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Clinical profile of fungal sepsis in new born: a tertiary centre experience from Bangladesh 新生儿真菌败血症的临床概况:来自孟加拉国的三级中心经验
Pub Date : 2020-12-28 DOI: 10.15406/JPNC.2020.10.00432
Farhana Tasneem, M. Hossain, S. Mahmud, Syed Shafi Ahmed
Background: Candida infections are frequent and major causes of septicemia in neonatal intensive care units and are associated with high morbidity and mortality. Low birth weight preterm infants are especially vulnerable to these devastating infections. Material and methods: A prospective observational study was done from May 2013 to June 2014 in SCABU (Special Care Baby Unit) & ICU (Intensive Care Unit) of Dhaka Shishu (Children) Hospital, Dhaka. All neonates admitted with suspected clinical sepsis were analyzed in the study. Among which 30 culture positive candida cases were identified and included in this study. Outcome measures assessed was the incidence of candidemia in our NICU with clinical profiles and associated risk factors. Results: Out of 30 newborns 18 (60%) were preterms, 20% of study population were having a birth weight of <1 kg, 23.3% with a birth weight of 1-1.5 kg and 23.3% with a birth weight of 1.5-2.5 kg. 73.4% of the study population were hospitalized for >1 week. In the study group 56.7% had feed intolerance, 53.3% needed ventilator support, 56.7% had temperature instability, 73.3% had thrombocytopenia 63.3% had apnea and 73.3% had jaundice. The overall survival was 63.3%. Conclusions Low birth weight, prematurity, use of broad spectrum antibiotics, mechanical ventilation and prolonged hospital stay were important risk factors associated with neonatal candidiasis in this study. Thrombocytopenia, feed intolerance, increased requirement for ventilator support, temperature instability, jaundice and apnea were significant clinical parameters noted in babies with culture proven neonatal candidiasis. The overall survival was 63.3% in the study group.
背景:念珠菌感染是新生儿重症监护室败血症的常见和主要原因,并与高发病率和死亡率有关。低出生体重早产儿尤其容易受到这些毁灭性感染。材料和方法:2013年5月至2014年6月,在达卡Shishu(儿童)医院的SCABU(特殊护理婴儿病房)和ICU(重症监护室)进行了一项前瞻性观察性研究。本研究分析了所有因疑似临床败血症入院的新生儿。其中30例念珠菌培养阳性,纳入本研究。评估的结果指标是NICU中念珠菌血症的发生率以及临床特征和相关风险因素。结果:在30名新生儿中,18名(60%)为学龄前儿童,20%的研究人群出生体重为1周。在研究组中,56.7%的人有进食不耐受,53.3%的人需要呼吸机支持,56.7%有温度不稳定,73.3%有血小板减少症,63.3%有呼吸暂停,73.3%患有黄疸。结论低出生体重、早产、使用广谱抗生素、机械通气和住院时间延长是本研究中新生儿念珠菌感染的重要危险因素。血小板减少、喂养不耐受、对呼吸机支持的需求增加、温度不稳定、黄疸和呼吸暂停是培养证实的新生儿念珠菌感染婴儿的重要临床参数。研究组的总生存率为63.3%。
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引用次数: 1
Foreign body aspiration in an 11-month-old child; the importance of anamnesis and respiratory examination 11月龄儿童异物吸入术1例回顾和呼吸检查的重要性
Pub Date : 2020-11-11 DOI: 10.15406/JPNC.2020.10.00429
M. Engin, F. Erdoğan, Ö. Küçük, M. Kaya
Foreign body aspiration (FBA) is common in children. Especially in children, the majority of accidental deaths occur due to FBA. Morbidity and mortality rates increase, especially in children between the ages of one and four, and as a result of delay in diagnosis. The most common symptoms in patients with FBA are cough, dyspnea, hemoptysis, stridor and wheezing. In this case report, a patient who presented with sudden respiratory distress in the Pediatric Emergency Department was presented and the importance of anamnesis and respiratory examination in the diagnosis of FBA was emphasized.
