate and Phototherapy on Prolonged Jaundice due to Breast Milk in Full-Term Neonates. 氯贝酸钠与光疗对足月新生儿母乳所致延长性黄疸的影响。
IF 1.5 Pub Date : 2023-01-01 DOI: 10.1177/11795565231177987
Fatemeh Eghbalian, Roya Raeisi, Javad Faradmal, Amin Asgharzadeh

Introduction: Jaundice is one of the most common problems during infancy. It is believed that breast milk jaundice is one of the reasons for the persistence of jaundice after 14 days of prolonged jaundice. This study evaluates the effect of Clofibrate and phototherapy on prolonged jaundice originating from breast milk in term and healthy neonates.

Materials and methods: This double-blind clinical trial study was performed on 100 randomly divided neonates in the neonatal ward of Besat Hospital. In addition to phototherapy, the case group received a single dose of edible Clofibrate (50 mg/kg) dissolved in 2 CCs of distilled water. The control group received the same amount of distilled water as the phototherapy group. After treatment, bilirubin change rate, duration of hospitalization, and any association with gender, gestational age, hemoglobin, blood type, and Rh of neonates were determined and compared throughout the 2 groups.

Results: Data analysis showed that the bilirubin reduction rate was statistically significantly higher in the case group than in the control group (P < .05). The mean duration of hospitalization and phototherapy in the case group was significantly lower than in the control group (P = .005). The bilirubin reduction rate was not affected significantly by gestational age, blood type, or Rh.

Conclusion: This study's results demonstrated that Clofibrate effectively decreased bilirubin levels and shortened the duration of phototherapy and hospitalization in infants with probable breast milk jaundice.

Registration: IRCT2012092910933N1.

黄疸是婴儿期最常见的问题之一。认为母乳黄疸是黄疸持续14天后持续的原因之一。本研究评估了氯贝特和光疗对足月和健康新生儿源于母乳的长期黄疸的影响。材料与方法:本双盲临床试验研究在贝萨特医院新生儿病房随机分组的100例新生儿中进行。除光疗外,病例组接受单剂量(50 mg/kg)溶解于2cc蒸馏水中的食用氯贝特。对照组给予与光疗组等量蒸馏水。治疗后比较两组患者胆红素变化率、住院时间以及与新生儿性别、胎龄、血红蛋白、血型、Rh的关系。结果:资料分析显示,病例组胆红素降低率显著高于对照组(P P = 0.005)。胆红素降低率不受胎龄、血型或Rh的显著影响。结论:本研究结果表明,氯贝特能有效降低可能患有母乳黄疸的婴儿的胆红素水平,缩短光疗和住院时间。注册:IRCT2012092910933N1。
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引用次数: 1
Celiac Disease With Autoimmune Hemolytic Anemia and Autoimmune Hepatitis in a Young Child: Case Report and Literature Review. 幼儿乳糜泻合并自身免疫性溶血性贫血和自身免疫性肝炎1例:病例报告和文献复习
IF 1.5 Pub Date : 2022-08-25 eCollection Date: 2022-01-01 DOI: 10.1177/11795565221120565
Sabeen Abid Khan, Muhammad Imran, Qamar Ali, Munir Iqbal Malik

Celiac disease (CD) is a chronic autoimmune condition with intestinal and extra-intestinal features. Extra intestinal features including hematological, neurological, and endocrine symptoms are seen more frequently in elder children. A 4 years 7 months old male child presented in clinic with history of abdominal pain and diarrhea on and off for 1 year. On examination, he was hemodynamically stable, pale, and malnourished with distended abdomen. He was investigated for CD, Anti TTG IgA <0.1 (positive >10), Anti TTG IgG 13 (positive >10). To confirm celiac disease, Esophagogastroduodenoscopy (EGD) was done which was consistent with diagnosis of Celiac disease (MARSH Type 3a). Gluten free diet was advised. Later, after 12 days he again presented with jaundice, fever, anorexia, and dark colored urine and irritability. He was admitted for fulminant hepatic failure, his workup revealed direct hyperbilirubenemia, ANA +ve, and hyper IgG. Liver biopsy confirmed autoimmune hepatitis. Further workup for anemia showed reticulocyte count 7.1, LDH 423, direct and indirect coombs test was positive confirming autoimmune hemolytic anemia. Child responded well to Azathioprine and prednisolone with clinical improvement. We report a rare presentation of celiac disease with polyautoimmunity in a young child. Case reports of autoimmune hepatitis with CD patients have been reported in adult patients. Association of celiac disease with autoimmune hemolytic anemia and autoimmune hepatitis is a distinct and rare condition.

