Treatment Of Disease In Children Research Articles

Remedial Dosing Recommendations for Sirolimus Delayed or Missed Dosages Caused by Poor Medication Compliance in Pediatric Tuberous Sclerosis Complex Patients.

Delayed or missed dosages caused by poor medication compliance significantly affected the treatment of diseases in children. The present study aimed to investigate the influence of delayed or missed dosages on sirolimus pharmacokinetics (PK) in pediatric tuberous sclerosis complex (TSC) patients and to recommend remedial dosages for nonadherent patients. A published sirolimus population PK model in pediatric TSC patients was used to assess the influence of different nonadherence scenarios and recommend optimally remedial dosages based on Monte Carlo simulation. Thirteen nonadherent scenarios were simulated in this study, including delayed 2h, 4 h, 6 h, 8 h, 10 h, 12 h, 14 h, 16 h, 18 h, 20 h, 22 h, 23.5 h, and missed one dosage. Remedial dosing strategies contained 10-200% of scheduled dosages. The optimal remedial dosage was that with the maximum probability of returning the individual therapeutic range. For delayed or missed sirolimus dosages in pediatric TSC patients, when the delayed time was 0-8 h, 8-10 h, 10-18 h, 18-22.7 h, 22.7-24 h, 70%, 60%, 40%, 30%, 20% scheduled dosages were recommended to take immediately. When one dosage was missed, 120% of scheduled dosages were recommended at the next dose. It was the first time to recommend remedial dosages for delayed or missed sirolimus therapy caused by poor medication compliance in pediatric TSC patients based on Monte Carlo simulation. Meanwhile, the present study provided a potential solution for delayed or missed dosages in clinical practice.

Health among Slum Children- A Sociological Study of Chennai City

The World Health Organization (WHO) defined health in its broader sense in its 1948 constitution as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Child health is the purview of pediatrics, which became a medical specialty in the mid-nineteenth century. Before that time the care and treatment of childhood diseases were included within such areas as general medicine, obstetrics and midwifery. A slum is a densely populated urban area and characterized by low standard of living. The rapid urbanization and increase in population resulted in the depletion and degradation of natural resources. Industrial expansion lead to the increase in the job potential in large cities, which attracted the rural population to migrate to cities and further converted the cities into a major slum and concrete jungles. Numbers of slums are increased in metropolitan cities due to acute shortage space for housing. At the same time, access to services like healthcare, fresh food, and basic sanitation may start to become restricted, creating filth and squalor. The present study titled Health among Slum Children- A Sociological Study of Chennai city has focused on the health conditions of Slum Children with three research objectives as (i). To find out the socio-economic background of the slum children in Chennai city, (ii). To bring out the nature and causes of health problems among slum children and (iii) To identify the types of health problems among slum children. The present study is descriptive in nature and tries to find out the nature and causes of health problems of slum children. The universe of the research is the total number of households of Ayothikuppam slum (1250 HH) and Saidapet slum (2220 HH). The total numbers of households are 3470. In order to have reliable data collection, the researcher has interviewed 50 slum children from the age group of 8-14 on the basis of convenient sampling method under Non-Random Sampling. The researcher has used interview schedule to collect data from the respondents. The findings of the study divulges that most of the slum children experienced diseases or health problems once in a month which are cold, cough and fever. During the illness time, 26% of the slum children were going to government hospital. 60% of the slum children are not having the habit of washing their hands before taking meals due to them play with friends and neighborhoods. 40% of the slum children are frequently affected by the fever like Malaria, Typhoid and 20% of the slum children were affected by cold and cough; sometimes it was in severe stage. The study has provided the following recommendations; i). Government has to provide formal education to the slum children and to guide them to go to school, ii) Government should take necessary step to clean the slum areas and near the Kuvam River, iii) NGO’s has to conduct more number of medical camps, awareness programmes about health and education to the slum children as well as their parents and iv) The government has to construct the public latrine for the slum areas.

