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BioMed Central Page 1 of 7 (page number not for citation purposes) Virology Journal Open Access Research Multipathogen infections in hospitalized children with acute respiratory infections Dan Peng 1 , Dongchi Zhao* 1 , Jingtao Liu 1 , Xia Wang 1 , Kun Yang 1 , Hong Xicheng 2 , Yang Li 2 and Fubing Wang 3 Address: 1 Pediatrics Department, Zhongnan Hospital, Wuhan University, Wuhan 430071, PR China, 2 Statistics Department, Public Health Institute, Wuhan University, Wuhan 430071, PR China and 3 Clinical Investigation Department, Zhongnan Hospital, Wuhan University, Wuhan 430071, PR China Email: Dan Peng - pengdan83@126.com; Dongchi Zhao* - zhaodong@public.wh.hb.cn; Jingtao Liu - liujingtao74@yahoo.cn; Xia Wang - ruxuepiaohua@163.com; Kun Yang - yk.0726@163.com; Hong Xicheng - hongxicheng@sina.com; Yang Li - pengdan83@126.com; Fubing Wang - wfb20042002@sina.com * Corresponding author Abstract Background: To explore the epidemiologic and clinical features of, and interactions among, multipathogen infections in hospitalized children with acute respiratory tract infection (ARTI). A prospective study of children admitted with ARTI was conducted. Peripheral blood samples were analyzed by indirect immunofluorescence to detect respiratory agents including respiratory syncytial virus; adenovirus; influenza virus (Flu) types A and B; parainfluenza virus (PIV) types 1, 2, and 3; chlamydia pneumonia; and mycoplasma pneumonia. A medical history of each child was taken. Results: Respiratory agents were detected in 164 (51.9%) of 316 children with ARTI. A single agent was identified in 50 (15.8%) children, and multiple agents in 114 (36.1%). Flu A was the most frequently detected agent, followed by Flu B. Coinfection occurred predominantly in August and was more frequent in children between 3 and 6 years of age. A significantly higher proportion of Flu A, Flu B, and PIV 1 was detected in samples with two or more pathogens per sample than in samples with a single pathogen. Conclusion: Our study suggests that there is a high occurrence of multipathogen infections in children admitted with ARTI and that coinfection is associated with certain pathogens. Introduction Almost two million children die each year from acute res- piratory tract infection (ARTI), and most of these children live in developing countries [1]. In developed countries, the incidence of lower respiratory tract infection is high and causes 19% to 27% of hospitalizations in children under the age of 5 years in the USA [2,3]. The etiologic agents of these common infections are respiratory syncy- tial virus (RSV); adenovirus (Adv); influenza virus (Flu) types A and B; parainfluenza virus (PIV) types 1, 2, and 3; chlamydia pneumonia (CP); and mycoplasma pneumo- nia (MP) [4]. The relationship between clinical symptoms and respira- tory infections has been discussed frequently in the litera- ture, but viral detection provides more specific Published: 29 September 2009 Virology Journal 2009, 6:155 doi:10.1186/1743-422X-6-155 Received: 15 July 2009 Accepted: 29 September 2009 This article is available from: http://www.virologyj.com/content/6/1/155 © 2009 Peng et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Virology Journal 2009, 6:155 http://www.virologyj.com/content/6/1/155 Page 2 of 7 (page number not for citation purposes) information on the correlation between clinical symp- toms and specific infections [5-7]. With recent advances in methods to detect respiratory agents, numerous studies have shown that some pediatric patients with acute lower respiratory tract infection become infected simultane- ously with multiple respiratory viruses [8-10]. However, despite the high rate of infection with viral and other res- Probiotics May Lower Risk for Nosocomial Infections in Hospitalized Children A randomized, double-blind, placebo-controlled trial reported in the May issue of Pediatrics 2010 Children ‘s Hospital – Infection Control Department BACKGROUNDS The incidence of nosocomial infections, predominantly gastrointestinal and respiratory, in children in developed countries is high, ranging from 5% to 44% Gastrointestinal infections (4.5–22.6 episodes per 100 admissions) and respiratory infections (incidence ranging from 13% to 53% in all hospitalized children) account for the predominant