异物吸入(FBA)在儿童中很常见。特别是在儿童中,大多数意外死亡是由FBA引起的。发病率和死亡率上升,特别是1至4岁儿童的发病率和死亡率上升,这是诊断延误的结果。FBA患者最常见的症状是咳嗽、呼吸困难、咯血、喘鸣和喘息。在本病例报告中,我们报告了一名在儿科急诊科出现突发性呼吸窘迫的患者,并强调了记忆和呼吸检查在FBA诊断中的重要性。
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引用次数: 2
Clinical profile of neonates delivered from mothers with confirmed COVID-19 infection: An experience from a Tertiary Perinatal Care Center in Dubai, UAE 确诊感染COVID-19的母亲所生新生儿的临床概况:来自阿联酋迪拜一家三级围产期护理中心的经验
Pub Date : 2020-11-11 DOI: 10.15406/jpnc.2020.10.00427
M. Elhalik
Background: The Coronavirus disease 2019 (COVID-19) outbreak is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1 On January 30, 2020, the World Health Organization (WHO) declared the outbreak, as a Public Health Emergency of international concern and later on upgraded the outbreak on 11 March 2020, to a Pandemic. Neonates are a special population who might have different level of risks and susceptibilities to the virus. The risk of in-utero (vertical transmission) transmission of SARS-CoV-2 is anticipated to be low. The risk of perinatal transmission, especially during breastfeeding and the neonate’s risk of developing COVID-19 during the perinatal period are also unknown. Until date, the knowledge is limited on whether rooming-in the neonate with mother (if she is SARS-COV-2 positive) after delivery is a safe practice. Methods: This is a retrospective observational study, which is conducted at the Neonatal Intensive Care Unit (NICU) and post-natal wards of Latifa Women and Children Hospital (LWCH), Dubai, United Arab Emirates (UAE). We conducted this study aiming to evaluate and follow up neonates born to SARS-COV-2 positive mothers. In addition, to find out any potential risk factors associated with transmission of infection and elucidate best infection control and management practices. Maternal and neonatal data were collected retrospectively from our electronic medical records. Testing for neonates for SARS-COV-2 infection was done by real time reverse transcriptase Polymerase Chain Reaction (rtPCR) performed on nasopharyngeal swab samples. Samples are collected at birth (or as soon as possible) and 24-48 hours after the first sample; in case of any positive result, subsequent samples collected after 5-7days (at 24 hours interval), until two consecutive samples were negative. Universal COVID-19 screening for pregnant women presented for delivery was adopted. Results: st 2020 and th 2020, a total of 92 pregnant women were admitted to our hospital and diagnosed positive for SARS- COv-2 infection. Out of which, 35 mothers and their 36 neonates (one was twin delivery) were included for analysis. Two (5.5%) neonates were confirmed positive for SARS-COV-2 infection and one had inconclusive report. All neonates were stable and asymptomatic, and their subsequent rtPCR tests were negative. All the neonates (including the positive cases) were roomed-in together with their mother and exclusive breast-feeding was given unless not feasible. These practices did not increase the risk of neonatal SARS-COV-2 infection. All neonates were discharge home in good condition. Neonates were clinic follow up (outpatient clinic or telephonic) and were found to be in healthy condition. Conclusion: our current study, we found out that transmission rate of SARS-COV-2 from mother to child is minimal if proper identification of infections and proper education to and adherence to infection control practice is ensured. If possible, mother a