Modern strategy for management of pediatric patients with gastroesophageal reflux disease in compliance with the international and national guidelines

Recent epidemiological studies demonstrated that gastroesophageal reflux disease (GERD) takes a leading place among acid‑dependent gastroenterological diseases. The problems of GERD development prevention and its treatment are topical since GERD significantly reduces the quality of life, especially when extraesophageal symptoms appear. Timely and correct GERD diagnosis, treatment and monitoring in pediatric patients prevents the development of complicated course of the disease in adults. Last decade, priority attention has been given to improving the quality of medical care in most countries worldwide. To achieve this purpose, effective medical care should be provided and the results of treatment of patients should be improved.
 The review presents analysis of current strategies for GERD diagnosis and treatment in pediatric patients based on the international and national guidelines. To ensure the proper quality of medical care, it is necessary to standardize approaches to diagnosis and treatment of diseases in childhood. The preparation of the Medical Standards of Care «Gastroesophageal Reflux Disease in Children» by a multidisciplinary group of experts and the adaptation of the clinical guideline are purposed to the improvement of existing diagnostic and treatment approaches to GERD pediatric patients in Ukraine, to ensuring high‑quality and effective medical care and establishing the uniform requirements for prevention, diagnosis and treatment of this group of patients. The results of modern investigations, based on international consensuses on the GERD diagnosis and treatment in childhood, have been highlighted. The latest information on the expediency of administration of instrumental examinations and treatment tactics has been presented.

Comparative studies of phytonutrients content and therapeutic potential of fruits parts of Dialium guineense Willd (Fabaceae) and Ziziphus mauritiana Lam. (Rhamnaceae) used in traditional pediatric in Burkina Faso

ABSTRACT Objective: The objective of the present study was to determine the phytonutrients content and selected biological activities of fruit parts of Dialium guineense commonly known as velvet tamarind and Ziziphus mauritiana called jujube tree used in the management of childhood diseases. Methodology and Results: Phytochemical components were determined by specific reagents and biological activities by antiradical and antibacterial test. The fruit pulp of Ziziphus mauritiana had the best antioxidant activity (IC50 = 0.27 mg/mL) due to its high contents ( p < 0.05 ) of total phenolic compounds (31.18 ± 0.06 mg GAE/g), flavonoids (0.73 ± 0.50 mg RE /g), hydrolysable tannins (11.37 ± 0.05 mg TAE/g) and condensed tannins (9.86 ± 0.30 mg CE/g). It also exhibited the highest contents of -carotene (72 ± 0.01 mg/100g) and macroelements Na (12 ± 0.00 mg/100g), K (605 ± 0.20 mg/100g). On the other hand, the fruit pulp of Dialium guineense had the best contents of vitamin C (36 ± 0.07 mg/100g), vitamin E (0.109 ± 0.07 mg/100g) and microelements (Fe, Zn) with 8.00 ± 0.01 mg/100g and 1.10 ± 0.02 mg/100g respectively. The fruits pulp of these two species showed antibacterial activity against E. coli with the best minimum inhibitory concentration (MIC) of 3.12 mg/mL Conclusions and application of results: Recommendations of enhancement and promotion of these two fruit species could constitute important sources for the development of new nutraceuticals and phytomedicines in the prevention and treatment of childhood diseases. Keywords: Childhood diseases, Dialium guineense, Ziziphus mauritiana, Nutraceuticals.

Antifosfolipidni sindrom kod dece

Antiphospholipid syndrome is a multisystemic autoimmune disease characterized by the appearance of arterial and/or venous thrombosis, often in multiple locations, thrombocytopenia and repeated spontaneous abortions in affected pregnant women, due to the permanent presence of antiphospholipid antibodies. It can also occur in children and manifest itself in any period of childhood, from infancy, due to transplacental transfer of maternal antibodies, or de novo production of autoantibodies, to adolescence. Clinical manifestations described in adults can also occur in children but are modified by age characteristics, such as the immaturity of the immune or other organ systems, greater exposure to viral and bacterial infections, implementation of routine immunization, absence of thrombogenic risk factors common to adults (hypertension, arteriosclerosis, consumption of cigarettes, alcohol and/or oral contraceptives), as well as the absence of pregnancy. Antiphospholipid antibodies most often used in daily clinical work are anticardiolipin antibodies, anti-b2 glycoprotein I antibodies, and lupus anticoagulants. Pathogenic mechanisms have not been investigated in detail - it is assumed that they are similar to the adult form of the disease. However, there is rare evidence of the existence of specific patterns of immune response to individual antigenic components, which may lead to specific production of antiphospholipid antibodies during childhood. It is also important to note that these antibodies can be found in about 25% of healthy children. The Sapporo criteria are used to diagnose antiphospholipid syndrome in adults. They include clinical (vascular thrombosis, repeated fetal losses) and laboratory parameters (persistent presence of one of the antiphospholipid antibodies) in the IgG and/or IgM class, in medium or high titer. The updated Sapporo criteria also apply to children. They include the same laboratory and clinical criteria, except for pregnancy pathology. The differential diagnosis is very broad and requires extensive diagnostics. Considering the specificity of the disease in childhood, the recommendations valid for adults, modified to a certain degree, apply to the treatment of diseases in children.