乳糜泻(CD)是一种具有肠道和肠道外特征的慢性自身免疫性疾病。肠外特征包括血液学、神经学和内分泌症状更常见于年龄较大的儿童。一名4岁7个月大的男婴因腹痛和腹泻断断续续1年就诊。经检查,他血流动力学稳定,脸色苍白,营养不良,腹部膨胀。检测CD、抗TTG IgA 10、抗TTG IgG 13(阳性>10)。为确认乳糜泻,行食管胃十二指肠镜检查(EGD),符合乳糜泻的诊断(MARSH 3a型)。建议无麸质饮食。12天后,患者再次出现黄疸、发热、厌食、尿色深和烦躁。他因暴发性肝功能衰竭入院,他的检查显示直接高胆红素血症,ANA +ve和高IgG。肝脏活检证实自身免疫性肝炎进一步贫血检查显示网织红细胞计数7.1,LDH 423,直接和间接coombs试验阳性,证实自身免疫性溶血性贫血。患儿对硫唑嘌呤和泼尼松龙治疗反应良好,临床改善。我们报告一例罕见的乳糜泻合并多重自身免疫的病例。自身免疫性肝炎合并乳糜泻患者的病例报告已在成人患者中报道。乳糜泻与自身免疫性溶血性贫血和自身免疫性肝炎的关联是一种独特而罕见的疾病。
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引用次数: 1
A Review of Coronaviruses Associated With Kawasaki Disease: Possible Implications for Pathogenesis of the Multisystem Inflammatory Syndrome Associated With COVID-19. 川崎病相关冠状病毒综述:与COVID-19相关的多系统炎症综合征发病机制的可能影响
IF 1.7 Q2 PEDIATRICS Pub Date : 2022-02-16 eCollection Date: 2022-01-01 DOI: 10.1177/11795565221075319
Fatima Farrukh Shahbaz, Russell Seth Martins, Abdullah Umair, Ronika Devi Ukrani, Kausar Jabeen, M Rizwan Sohail, Erum Khan

Multisystem Inflammatory Syndrome in Children (MIS-C), representing a new entity in the spectrum of manifestations of COVID-19, bears symptomatic resemblance with Kawasaki Disease (KD). This review explores the possible associations between KD and the human coronaviruses and discusses the pathophysiological similarities between KD and MIS-C and proposes implications for the pathogenesis of MIS-C in COVID-19. Since 2005, when a case-control study demonstrated the association of a strain of human coronavirus with KD, several studies have provided evidence regarding the association of different strains of the human coronaviruses with KD. Thus, the emergence of the KD-like disease MIS-C in COVID-19 may not be an unprecedented phenomenon. KD and MIS-C share a range of similarities in pathophysiology and possibly even genetics. Both share features of a cytokine storm, leading to a systemic inflammatory response and oxidative stress that may cause vasculitis and precipitate multi-organ failure. Moreover, antibody-dependent enhancement, a phenomenon demonstrated in previous coronaviruses, and the possible superantigenic behavior of SARS-CoV-2, possibly may also contribute toward the pathogenesis of MIS-C. Lastly, there is some evidence of complement-mediated microvascular injury in COVID-19, as well as of endotheliitis. Genetics may also represent a possible link between MIS-C and KD, with variations in FcγRII and IL-6 genes potentially increasing susceptibility to both conditions. Early detection and treatment are essential for the management of MIS-C in COVID-19. By highlighting the potential pathophysiological mechanisms that contribute to MIS-C, our review holds important implications for diagnostics, management, and further research of this rare manifestation of COVID-19.