背景:2019冠状病毒病(COVID-19)疫情是由新型严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的。1 2020年1月30日,世界卫生组织(世卫组织)宣布此次疫情为国际关注的突发公共卫生事件,随后于2020年3月11日将疫情升级为大流行。新生儿是一个特殊的人群,他们可能有不同程度的风险和对病毒的易感性。预计SARS-CoV-2在子宫内(垂直传播)传播的风险较低。围产期传播的风险,特别是在母乳喂养期间以及新生儿在围产期感染COVID-19的风险也不得而知。到目前为止,人们对分娩后将新生儿与母亲(如果她是SARS-COV-2阳性)同住是否是一种安全做法的了解有限。方法:本研究是一项回顾性观察性研究,在阿拉伯联合酋长国(UAE)迪拜拉提法妇幼医院(LWCH)新生儿重症监护病房(NICU)和产后病房进行。我们开展了这项研究,旨在评估和随访SARS-COV-2阳性母亲所生的新生儿。此外,发现与感染传播有关的任何潜在危险因素,并阐明最佳感染控制和管理措施。从我们的电子病历中回顾性地收集了孕产妇和新生儿的数据。新生儿SARS-COV-2感染检测采用实时逆转录酶链反应(rt - pcr)对鼻咽拭子样本进行检测。在出生时(或尽快)和第一次采样后24-48小时采集样本;如有阳性结果,则在5-7天后(间隔24小时)采集后续样本,直至连续两次样本为阴性。对即将分娩的孕妇进行COVID-19普遍筛查。结果:2020年1月至2020年2月,我院共收治92例确诊为SARS- COv-2感染阳性孕妇。其中,35名母亲和她们的36名新生儿(其中一名是双胞胎)被纳入分析。2例(5.5%)新生儿确诊为SARS-COV-2感染阳性,1例报告不确定。所有新生儿均稳定且无症状,随后的rtPCR检测均为阴性。所有新生儿(包括阳性病例)与母亲同住,除非可行,否则一律母乳喂养。这些做法并未增加新生儿感染SARS-COV-2的风险。所有新生儿出院时状况良好。对新生儿进行门诊随访(门诊或电话随访),发现其健康状况良好。结论:我们目前的研究发现,如果正确识别感染,并确保适当的教育和遵守感染控制措施,SARS-COV-2从母亲到儿童的传播率是最低的。如果可能的话,母亲和婴儿应该在一个房间里,并且完全母乳喂养是可行的,不会有任何额外的将SARS-COV-2感染传播给新生儿的风险。
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引用次数: 7
Incidence of G6PD deficiency among neonates with hyperbilirubinemia requiring phototherapy at postnatal wards of a tertiary care perinatal center, Dubai, UAE: A longitudinal cross-sectional study 阿联酋迪拜一家三级保健围产期中心产后病房需要光疗的高胆红素血症新生儿G6PD缺乏的发生率:一项纵向横断面研究
Pub Date : 2020-10-26 DOI: 10.15406/jpnc.2020.10.00425
M. Elhalik
Purpose : To investigate the incidence of glucose 6 phosphate dehydrogenase (G6PD) deficiency in neonates with hyperbilirubinemia requiring phototherapy. Methods : We conducted a longitudinal, cross-sectional, study that recruited all late preterm and term infants with hyperbilirubinemia who needed for phototherapy at postnatal wards of a tertiary care hospital in UAE through the period from April 2017 to January 2018. Neonates with an inborn error of metabolism, sepsis, or Neonatal intensive care unit (NICU) admission were excluded. A non-probability consecutive sampling technique was employed to recruit eligible neonates. Results : The present study included 658 late preterm and term infants with hyperbilirubinemia. The majority of the neonates were females (51.4%) with a median (IQR) birth weight of 2846 (628) grams. Only 29 (4.4%) neonates had a positive family history of G6PD deficiency. Sixty-nine (10.5%) neonates had deficient G6PD activity. The association analysis showed that there were statistically significant associations between the presence of G6PD deficiency and the male gender (p <0.001), low birth weight (p <0.001), and positive family history of G6PD deficiency (p <0.001). Conclusion : In conclusion, the present study showed that about 10% of the neonates admitted for phototherapy had G6PD deficiency in postnatal wards of a tertiary care hospital UAE. This finding highlights the critical role testing for G6PD to all newborns who are receiving phototherapy, especially those with unknown etiology or poor response to phototherapy. Further long-term studies are still needed to confirm our findings.