types of infections BACKGROUNDS One of the potential strategies for the prevention of nosocomial infections is the use of probiotics The objective of this study was to investigate the role of Lactobacillus GG (LGG) in preventing nosocomial gastrointestinal and respiratory tract infections at a pediatric hospital METHODS The study design was a prospective, randomized, double-blind, placebo-controlled trial 742 children, aged to 18 years, were randomly assigned to receive LGG (n = 376) or placebo (n = 366) during their hospitalization at Pediatric Department (Children's Hospital Zagreb, Zagreb, Croatia) from November 2007 to May 2008 METHODS LGG was given at a dose of 109 colony-forming units in 100 mL of a fermented milk product, and the placebo consisted of the same postpasteurized fermented milk product without LGG The LGG product and placebo were packed in identical bottles; they were of the same color, weight, smell, and taste METHODS During the test period, patients were not allowed to consume any other product that contained probiotics or prebiotics All gastrointestinal and respiratory tract infections were diagnosed by a pediatrician RESULTS The risk for gastrointestinal infections was significantly reduced in the LGG group compared with the placebo group (RR: 0.40 [95% CI: 0.25 –0.70]; NNT: 15 [95% CI: 9–34]) Similarly, the risk for respiratory tract infections was significantly reduced in the LGG group compared with the placebo group (RR: 0.38 [95% CI: 0.18–0.85]; NNT: 30 [95% CI: 16–159]) RESULTS Moreover, in gastrointestinal infections patients, they compared the LGG group with the placebo group, children in the LGG group had a reduced risk for vomiting episodes (RR: 0.5 [95% CI: 0.3–0.9]) and diarrheal episodes (RR: 0.24 [95% CI: 0.10–0.50] RESULTS None of the gastrointestinal infection patients had a bacterial infection In patients, rotavirus (2 patients: both in the placebo group) or norovirus (3 patients: in the placebo group and in the LGG group) was isolated All patients were treated symptomatically, and none required antibiotic treatment RESULTS In regard to respiratory tract infections, patients in the LGG group had a lower risk for episodes of respiratory tract infections that lasted >3 days than patients in the placebo group (RR: 0.4 [95% CI: 0.2–0.9]; NNT: 33 [95% CI: 17–257]) RESULTS All patients had upper respiratory tract infections, and only patient in the placebo group also had a diagnosis of pneumonia A bacterial cause was determined and treated with antibiotics in only patients with upper respiratory tract infections (4 were from the placebo group) CONCLUSIONS The results of the randomized, double-blind, placebo-controlled trial suggests that Lactobacillus GG administration decreases the risk for nosocomial gastrointestinal and respiratory tract infections in hospitalized children LGG administration can be recommended as a valid measure for decreasing the risk for nosocomial gastrointestinal and respiratory tract infections in pediatric facilities CONCLUSIONS However, they suggest that this may not be justified in all hospitalized children because of the relatively high NNT (15 for gastrointestinal tract infections and 30 for respiratory tract infections) CONCLUSIONS Limitations of the study include exclusion of infants younger than year, and short duration and unproven cause of most of the nosocomial infections diagnosed during the study They encourage future studies of children who are younger than 12 months THANK YOU Timing of default from tuberculosis treatment: a systematic review Margaret E. Kruk 1 , Nina R. Schwalbe 2 and Christine A. Aguiar 1 1 Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA 2 Global Alliance for TB Drug Development, TB Alliance, New York, NY, USA Summary objectives To provide a systematic assessment of the timing of default from tuberculosis (TB) treatment which could help to quantify the potential contribution of new shorter duration TB drugs to global TB control. methods We performed a systematic review following QUOROM guidelines. MEDLINE was searched from 1998 to the present using the terms TB and default or drop-out or compliance or adherence and therapy. A total of 840 articles were returned. A further detailed manual review selected 15 randomized trials and observational studies that reported timing of drop-out and focused