Evidence on postbiotics in infants and children.

The aim is to provide updated information on the concept of postbiotics and recent data on the efficacy of postbiotics for the prevention and treatment of childhood diseases. In line with a recently proposed consensus definition, a postbiotic is 'a preparation of inanimate microorganisms and/or their components that confers a health benefit on the host'. Although inanimate, postbiotics may exert health benefits. There are only limited data on infant formulas containing postbiotics, but they are well tolerated, support adequate growth and demonstrate no potential identifiable risks, although clinical benefits remain limited. Currently, there is only limited support for postbiotic use for treating diarrhoea and preventing common paediatric infectious diseases in young children. Given the limited evidence, sometimes with a high risk of bias, caution is justified. No data in older children and adolescents are available. The consensus definition of postbiotics facilitates further research. As not all postbiotics are the same, the type of disease and specific postbiotic studied should be considered when choosing postbiotics for the prevention or treatment of childhood diseases. Additional studies are needed to assess disease conditions responsive to postbiotics. Mechanisms of action of postbiotics need to be evaluated and characterized.

Innovations in Pediatric Therapeutics Development: Principles for the Use of Bridging Biomarkers in Pediatric Extrapolation

Even with recent substantive improvements in health care in pediatric populations, considerable need remains for additional safe and effective interventions for the prevention and treatment of diseases in children. The approval of prescription drugs and biological products for use in pediatric settings, as in adults, requires demonstration of substantial evidence of effectiveness and favorable benefit-to-risk. For diseases primarily affecting children, such evidence predominantly would be obtained in the pediatric setting. However, for conditions affecting both adults and children, pediatric extrapolation uses scientific evidence in adults to enable more efficiently obtaining a reliable evaluation of an intervention’s effects in pediatric populations. Bridging biomarkers potentially have an integral role in pediatric extrapolation. In a setting where an intervention reliably has been established to be safe and effective in adults, and where there is substantive evidence that disease processes in pediatric and adult settings are biologically similar, a ‘bridging biomarker’ should satisfy three additional criteria: effects on the bridging biomarker should capture effects on the principal causal pathway through which the disease process meaningfully influences ‘feels, functions, survives’ measures; secondly, the experimental intervention should not have important unintended effects on ‘feels, functions, survives’ measures not captured by the bridging biomarker; and thirdly, in statistical analyses in adults, the intervention’s net effect on ‘feels, functions, survives’ measures should be consistent with what would be predicted by its level of effect on the bridging biomarker. A validated bridging biomarker has considerable potential utility, since an intervention’s efficacy could be extrapolated from adult to pediatric populations if evidence in children establishes the intervention not only to be safe but also to have substantive effects on that bridging biomarker. Proper use of bridging biomarkers could increase availability of reliably evaluated therapies approved for use in pediatric settings, enabling children and their caregivers to make informed choices about health care.

Safety Evaluation of Oral Sirolimus in the Treatment of Childhood Diseases: A Systematic Review.

Background: Sirolimus, a mammalian target of rapamycin inhibitor, has been widely used in pediatric patients, but the safety of sirolimus in pediatric patients has not been well determined. Objective: The objective of this study was to systematically evaluate prospective studies reporting the safety of sirolimus in the treatment of childhood diseases. Methods: The following data were extracted in a standardized manner: study design, demographic characteristics, intervention, and safety outcomes. Results: In total, 9 studies were included, encompassing 575 patients who received oral sirolimus for at least 6 months. Various adverse events occurred. The most common adverse event was oral mucositis (8.2%, 95% CI: 0.054 to 0.110). Through comparative analysis of the subgroups based on the targeted concentration range, we discovered that many adverse events were significantly higher in the high concentration group (≥10 ng/mL) than in the low concentration group (<10 ng/mL) (p < 0.01). More interestingly, we found that oral mucositis was more frequently reported in children with vascular anomalies than tuberous sclerosis complex. Conclusions: This study shows that oral sirolimus in the treatment of childhood diseases is safe and reliable. However, sirolimus treatment in the pediatric population should be strictly monitored to reduce the occurrence of serious or fatal adverse events.