目的:探讨需要光疗的新生儿高胆红素血症中葡萄糖-6-磷酸脱氢酶(G6PD)缺乏的发生率。方法:我们进行了一项纵向、横断面研究,招募了2017年4月至2018年1月期间需要在阿联酋一家三级护理医院产后病房接受光疗的所有患有高胆红素血症的晚期早产儿和足月儿。先天性代谢异常、败血症或新生儿重症监护室(NICU)入院的新生儿除外。采用非概率连续抽样技术招募符合条件的新生儿。结果:本研究纳入658名患有高胆红素血症的晚期早产儿和足月儿。大多数新生儿为女性(51.4%),出生体重中位数(IQR)为2846(628)克。只有29名(4.4%)新生儿有G6PD缺乏症阳性家族史。69名(10.5%)新生儿G6PD活性不足。关联分析显示,G6PD缺乏症的存在与男性(p<0.001)、低出生体重(p<001)和G6PD缺乏阳性家族史(p<0.01)之间存在统计学上显著的关联,目前的研究表明,在阿联酋一家三级护理医院的产后病房里,接受光疗的新生儿中约有10%患有G6PD缺乏症。这一发现强调了G6PD对所有接受光疗的新生儿的关键作用测试,尤其是那些病因不明或对光疗反应不佳的新生儿。还需要进一步的长期研究来证实我们的发现。
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引用次数: 1
Single center experience from Egypt about fulminant hepatic failure in children 埃及关于儿童暴发性肝衰竭的单中心经验
Pub Date : 2020-07-31 DOI: 10.15406/JPNC.2020.10.00421
E. Salama, N. Adawy, Ashraf Mansour Habib Mansour
Aim: To assess fulminant hepatic failure (FHF) in children and its interrelating factors. Methods and materials: A retrospective review study of 24 patients less than 17 years old who presented to the National Liver Institute with FHF over a period of two years was done. FHF was defined as the presence of acute liver failure with or without encephalopathy without pre-existing liver disease, within 8 weeks of the onset of clinical liver disease. Hepatitis A virus (HAV) IgM antibodies, Hepatitis B virus surface antigen (HBsAg), IgM-anti Hepatitis B core antigen (HBc), Hepatitis E virus (HEV) IgM and Hepatitis C virus (HCV) RNA in nested PCR were done in all patients. Special investigations like alpha fetoprotein, serum copper, blood culture, drug levels and other metabolic studies were carried out whenever indicated. Detailed clinical evaluations and routine hepatic laboratory profile were done. Results: Acute hepatitis-A virus was the commonest cause. Severe coma was significantly present among non-survivals and no ascites. Patients who survived had got significantly lower level of prothrombin time, they also had significantly lower rate of descent of prothrombin time. Conclusion: Hepatitis A virus was the commonest etiology of FHF. The peak level of total serum bilirubin, the rate of change of the prothrombin time/day and ammonia level were significant predictors of mortality.
目的:探讨儿童暴发性肝功能衰竭(FHF)及其相关因素。方法和材料:对24名17岁以下的FHF患者进行了为期两年的回顾性研究。FHF被定义为在临床肝病发作后8周内出现急性肝功能衰竭,伴有或不伴有脑病,且没有预先存在的肝病。所有患者均采用巢式聚合酶链式反应检测甲型肝炎病毒(HAV)IgM抗体、乙型肝炎病毒表面抗原(HBsAg)、抗乙型肝炎核心抗原(HBc)IgM、戊型肝炎病毒(HEV)IgM和丙型肝炎病毒(HCV)RNA。只要有需要,就会进行特殊的研究,如甲胎蛋白、血清铜、血液培养、药物水平和其他代谢研究。进行了详细的临床评估和常规肝脏实验室检查。结果:急性肝炎病毒是最常见的病因。严重昏迷在未存活且无腹水的患者中明显存在。存活的患者凝血酶原时间水平显著降低,凝血酶原时间下降率也显著降低。结论:甲型肝炎病毒是FHF最常见的病因。血清总胆红素峰值水平、凝血酶原时间/天的变化率和氨水平是死亡率的重要预测因素。
{"title":"Single center experience from Egypt about fulminant hepatic failure in children","authors":"E. Salama, N. Adawy, Ashraf Mansour Habib Mansour","doi":"10.15406/JPNC.2020.10.00421","DOIUrl":"https://doi.org/10.15406/JPNC.2020.10.00421","url":null,"abstract":"Aim: To assess fulminant hepatic failure (FHF) in children and its interrelating factors. Methods and materials: A retrospective review study of 24 patients less than 17 years old who presented to the National Liver Institute with FHF over a period of two years was done. FHF was defined as the presence of acute liver failure with or without encephalopathy without pre-existing liver disease, within 8 weeks of the onset of clinical liver disease. Hepatitis A virus (HAV) IgM antibodies, Hepatitis B virus surface antigen (HBsAg), IgM-anti Hepatitis B core antigen (HBc), Hepatitis E virus (HEV) IgM and Hepatitis C virus (HCV) RNA in nested PCR were done in all patients. Special investigations like alpha fetoprotein, serum copper, blood culture, drug levels and other metabolic studies were carried out whenever indicated. Detailed clinical evaluations and routine hepatic laboratory profile were done. Results: Acute hepatitis-A virus was the commonest cause. Severe coma was significantly present among non-survivals and no ascites. Patients who survived had got significantly lower level of prothrombin time, they also had significantly lower rate of descent of prothrombin time. Conclusion: Hepatitis A virus was the commonest etiology of FHF. The peak level of total serum bilirubin, the rate of change of the prothrombin time/day and ammonia level were significant predictors of mortality.","PeriodicalId":92678,"journal":{"name":"Journal of pediatrics & neonatal care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45177003","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