on developing countries. results The selected studies comprised randomized controlled trials, retrospective record reviews, and qualitative assessments and spanned 10 countries. Both directly observed treatment (DOT) and non-DOT programs were represented. Thus results were highly heterogeneous and not statistically aggregated. Data suggest, but do not conclude, that the majority of defaulters across the studies completed the 2-month intensive phase of treatment. conclusions There is insufficient high-quality comparable information on the timing of default from TB treatment to permit any firm conclusions on trends in default. However, a substantial pro- portion of defaulters appear to leave treatment in the later stages of the current 6-month regimen, suggesting that new TB chemotherapeutic agents which can reduce the length of treatment have the potential to improve global TB treatment success rates. keywords tuberculosis therapy, directly observed treatment, default, time of default, temporal trends Introduction Tuberculosis (TB) is a global health emergency, killing nearly 1.6 million people each year, mostly in low- and middle-income countries (Stop-TB Partnership 2006). TB cases in Africa have more than quadrupled since 1990, as a result of co-infection with HIV (WHO 2005). The World Health Organization (WHO) – recommended treatment strategy, directly observed treatment or direct observation (DOT), which forms the basis of the Stop TB Strategy, is a 6- to 8-month regimen with a combination of anti-TB agents (Lienhardt & Ogden 2004). This regimen is also known as short-course chemotherapy (SCC). The first 2 months of SCC, known as the intensive phase, generally involve a combination of four drugs and the 4- to 6-month follow-up period, known as the continuation phase, involves two drugs. Both the drugs used in treatment and the duration of the intensive phase may vary within SCC programs. While cure rates with this combination under optimal conditions approach 95%, actual global treatment success in 2005 was 84% (Borgdorff et al. 2002; WHO 2007). This figure is much lower in some regions: In Africa, the overall cure rate for smear-positive TB was 74% and as low as 54% in some areas (WHO 2007.) Further, Mycobacterium tuberculosis resistant to both isoniazid and rifampicin, or multi-drug resistant TB, is now diagnosed in an estimated 4.3% of all new and previously treated TB patients (Zignol et al. 2006). A major contributor to both treatment failure and the rise of multidrug-resistant TB is inadequate and incomplete treatment (Borgdorff et al. 2002; Sharma & Mohan 2006). While structural factors such as interruptions in drug supply play a role, patient default ESPGHAN Committee on ORIGINAL RESEARCH Open AccessEmergency intraosseous access in a helicopteremergency medical service: a retrospective studyGeir A Sunde1,2*, Bård E Heradstveit1,2, Bjarne H Vikenes1,2, Jon K Heltne1,2,3AbstractBackground: Intraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation ofcritically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseoustechniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articlesdocument IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS.Methods: We reviewed all medical records from the period May 2003 to April 2010, and compared three differenttechniques: Bone Injection Gun (B.I.G® - Waismed), manual bone marrow aspiration needle (Inter V - Medical DeviceTechnologies) and EZ-IO® (Vidacare), used on both adults and paediatric patients.Results: During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success onfirst attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p <0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%)and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used inconnection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Otherdiagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratoryfailure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger thantwo years. No cases of osteomyelitis or other serious complications were documented on the follow-up.Conclusions: Newer intraosseous techniques may enable faster and more reliable vascular access, and this canlower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believethat all emergency services that handle critically ill or injured paediatric and adult patients should be