RESUMEN
OBJECTIVE: To detect the efficacy of neutrophil gelatinase-associated lipocalin (NGAL) in the early prediction of acute kidney injury (AKI) in children undergoing cardiopulmonary bypass (CPB). METHODS: A prospective observational study was conducted wherein 174 patients, aged 6 to 60 months, with congenital heart disease, undergoing CPB and who had a normal baseline renal function were enrolled. Plasma NGAL measurement was done preoperatively and serially at 2, 12, 24, 36, and 48 hours post-CPB initiation. Patients were classified into 2 groups according to the development of postoperative AKI. RESULTS: Plasma NGAL levels post-CPB were significantly higher in the AKI group compared to the non-AKI group with positive significant correlations between plasma NGAL level and severity of AKI. A rise in plasma NGAL of 500% from its preoperative basal level, when measured at 2 hours post-CPB initiation (NGAL 2-0 index), showed sensitivity and specificity of 83% and 64%, respectively (AUC = 0.667) and at 12 hours post-CPB initiation (NGAL 12-0 index) showed sensitivity and specificity of 66% and 64% respectively (AUC = 0.762). CONCLUSION: Plasma NGAL is a predictive biomarker for acute kidney injury after pediatric cardiac surgery. A 500% rise in plasma NGAL at 2 hours post-CPB initiation from its basal preoperative level (NGAL 2-0 index) is a precise, sensitive, and early predictor of AKI in children.
Asunto(s)
Lesión Renal Aguda , Biomarcadores , Puente Cardiopulmonar , Lipocalina 2 , Humanos , Lesión Renal Aguda/sangre , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Lipocalina 2/sangre , Puente Cardiopulmonar/efectos adversos , Preescolar , Lactante , Masculino , Femenino , Estudios Prospectivos , Biomarcadores/sangre , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/sangre , Sensibilidad y Especificidad , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/diagnósticoRESUMEN
BACKGROUND: About 25-50% of multisystem inflammatory syndrome in children (MIS-C) patients meet the criteria for diagnosis of Kawasaki disease (KD). The differentiation of both conditions is so challenging on clinical practice as the management of both is time dependant and precise diagnosis is fundamental. METHOD: Data were collected from children < 18 years old hospitalized with MIS-C or KD. Patient demographics, clinical, and laboratory data were compared, and a discrimination score was created to assist in clinical differentiation. RESULTS: 72 patients with MIS-C and 18 with KD were included in the study. Patients with MIS-C had a higher prevalence of abdominal pain (p = 0.02), vomiting (p = 0.03), and cervical lymphadenopathy (p = 0.02) compared with KD cases. MIS-C patients had higher liver enzymes (aspartate aminotransferase (AST) (p = 0.04), alanine aminotransferase (ALT) (p = 0.03), serum creatinine (p = 0.03), and lower platelet count nadir (p = 0.02) than KD. Four variables were detected in the regression analysis model, and the independent predictors were utilized to generate a scoring model that distinguished MIS-C from KD with an area under the curve of 0.70. CONCLUSION: This study constructed a prediction model for differentiation of MIS-C from KD based on clinical and laboratory profiles. This model will be valuable to guide clinicians in the treatment decisions. Key Points ⢠Children with MIS-C are more likely to have gastrointestinal symptoms, cervical lymphadenopathy, and respiratory involvement than KD patients. ⢠Elevated liver enzymes and lower platelet count are more pronounced laboratory findings in MIS-C than KD. ⢠This study constructed a prediction model for differentiation of MIS-C from KD based on clinical and laboratory profiles. This model will be valuable to guide clinicians in the treatment decisions.
Asunto(s)
COVID-19 , Síndrome Mucocutáneo Linfonodular , Niño , Humanos , Adolescente , SARS-CoV-2 , Estudios de Cohortes , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/diagnóstico , COVID-19/epidemiologíaRESUMEN
UNLABELLED: To demonstrate safety and efficacy of using normal saline (NS) for initial volume expansion (IVE) and rehydration in children with diarrhea-related hypernatremic dehydration (DR-HD), forty eight patients with DR-HD were retrospectively studied. NS was used as needed for IVE and for initial rehydration. Fluid deficit was given over 48 h. Median Na(+) level on admission was 162.9 mEq/L (IQR 160.8-165.8). The median average hourly drop at 6 and 24 h was 0.53 mEq/L/h (0.48-0.59) and 0.52 mEq/L/h (0.47-0.57), respectively. Compared to children not needing IVE, receiving ≥40 ml/kg IVE was associated with a higher average hourly drop of Na(+) at 6 h (0.51 vs. 0.58 mEq/L/h, p = 0.013) but not at 24 h (p = 0.663). The three patients (6.3%) with seizures had a higher average hourly drop of Na(+) at 6 and 24 h (p = 0.084 and 0.021, respectively). Mortality (4/48, 8.3%) was not related to Na(+) on admission or to its average hourly drop at 6 or 24 h. Children receiving ≥40 ml/kg IVE were more likely to die (OR 3.3; CI, 1.5-7.2). CONCLUSION: In children with DR-HD, NS is a safe rehydration fluid with a satisfactory rate of Na(+) drop and relatively low incidence of morbidity and mortality. Judicious use of IVE should be exerted and closer monitoring should be guaranteed for children requiring large volumes for IVE and for those showing rapid initial drop of serum Na(+) to avoid neurological complications and poor outcome.