New approach of chemotherapy for the treatment of retinoblastoma: a review 视网膜母细胞瘤的化疗新途径综述
Pub Date : 2020-07-02 DOI: 10.15406/jpnc.2020.10.00419
Ghosh Ak, Das Gupta SP
Retinoblastoma is the most common primary intraocular malignancy of childhood. A potentially curable cancer, its treatment has improved significantly over the last few decades. In developed world current treatment options aim to preserve the globe as well as vision with minimum morbidity. High resolution imaging has improved tumor detection and is useful for prognosticating cases and monitoring response to treatment. Targeted chemotherapy has shown promising results and these routes are being increasingly employed world-wide for globe preservation. Chemotherapy is currently used as a first line approach for children with this malignancy and can be delivered by intravenous, intra-arterial, periocular, and intravitreal routes. The choice of route for chemotherapy administration depends upon the tumor laterality and tumor staging. This review aims to highlight newer advancements in the field of management of retinoblastoma that have been introduced in recent times, with a special emphasis on globe-preserving therapy.
视网膜母细胞瘤是儿童最常见的原发性眼内恶性肿瘤。作为一种潜在的可治愈的癌症,其治疗方法在过去几十年里有了显著的改善。在发达国家,目前的治疗方案旨在以最低的发病率保护全球和视力。高分辨率成像改善了肿瘤的检测,对预测病例和监测治疗反应很有用。靶向化疗已经显示出有希望的结果,这些途径越来越多地用于全球保存。化疗目前被用作治疗儿童恶性肿瘤的一线方法,可通过静脉、动脉、眼周和玻璃体内途径进行。化疗途径的选择取决于肿瘤的侧边性和肿瘤分期。这篇综述旨在强调近年来视网膜母细胞瘤治疗领域的最新进展,特别强调全球保留治疗。
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引用次数: 0
Relationship between prematurity, high blood pressure and kidney injury 早产、高血压与肾损伤的关系
Pub Date : 2020-07-02 DOI: 10.15406/jpnc.2020.10.00420
E. Mah, Suzanne Ngo Um Sap, Hermann Ngwanou, D. K. Tague, Linda Maguip, D. Chelo, Temgoua Ngou Mazou, Gides Zantia, A. Chiabi
Introduction: Prematurity is a public health problem worldwide. Reducing the morbidity and mortality of prematurity through improved management techniques reveal the emergence of cardiovascular risk diseases, including kidney disease and high blood pressure, which can compromise health in adulthood. The prevalence of these diseases varies from country to country. The main objective of this study was to determine the factors associated with renal injury and high blood pressure in children born preterm. Methodology: We conducted a historical cohort study including children aged 6 to 11 years, matched for gender and sex in a 1:2 ratio. Data were collected from the records of premature and full-term infants hospitalized from January 1, 2008 to December 31, 2013. Patients were reviewed during outpatient consultation, where height, blood pressure were measured and a urine dipstick was performed. Patients with high blood pressure or positive protein uria were seen again two weeks later for follow-up. The Fisher test and the Chi-square test were used to compare proportions. The significance threshold was defined for p<0.05. Relative risk (RR) was used to establish the risk relationship between the different variables. Results: We enrolled 125 children born preterm and 250 born at full-term. The mean age was 8.2+/-1.6 years with discrete female predominance. The cumulative incidence of pathologies varied according to type: 17.60% in preterm versus 2% in full-term (p?0,001) for high blood pressure and 69.60% in preterm versus 33.20% in full-term children (p?0,001) for proteinuria. Factors associated with renal in jury were the use of amino glycosides, aminophylline and neonatal infection. We found a correlation between the presence of proteinuria and high blood pressure (r=1.14, p=0.000002). Conclusion: Renal damage and high blood pressure were more common in children born preterm than in full-term. Associated factors were neonatal infection, use of amino glycosides and aminophylline.