Photodynamic Therapy for Treatment of Disease in Children-A Review of the Literature.

Photodynamic therapy is a mode of treatment whereby local irradiation of an administered photosensitizer with light of a specific wavelength generates cytotoxic reactive oxygen species. Despite the upward trend in the popularity of this method in adults, it is not yet commonly used in the treatment of children. Due to certain limitations, underdeveloped treatment regimens and potential side effects, the use of photodynamic therapy in the pediatric population is still in the initial phases of evaluation in clinical trials. Method: This study is a review of articles in English from the databases PubMed and Web of Science retrieved by applying the search term “photodynamic therapy in children” from 2000–2020. Results: Based on the literature review, we analyze selected pediatric clinical cases in which photodynamic therapy was used for treatment in children. Examples of photodynamic therapy for treatment of dermatological diseases, diseases of the mucosa of the upper respiratory tract, halitosis, eye diseases and brain tumors are described. The paper describes the effectiveness of anti-cancer photodynamic therapy, including its use in antibacterial therapy. Conclusions: The results of the analysis suggest the potential of photodynamic therapy for the treatment of various diseases in children.

Cell Based Treatment of Autoimmune Diseases in Children.

Mesenchymal stem cells have recently been recoined as medicinal signaling cells (MSC) for their ability to promote tissue homeostasis through immune modulation, angiogenesis and tropism. During the last 20 years, there has been a plethora of publications using MSC in adults and to lesser extent neonates on a variety of illnesses. In parts of the world, autologous and allogeneic MSCs have been purified and used to treat a range of autoimmune conditions, including graft versus host disease, Crohn’s disease, multiple sclerosis, refractory systemic lupus erythematosus and systemic sclerosis. Generally, these reports are not part of stringent clinical trials but are of note for good outcomes with minimal side effects. This review is to summarize the current state of the art in MSC therapy, with a brief discussion of cell preparation and safety, insights into mechanisms of action, and a review of published reports of MSC treatment of autoimmune diseases, toward the potential application of MSC in treatment of children with severe autoimmune diseases using multicenter clinical trials and treatment algorithms.

Сучасні аспекти захворюваності гінгівітом та пародонтитом дітей та підлітків України, ефективність лікування та профілактики

The purpose of the work was to study modern aspects of the incidence of gingivitis and periodontitis in children and adolescents in Ukraine and to create an algorithm for treatment and prevention tactics in this pathology. It has been established that the high prevalence of gingivitis and periodontitis among children and adolescents makes this problem one of the most important problems of modern dentistry. The problem of periodontal pathology in children and adolescents is due to both the prevalence of diseases and the fact that poor-quality treatment of diseases in childhood and adolescence will lead to severe irreversible damage to periodontal tissues in adults. Modern prevention of inflammatory periodontal diseases in children and adolescents should be carried out on the basis of an algorithm of therapeutic and preventive measures: elimination of local traumatic factors, restoration of the anatomical shape of the teeth, high-quality treatment of the root system, replacement of defective restorations, professional oral hygiene, selection and correction of means and methods of individual hygiene. Results and discussion. The results of the study of oral hygiene and periodontal condition in patients with chronic limited catarrhal gingivitis and chronic localized periodontitis showed that the average value of most of the studied parameters in patients had significant differences when compared with healthy individuals in the control group, as well as between groups of patients. Index evaluation of the functional state of the peripheral circulation in the periodontal tissues of young patients revealed a significant decrease in capillary resistance. Based on literature data and the results of our own research and an objective method for predicting the localization of inflammatory diseases of periodontitis, a therapeutic and prophylactic tactic was developed in young patients with indications of diseases and risk factors for their development. Evaluation of the effectiveness of the developed method of treatment and prevention of localized periodontal tissue damage in patients of the main group was carried out on the basis of the results of clinical, physicochemical and functional research methods in comparison with groups of patients who underwent therapeutic and preventive measures in the traditional way. The results of treatment of localized inflammatory periodontal diseases were analyzed in 34 patients of the main group with chronic limited catarrhal gingivitis, 26 patients with chronic localized periodontitis of degree I and in a similar number of patients in the comparison group with an identical diagnosis. Conclusion. The results of treatment of 60 patients of the main group showed the high efficiency of the developed method. At the same time, a significant improvement in the subjective and objective symptoms of diseases was found. Complete clinical recovery with the elimination of the inflammatory process in the gums was found in 94.1% of patients with chronic limited catarrhal gingivitis of degree I. The obtained positive results of treatment of the main group of young patients with localized inflammatory lesions of periodontal tissues in terms of hygienic and periodontal indices and the state of peripheral circulation confirm the high efficiency of the developed algorithm for the treatment and prevention of these diseases

Accessibility of Essential Medicines for Children in Sichuan Province of China: A Cross-Sectional Study.