familiar withintraosseous techniques.BackgroundVascular access is important in the resuscitation of criti-cally ill or injured adult and paediatric patients [1,2]. Itcan be challenging to obtain vascular access, especiallyin the resuscitation of small children in emergencysituations [3-5]. The European Resuscitation Council2005 guidelines [6] and International Liaison Committeeon Resuscitation guidelines [4] recommend intraosseousaccess during resuscitation if intravenous access provesto be difficult or impossible. Despite these recommenda-tions, intraosseous techniques appear to be rarely used[7]. While numerous reports have been published aboutthe use of different intraosseous devices in emergencypatients, they are primarily from paramedic-basedambulance services [2,8]. Few comparisons have beenpublished of different IO techniques used by physiciansin emergency departments [7] or in HEMS servicesmanned by physicians/nurses [9,10].Typical HEMS operating conditions make specialdemands on medical equipment such as IO devices.Rain, cold, darkness and non-sterile conditions meanthat such equipment must be durable and simple to usein all conditions. User friendliness is important for res-cuers, both on-scene and in-flight [10].Intravenous access is traditionally regarded as theoptimal route for medication and fluids, and the* Oral Ondansetron for Gastroenteritis in a Pediatric Emergency Department Background BỘ GIÁO DỤC VÀ ĐÀO TẠO TRƯỜNG ĐẠI HỌC DÂN LẬP HẢI PHÒNG ------------------------------- ISO 9001 : 2008 KHÓA LUẬN TỐT NGHIỆP NGÀNH: NGOẠI NGỮ HẢI PHÒNG - 2010 2 HAIPHONG PRIVATE UNIVESITY FOREIGN LANGUAGES DEPARTMENT ----------------------------------- GRADUATION PAPER A STUDY ON TRANSLATION OF ENGLISH - RELATED TERMS IN FINANCE AND BANKING INTO VIETNAMESE By: BUI THI THOM Class: NA 1004 Supervisor: DAO THI LAN HUONG, M.A HAI PHONG - 2010 3 BỘ GIÁO DỤC VÀ ĐÀO TẠO TRƯỜNG ĐẠI HỌC DÂN LẬP HẢI PHÒNG -------------------------------------- Nhiệm vụ đề tài tốt nghiệp Sinh viên: .Mã Số: Lớp: Ngành: Tên đề tài: . . 4 Nhiệm vụ đề tài 1. Nội dung và các yêu cầu cần giải quyết trong nhiệm vụ đề tài tốt nghiệp ( về lý luận, thực tiễn, các số liệu cần tính toán và các bản vẽ). …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… 2. Các số liệu cần thiết để thiết kế, tính toán. …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… Update on mangement of patent ductus arteriosus in preterm infants Dr Trinh Thi Thu Ha Outline Overview of PDA Timing of screening PDA? When to treat PDA? Timing of ductal closure Prenatal MgSO4, tocolytic Postnatal surfactant Early, severe pulmonary hemorrhage is associated with ductal patency at 12 to 18 hours of age, but later pulmonary hemorrhage (after the first week) is not related to persistent ductal patency (Workbook in Practical Neonatology 5th Edition 2015) Diagnosis: In most cases, the clinically silent PDA during the first few days goes undetected unless an echocardiogram is performed Signs of bounding pulses, active precordium, and systolic murmur were of reasonable specificity but very low sensitivity in the first to days of birth for diagnosis of an echocardiographically defined significant PDA Relying on clinical signs alone led to a mean diagnostic delay of days (A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for patent ductus arteriosus.Skelton R1, Evans N, Smythe J JPaediatr Child Health 1994 Oct;30(5):406-11) Ibuprofen Prophylaxis No significant differences in mortality, IVH, or BPD No reduction in IVH, PAL in the treated group Increased risk of gastrointestinal bleeding Prophylactic ibuprofen exposes many infants to renal and gastrointestinal side effects without any important short-term benefits and is not recommended Pre-symptomatic Pharmacologic Treatment No effect on the rate of mortality, BPD, IVH, ROP, or length of ventilation, death, IVH, NEC,… More renal side effect Presymptomatic indomethacin or ibuprofen therapy for PDA in preterm infants is not recommended Conservative Management Fluid restriction Diuretics, avoidance of loop diuretics Maintaining a hematocrit of 35 to 40 percent Increased positive airway pressure Correction of alkalosis Avoidance of pulmonary vasodilators: oxygen or NO Asymptomatic infants with PDAs generally not require medical management or surgical ligation These infants should be monitored for evidence of