引言:早产是一个全球性的公共卫生问题。通过改进管理技术降低早产的发病率和死亡率,揭示了心血管风险疾病的出现,包括肾脏疾病和高血压,这些疾病可能会损害成年后的健康。这些疾病的流行率因国家而异。本研究的主要目的是确定早产儿童肾损伤和高血压的相关因素。方法:我们进行了一项历史队列研究,包括6至11岁的儿童,他们的性别和性别以1:2的比例匹配。数据收集自2008年1月1日至2013年12月31日住院的早产儿和足月儿的记录。在门诊会诊期间对患者进行了检查,测量了身高、血压,并进行了尿检。两周后再次观察高血压或蛋白尿阳性患者进行随访。Fisher检验和卡方检验用于比较比例。显著性阈值定义为p<0.05。相对风险(RR)用于建立不同变量之间的风险关系。结果:我们招募了125名早产儿童和250名足月出生的儿童。平均年龄为8.2+/-1.6岁,以离散女性为主。病理学的累积发生率因类型而异:高血压的早产发生率为17.60%,足月发生率为2%(p?0001),蛋白尿的早产发病率为69.60%,足月儿童发生率为33.20%(p?0.001)。与肾脏损害相关的因素是氨基糖苷类药物的使用、氨茶碱和新生儿感染。我们发现蛋白尿的存在与高血压之间存在相关性(r=1.14,p=0.000002)。结论:早产儿童的肾损伤和高血压比足月儿童更常见。相关因素包括新生儿感染、氨基糖苷类药物和氨茶碱的使用。
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引用次数: 2
Intra pericardial herniation in congenital diaphragmatic hernia 先天性膈疝的心包内疝
Pub Date : 2020-07-02 DOI: 10.15406/jpnc.2020.10.00422
Mohamed H Koura, Hamid Qoura, M. Nayar, Mohammed J Al Sajwani
Intrapericardial diaphragmatic hernia is a rare condition with only few cases reported in the English language literature.1 During a span of eight months in 2010-2011 we treated two cases of congenital intra pericardial diaphragmatic hernia in Royal Hospital in the Sultanate of Oman. The first case was not diagnosed antenatally as diaphragmatic hernia. Post-natally the neonate was diagnosed as having pericardial effusion and correct diagnosis arrived at by CTs can. The second case was diagnosed by antenatal scan as diaphragmatic hernia and confirmed in postnatal period by chest X-Ray as left congenital diaphragmatic hernia but intra-operative finding was an anterior diaphragmatic hernia with intra pericardial herniation of the liver and part of the bowel into the pericardial sac. Both neonates were intubated after birth due to respiratory distress. A polytetrafluoroethylene (PTFE) patch was used for repair of the defect in first case and the second case was repaired without a patch. In both cases, apart from the defect, the rest of the diaphragm, on either side, was intact; sac was absent and a pericardial defect was present. Both neonates were discharged in good condition.
心包内膈疝是一种罕见的疾病,英文文献中只报道了少数病例。1在2010-2011年的八个月时间里,我们在阿曼苏丹国皇家医院治疗了两例先天性心包内膈膜疝。第一例在出生前未被诊断为膈疝。出生后,新生儿被诊断为心包积液,CT可以做出正确诊断。第二例经产前扫描诊断为膈疝,产后胸部X光检查证实为左侧先天性膈疝,但术中发现为前膈疝,伴有肝和部分肠进入心包囊的心包内疝。两名新生儿出生后均因呼吸窘迫而插管。第一例使用聚四氟乙烯(PTFE)补片修复缺损,第二例不使用补片修复。在这两种情况下,除了缺陷外,隔膜两侧的其余部分都完好无损;囊缺失,出现心包缺损。两名新生儿出院时情况良好。
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引用次数: 0
Outcome of neonatal thrombocytopenia in tertiary care NICU 新生儿血小板减少症在新生儿重症监护病房的结局
Pub Date : 2020-06-29 DOI: 10.15406/JPNC.2020.10.00418
D. Madhavi, Shamama Subuhi, Mohammed Zubai
Thrombocytopenia is one of the commonest haematological disorders in the neonatal period, affecting up to a third of those admitted to neonatal intensive care units. It is well recognized that many fetomaternal and neonatal conditions are associated with thrombocytopenia. The majority of episodes of neonatal thrombocytopenia are relatively mild, self-limiting and of short duration but it may cause severe morbidity & mortality due to severe complication like IVH. Methods & material: 140 Newborn admitted in tertiary care NICU were selected to find out outcome and etiology of neonatal thrombocytopenia. Detail maternal history and neonatal physical examination done and Neonates were followed for outcome, relevant investigation done according to cases. Result: Out of 140 neonates 63 neonates had thrombocytopenia (45%).42.8% neonates were premature out of which 63.3% had thrombocytopenia. Other neonatal risk factor for thrombocytopenia are sepsis 38 (74.5%), SGA/IUGR 28(80%) and NEC 9(100%). Maternal risk factor for thrombocytopenia are eclampsia81.8% and infection during pregnancy 72.72%. 95.5 % of all study population were discharged.4.5 % cases of whole study population didn’t survive. 4.54% of mild, 9.09% of moderate and 60 % of severe thrombocytopenic babies didn’t survive. Conclusion: Bleeding manifestations i.e. mucosal, cutaneous and intracranial bleed were significantly associated with severe thrombocytopenia. 60% of mortality was found in severe thrombocytopenic group. Thus, severe thrombocytopenia was found to be a predictor of poor outcome in sick neonates of NICU.