Background: Essential medicines for children are those medicines that satisfy the priority health care needs of children. Access to essential medicines for children is a big challenge, particularly in low- and middle-income countries. Our study aimed to assess the accessibility of essential medicines for children in public sector in Sichuan Province of China, based on availability, affordability, and price. Methods: We adopted the modified World Health Organization/Health Action International (WHO/HAI) standardization methodology to measure the availability, affordability, and prices of 30 essential medicines for children in 20 public hospitals in nine regions of the Sichuan Province, China. Availability was expressed as the percentage of public medicine outlets that stocked surveyed medicines on the day of data collection, and prices were expressed as median price ratio (MPR). Affordability was assessed as the number of Sichuan Province’s daily wages required for the lowest-paid government unskilled worker (11.03 USD per day) to purchase one standard treatment of an acute disease or treatment for chronic disease for a month. Results: The mean availability of originator brands (OBs) and lowest priced generics (LPGs) were 9.7 and 46.5% in public sector. MPRs of only 3 OBs could be calculated, ranging from 0.55 to 13.37. MPRs of 18 LPGs ranged from 0.07 to 25.05. Among them, 2 OBs and 11 LPGs were priced at more than 1.5 times their international reference prices (IRPs) in public sector, most of which were injections. Except for cefazolin injection and ceftriaxone injection, most LPGs were affordable for the treatment of childhood diseases in public sector, as they each cost one or less than the daily wage for the lowest-paid unskilled government worker. Conclusions: Although the availability of LPGs for children was higher than OBs in public sector, the availability of children’s essential medicines was low in surveyed public sector in Sichuan Province, which was similar to previous studies in other provinces of China. The price of most medicines surveyed was higher than their IRPs in surveyed public sector, especially for some injections. The affordability of most surveyed LPGs was reasonable in surveyed public sector, except for ceftriaxone injection and cefazolin injection.

Ефективність препарату Новірин у дітей із вірусними діареями

Стаття присвячена питанням лікування вірусних діарей. Основним напрямком лікування гострих кишкових інфекцій вірусної етіології є застосування регідратації та засобів симптоматичної терапії. Також даними досліджень неодноразово підтверджена ефективність противірусних засобів. Останніми роками при лікуванні захворювань вірусної етіології у дітей успішно використовується інозин пранобекс, противірусний засіб з імуномодулюючими властивостями. У наведеному авторами дослідженні продемонстрована ефективність препарату Новірин (інозин пранобекс) при лікуванні вірусних діарей у дітей: призначення Новірину дозволило припинити діарею в перші 5 днів від початку лікування у вірогідно більшого числа дітей (80 %) порівняно з контрольною групою (43 %).

Актуальні питання з проведення антибактеріальної терапії у дітей із гострими респіраторними захворюваннями

У статті розглянуті питання проведення антибактеріальної терапії у дітей із гострими респіраторними захворюваннями (ГРЗ): обґрунтованість призначення, вибір стартового антибіотика і методики терапії. Наведено аналіз 369 історій хвороби дітей, які перебували на стаціонарному лікуванні з приводу гострих респіраторних вірусних інфекцій, бронхітів і пневмоній. Відзначено, що у третини дітей із ГРЗ призначення антибактеріальної терапії було необґрунтованим і передчасним. Як стартовий антибіотик при терапії ГРЗ домінують цефалоспорини II і III поколінь. Виявлено нечасте використання тактики ступеневої терапії і переважно парентеральне призначення антибіотиків.