CHF, failure or renal MANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN OVERVIEW • 1980s: dramatically improved by aciclovir HSV encephalitis in adults • Delays treatment(> 48h after hospital admission): associated with a worse prognosis OVERVIEW • Syndrome of neurological dysfunction: inflammation of the brain parenchyma • Many causes: Infectious: viruses, bacteria, parasites and fungi Non- infectious: antibody-mediated RECOMMENDATION • Which clinical features should lead to a suspicion of encephalitis in children? RECOMMENDATION • Current or recent febrile illness: altered behaviour, personality, cognition or consciousness, seizures or new focal neurological signs (A, II) • The differential diagnosis: metabolic, toxic, autoimmune causes or sepsis outside the CNS (B, III), past history is very important • Sub-acute (weeks to months) encephalitis: autoimmune, paraneoplastic, metabolic aetiologies (C, III) • Priority of the investigations: determined by clinical history and clinical presentation (C, III) RECOMMENDATION • Diagnostic features for specific aetiologies? Age Immunocompetence Geography Exposure HSV encephalitis RECOMMENDATION • Symptom: non – specific • Children: labial – herpes is diagnostic specific (develop encephalitis with primary HSV infection) • Acute opercular syndrome (disturbance of voluntary control of the facio-linguo-glossopharyngeal muscles leading to oro-facial palsy, dysarthria and dysphagia) • Sexual abuse RECOMMENDATION • MRI: as soon as possible on all patients with suspected encephalitis/ diagnosis is uncertain, 24 hrs – 48 hrs after hospital admission (B, II) • MRI: chosen appropriately should be interpreted by an experienced paediatric neuroradiologist • SPECT and PET are not indicated in the assessment of suspected acute viral encephalitis (B, II) • For which patients should aciclovir treatment be started empirically? RECOMMENDATIO • Initial CSF and/or imaging suspected encephalitis: start acyclovir within hours of admission if these results are awaited (A, II) • First CSF/imaging: normal, clinical suspicion of HSV or VZV encephalitis: start acyclovir within hours of admission whilst further diagnostic investigations are awaited (A, II) RECOMMENDATION • Dose? 3 months-12 years 500mg/m2 hourly >12 years 10mg/kg hourly reduced in patients with pre-existing renal impairment (A, II) If meningitis is also suspected, should also be treated (A, II) • How long should acyclovir be continued in proven HSV encephalitis, and is there a role for oral treatment? RECOMMENDATION • Proven: continued for 14-21 days (A, II), repeat LP • CSF PCR is still positive for HSV: aciclovir should continue, with weekly CSF PCR until it is negative (B, II) • months-12 years a minimum of 21 days of aciclovir should be given before repeating the LP (B, III) • When can presumptive treatment with aciclovir be safely stopped, in patients that are HSV PCR negative? RECOMMENDATION • An alternative diagnosis has been made, or • HSV PCR in the CSF is negative on two occasions 24-48 hours apart, and MRI imaging (performed >72 hours after symptom onset), is not characteristic for HSV encephalitis, or • HSV PCR in the CSF is negative once >72 hours after neurological symptom onset, with normal level of consciousness, normal MRI, CSF white cell count of less than 106/L (B, III) • What is the role of corticosteroids in HSVB encephalitis? RECOMMENDATION • Corticosteroids should not be used routinely in patients with HSV encephalitis (B, III) • Corticosteroids may have a role in patients with HSV encephalitis under specialist supervision (study results are awaited (C, III)) • What should be the specific management of VZV encephalitis? RECOMMENDATION • No specific treatment for VZV cerebellitis (B, II) • ... The incidence of nosocomial infections, predominantly gastrointestinal and respiratory, in children in developed countries is high, ranging from 5% to 44% Gastrointestinal infections (4.5 22 .6... GG administration decreases the risk for nosocomial gastrointestinal and respiratory tract infections in hospitalized children LGG administration can be recommended as a valid measure for decreasing... decreasing the risk for nosocomial gastrointestinal and respiratory tract infections in pediatric facilities CONCLUSIONS However, they suggest that this may not be justified in all hospitalized children