儿童多系统炎症综合征(MIS-C)是COVID-19表现谱中的一个新实体,其症状与川崎病(KD)相似。本综述探讨了川崎病与人类冠状病毒之间可能存在的联系,讨论了川崎病与 MIS-C 在病理生理学上的相似之处,并对 COVID-19 中 MIS-C 的发病机制提出了建议。自 2005 年一项病例对照研究证实一株人类冠状病毒与 KD 相关以来,又有多项研究提供了不同株人类冠状病毒与 KD 相关的证据。因此,在 COVID-19 中出现类似于 KD 的 MIS-C 疾病可能并非前所未有。KD 和 MIS-C 在病理生理学甚至遗传学上都有许多相似之处。两者都具有细胞因子风暴的特征,导致全身炎症反应和氧化应激,可能引起血管炎并诱发多器官功能衰竭。此外,抗体依赖性增强(这一现象在以前的冠状病毒中已得到证实)和 SARS-CoV-2 可能具有的超抗原性也可能是 MIS-C 的发病机制。最后,有一些证据表明,COVID-19 中存在补体介导的微血管损伤和内皮细胞炎。遗传也可能是 MIS-C 和 KD 之间的联系,FcγRII 和 IL-6 基因的变异可能会增加这两种疾病的易感性。早期发现和治疗对于治疗 COVID-19 中的 MIS-C 至关重要。通过强调导致 MIS-C 的潜在病理生理机制,我们的综述对 COVID-19 这种罕见表现的诊断、管理和进一步研究具有重要意义。
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引用次数: 0
Factors Influencing Frequency of Pediatric Clinically Distinguishable Influenza: A 2 Season Case-Control Study 影响儿童临床可区分流感发病频率的因素:一项2季病例对照研究
IF 1.5 Pub Date : 2022-01-01 DOI: 10.1177/11795565221084159
Ryan A. Salazar, Scott S. Field
Background: Little is known about the individual differences in susceptibility to, or lifetime frequency of clinically distinguishable influenza in children. Methods: Rapid enzyme linked immunoassay-confirmed influenza pediatric cases (n = 96) in season 1 (2017-2018) were compared to age-matched (mean 7.7 years) controls (n = 171) with no evidence of influenza in season 1. The 2 cohorts were again studied in season 2 (2018-2019) for influenza outcomes and influences. Medical records, questionnaires, and interviews were used to determine past influenza disease and vaccine histories. Results: After season 2, known lifetime influenza illnesses per year of age averaged 22.6% in cases and 5.6% in controls, with 62% of controls still having never experienced known influenza. Having had prior influenza was marginally significant as a risk for season 1 influenza in cases versus controls (P = .055), yet a significant risk factor in controls for season 2 (P = .018). Influenza vaccine rates were significantly higher in controls than in cases for season 1, with a greater female vaccine benefit. Lack of previous influenza had greater calculated effectiveness (52%) than vaccination (17%-26%) in escaping season 2 influenza. Lifetime rates of vaccination did not correlate with lifetime rates of known influenza in either cohort. Conclusions: Lifetime clinically distinguishable influenza rates varied among children, with many escaping it for years even without being immunized against it. Findings of less than expected clinical influenza, no correlation between vaccination frequency and disease frequency, sex differences, and an association between past clinical influenza and current risk, point to innate differences in individual influenza experiences.
背景:对于儿童对临床可区分的流感易感性的个体差异或终生发病率知之甚少。方法:将第1季(2017-2018年)快速酶联免疫测定确诊的儿童流感病例(n = 96)与第1季无流感证据的年龄匹配(平均7.7岁)对照组(n = 171)进行比较。在第二季(2018-2019)再次研究了这两个队列的流感结局和影响。使用医疗记录、问卷调查和访谈来确定过去的流感疾病和疫苗史。结果:在第二季后,每年年龄的已知终身流感疾病平均为22.6%,对照组为5.6%,62%的对照组仍然从未经历过已知的流感。与对照组相比,曾患过流感的患者患第1季流感的风险略微显著(P = 0.055),但在对照组中,患第2季流感的风险显著(P = 0.018)。对照组的流感疫苗接种率明显高于第一季病例,女性疫苗的益处更大。在逃避第二季流感方面,没有流感史的计算有效性(52%)高于接种疫苗(17%-26%)。在两个队列中,接种疫苗的终生率与已知流感的终生率无关。结论:儿童终生临床可区分的流感发病率各不相同,许多人即使没有接种疫苗也能逃避多年。临床流感的发现低于预期,疫苗接种频率与疾病频率之间没有相关性,性别差异,以及过去的临床流感与当前风险之间的关联,表明个体流感经历存在先天差异。
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Clinical Medicine Insights-Pediatrics
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