血小板减少症是新生儿时期最常见的血液系统疾病之一,影响了多达三分之一的新生儿重症监护室患者。众所周知,许多胎儿和新生儿疾病都与血小板减少症有关。大多数新生儿血小板减少症发作相对较轻,自我限制,持续时间短,但由于IVH等严重并发症,可能会导致严重的发病率和死亡率。方法与材料:选择140例新生儿重症监护室三级监护新生儿,了解新生儿血小板减少症的转归和病因。详细的产妇病史和新生儿体格检查,并跟踪新生儿的结果,根据病例进行相关调查。结果:140例新生儿中,63例有血小板减少症(45%),42.8%的新生儿早产,其中63.3%有血小板减少。新生儿血小板减少症的其他危险因素是败血症38(74.5%)、SGA/IUGR 28(80%)和NEC 9(100%)。血小板减少症的母体危险因素是子痫81.8%和妊娠期感染72.72%。95.5%的研究人群出院。4.5%的研究人群没有出院™无法生存。4.54%的轻度、9.09%的中度和60%的重度血小板减少症婴儿没有™无法生存。结论:出血表现,即粘膜、皮肤和颅内出血与严重血小板减少症显著相关。60%的死亡率发生在严重血小板减少组。因此,严重的血小板减少症被发现是新生儿重症监护室患病新生儿预后不佳的预测因素。
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引用次数: 0
The level and potential determinants of the adherence to the antiretroviral therapy among patients on HIV treatment in gemena referral hospital, South Ubangi, Democratic Republic of Congo, 2018 2018年,刚果民主共和国南乌班吉吉梅纳转诊医院接受艾滋病毒治疗的患者坚持抗逆转录病毒治疗的水平和潜在决定因素
Pub Date : 2020-05-29 DOI: 10.15406/jpnc.2020.10.00416
Charles Kombi K, Jerome Mastaki K, Antoinette Tshefu K, Micheline Fatuma, Herve Nzereka K
Introduction: Suboptimal adherence to antiretroviral therapy (ART) is a major hinderance to achieving the 90 90 90 goals in limited resources settings. South Ubangi province in DR Congo faces countless challenges providing universal HIV care. However, the level of ART adherence and associated factors among people on HIV treatment in this province remains unknown. Using a quantitative method approach, this study aimed to know the extend of adherence and to identify the determinants of optimal and suboptimal adherence among study participants. Methods: A cross-sectional research design was used to survey patients on ART in Gemena Referral Hospital. Results: After a simple randomly sampling from a sampling frame of 503 patients on treatment and who met the inclusion criteria of been using HIV treatment for at least one year, 438 were selected taking the even numbers in three rounds, but only 398 patients consented to participate to the study. Logistic regression was run to explore determinants of the adherence. The participants’ mean age was 42 years old (range: 8-62 years old). 280 participants were Female (=70.4%) and 118 were male (29.6%) with a sex ratio Female-male of 2.4/1. Most of the participants were married 185(46.5%), 45 were divorced (=1.3%), 136 widow/widowers (34.2% made up of 116 widowers=29% and 20 widows=4.2%) and only 32 were unmarried (8%). Among the married, 117 had only one partner (29% of overall), 42 had more than one partner (11%) and 26 were in a mere cohabitation (6.5%). ART adherence was 77% in the study population, while it should reach the optimal level of 95%. Adherence was positively associated