Asunto(s)
Deshidratación/terapia , Diarrea/complicaciones , Fluidoterapia/métodos , Hipernatremia/terapia , Cloruro de Sodio/uso terapéutico , Preescolar , Deshidratación/etiología , Deshidratación/mortalidad , Diarrea/mortalidad , Femenino , Humanos , Hipernatremia/etiología , Hipernatremia/mortalidad , Lactante , Soluciones Isotónicas/uso terapéutico , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Respiratory failure is a life threatening complication of Guillain Barré syndrome (GBS). There is no consensus on the specific treatment for this subset of children with GBS. METHODS: This was a prospective randomized study to compare the outcome of intravenous immunoglobulin (IVIG) and plasma exchange (PE) treatment in children with GBS requiring mechanical ventilation. Forty-one children with GBS requiring endotracheal mechanical ventilation (MV) within 14 days from disease onset were included. The ages of the children ranged from 49 to 143 months.Randomly, 20 children received a five-day course of IVIG (0.4 g/kg/day) and 21 children received a five-day course of one volume PE daily. Lumbar puncture (LP) was performed in 36 patients (18 in each group). RESULTS: Both groups had comparable age (p = 0.764), weight (p = 0.764), duration of illness prior to MV (p = 0.854), preceding diarrhea (p = 0.751), cranial nerve involvement (p = 0.756), muscle power using Medical Research Council (MRC) sum score (p = 0.266) and cerebrospinal fluid (CSF) protein (p = 0.606).Children in the PE group had a shorter period of MV (median 11 days, IQR 11.0 to 13.0) compared to IVIG group (median 13 days, IQR 11.3 to 14.5) with p = 0.037.Those in the PE group had a tendency for a shorter Pediatric Intensive Care Unit (PICU) stay (p = 0.094).A total of 20/21 (95.2%) and 18/20 (90%) children in the PE and IVIG groups respectively could walk unaided within four weeks after PICU discharge (p = 0.606).There was a negative correlation between CSF protein and duration of mechanical ventilation in the PE group (p = 0.037), but not in the IVIG group (p = 0.132). CONCLUSIONS: In children with GBS requiring MV, PE is superior to IVIG regarding the duration of MV but not PICU stay or the short term neurological outcome.The negative correlation between CSF protein values and duration of MV in PE group requires further evaluation of its clinical usefulness. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT01306578.
Asunto(s)
Síndrome de Guillain-Barré , Inmunoglobulinas Intravenosas/uso terapéutico , Intercambio Plasmático , Respiración Artificial , Niño , Preescolar , Egipto , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Unidades de Cuidado Intensivo Pediátrico , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Insuficiencia Respiratoria/terapiaRESUMEN
The aim of the study is to characterize markers of apoptosis in children with acute lymphoblastic leukemia (ALL) in relation to treatment outcome of the disease. The study was performed on 34 children with ALL and 39 healthy children as a control group. Apoptosis was assessed by cell morphology; DNA fragmentation; ELISA and RT-PCR for CD95, CD95L, BcL-2 and nuclear factor-kappa B (NF-kappaB); and flow cytometry for CD95, CD40, CD49d and CD11a. Apoptosis was significantly lower in patients than controls. Apoptosis detected by CD95 ligand was significantly lower in cases with no remission after treatment than those who achieved remission. Anti-apoptotic factors: CD40, BcL-2, and NF-kappaB were all found to be higher in cases than controls and in cases with no remission than those achieved remission. CD49d was significantly lower in cases than controls, and significantly lower in cases with who did not achieve remission. CD11a levels were similar in the various groups. Delayed apoptosis of ALL cells is genetically controlled either directly or indirectly by a network of oncogenes and tumor suppressor genes. CD40 appeared to stimulate both T and B lineage and is considered the most potent influencer and predictor of resistance to therapy. Inhibitors for the activity of CD40, Bcl-2 and NF-kappaB as well as stimulants to CD95 could have a potential therapeutic benefit.