with age, but suboptimal adherence was significantly associated with forget to take the drugs, distance, the degree of contentment to the family support, and moving out of home. Adherence was likely associated with age, in fact, old participants(44-60 age group) had 8.3 times an increased probability of being adherent( 2.30-8.84, 95% CI, p-value=0.001) compared to 8-25 age group. Additionally, taking his pills on daily basis had 1.68 times an increased probability of optimal adherence (1.39-1.98, 95% CI, p-value<0.001), compared to those patients who sometimes forget to take their pills. Distance < or = 5 km also had 2.47 an increased probability of being adherent (2.06-2.87, p-value<0.001) compared to people who live beyond 5 km from the health facility. Participants who stated they had a high degree of contentment to family support presented 1.93 times an increased probability of being adherent (1.93-1.46, 95% CI, p-value=0.001) compared with those with low degree of contentment to the family support. Participants who were resident had 1.55 times an increased significant probability to be adherent (1.28-1.82, 95% CI, p-value<0.001), compared to those who temporarily/definitely moved out their home for any reason. Gender, marital status, and monthly income did not have a significant association with adherence to antiretroviral
引言:在资源有限的情况下,对抗逆转录病毒疗法(ART)的次优依从性是实现90 90 90目标的主要障碍。刚果民主共和国南乌班吉省在提供普遍的艾滋病毒护理方面面临着无数挑战。然而,在该省接受艾滋病毒治疗的人群中,抗逆转录病毒疗法的依从性水平和相关因素仍然未知。本研究采用定量方法,旨在了解依从性的范围,并确定研究参与者中最佳和次优依从性的决定因素。方法:采用横断面研究设计对杰梅纳转诊医院的ART患者进行调查。结果:从503名接受治疗且符合HIV治疗至少一年的纳入标准的患者中进行简单随机抽样后,在三轮中选择了438名偶数患者,但只有398名患者同意参与该研究。采用Logistic回归分析来探讨依从性的决定因素。参与者的平均年龄为42岁(范围:8-62岁)。280名参与者为女性(=70.4%),118名参与者为男性(29.6%),男女比例为2.4/1。大多数参与者已婚185人(46.5%),离婚45人(=1.3%),寡妇/鳏夫136人(34.2%,其中116名鳏夫=29%,20名寡妇=4.2%),只有32人未婚(8%)。在已婚人群中,117人只有一个伴侣(占总人数的29%),42人有多个伴侣(11%),26人只是同居(6.5%)。研究人群中抗逆转录病毒疗法的依从性为77%,但应达到95%的最佳水平。依从性与年龄呈正相关,但次优依从性与忘记服药、距离、对家庭支持的满意度和搬离家显著相关。依从性可能与年龄有关,事实上,与8-25岁年龄组相比,老年参与者(44-60岁年龄组)的依从性概率增加了8.3倍(2.30-8.84,95%CI,p值=0.001)。此外,与那些有时忘记服药的患者相比,每天服用他的药丸的最佳依从性概率增加了1.68倍(1.39-1.98,95%CI,p值<0.001)。与居住在距离卫生设施5公里以外的人相比,距离小于或等于5公里的人粘附的概率也增加了2.47(2.06-2.87,p值<0.001)。与对家庭支持满意度较低的参与者相比,表示对家庭支持高度满意的参与者坚持的概率增加了1.93倍(1.93-1.46,95%CI,p值=0.001)。与那些因任何原因暂时/肯定搬离家园的参与者相比,居住的参与者坚持的显著概率增加了1.55倍(1.28-1.82,95%CI,p值<0.001)。在接受调查的人群中,性别、婚姻状况和月收入与坚持抗逆转录病毒疗法没有显著关联。结论:在资源有限的环境中,抗逆转录病毒药物使用者的次优依从性仍然是一个严重的问题。将依从性提高到最佳水平及以上的进一步战略将意味着提高个人遵守治疗指示的能力,减少代理人和患者家庭内部的污名和歧视障碍,促进家庭成员和社区在治疗中的影响,促进在家提供药物和差异化医疗管理等。
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Journal of pediatrics & neonatal care
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