Неалкогольна жирова хвороба печінки в дітей: сучасний погляд на можливості діагностики та лікування (I частина)

На цей час неалкогольна жирова хвороба печінки (НАЖХП) визнана провідною нозологічною формою в структурі хронічних дифузних захворювань печінки в дітей та підлітків у промислово розвинутих країнах світу. НАЖХП асоціюється з абдомінальним ожирінням, інсулінорезистентністю, порушенням толерантності до вуглеводів та дисліпідемією, тобто має тісний зв’язок з метаболічним синдромом та є його проявом. Дані досліджень свідчать, що НАЖХП пов’язана з підвищенням рівня загальної смертності та ймовірності формування серцево-судинних захворювань, що не залежить від наявності класичних факторів ризику розвитку атеросклерозу. Спостереження за перебігом захворювання протягом 20 років дозволило встановити скорочення терміну виживаності хворих на НАЖХП порівняно з очікуваним показником у загальній популяції, прогресування ступеня фіброзу у 80 % випадках спостережень, розвиток декомпенсованих форм цирозу печінки з потребою в трансплантації органа в 6 % хворих. Схильність до прогресування структурних змін печінки з розвитком термінальних стадій захворювання — цирозу й гепатоцелюлярної карциноми, висока ймовірність розвитку кардіоваскулярних ускладнень, можливість запобігання прогредієнтному перебігу за умов своєчасного терапевтичного втручання обумовлюють необхідність ранньої діагностики НАЖХП у дітей.Провідними конституціональними факторами ризику розвитку НАЖХП, які модифікуються, у дітей вважаються ожиріння та інсулінорезистентність.Механізм розвитку й прогресування НАЖХП є складним і багатофакторним процесом. У даний час існують дві провідні концепції, що пояснюють патогенез НАЖХП, — теорія двох ударів та теорія багатьох паралельних ударів.НАЖХП у дітей не має певних клінічних ознак і є випадковою знахідкою в асимптомних пацієнтів. Маніфестація захворювання найчастіше відбувається у віці понад 10 років. У клінічній картині НАЖХП у дітей превалюють неспецифічні симптоми: загальна слабкість, швидка втомлюваність, виснажливість.У клінічній практиці зазвичай першим кроком у діагностиці захворювання є виявлення підвищених рівнів печінкових трансаміназ та/або сонографічних ознак стеатозу при рутинному ультразвуковому дослідженні.Установлення діагнозу НАЖХП є можливим за відсутності ознак іншої природи ураження печінки, насамперед вірусного, аутоімунного й медикаментозно індукованого гепатиту.

Clinical and diagnostic value of the method of chromato-mass spectrometry of microbial markers in case of damage to the oral mucosa in children by rheumatic diseases

Due to the presence of a large percentage of 42.6% secondary oral infection in children with rheumatic diseases [1, 2], which arose during long-term treatment of shock and maintenance doses of anti-inflammatory therapy, it was important to study the microbiota [16, 17]. This paper for the first time applied a modern method for assessing the microbiota of various biotopes of the affected oral mucosa in children with rheumatic diseases – chromatosis-mass-spectrometry (CMSM), based on the quantitative determination of the level of markers of microorganisms: fatty acids, aldehydes, alcohols [5, 7, 10, 11]. СMSM is a highly sensitive method with a wide diagnostic spectrum. The study of a wide range of microorganisms provides new opportunities in the diagnosis of oral dysbacteriosis and increasing the effectiveness of individual treatment. The aim of the study is to improve the level of diagnosis and treatment of oral mucosal diseases in children with rheumatic diseases, through the use of chromato-mass-spectrometry of the oral microbiota.

667. Next Generation Sequencing of Microbial Cell Free DNA in the Diagnosis and Treatment of Infectious Disease in Children: When Does the Result Justify the Cost?

BackgroundPathogen testing using next-generation sequencing of microbial cell-free DNA (NGS cfDNA) is a promising diagnostic tool to identify pathogens that might not be detected using conventional lab evaluation. Considering the cost of this test, it is important to determine when it is most useful to the plan of care (POC). Figure 1. Unit of admission among cases Figure 2. Patient characteristics in cases determined to be valuable and not valuable to the plan of care (POC) MethodsIn this retrospective study, we collected data from the medical charts of 50 consecutive NGS cfDNA tests in a free-standing children’s hospital. We evaluated patients for demographics, underlying conditions, diagnosis at time of testing, conventional laboratory testing and timing, medical treatment, and NGS cfDNA test results for clinical relevance or false negative results compared to conventional testing. The primary goal was to identify patients for whom the NGS cfDNA testing affected the POC. Charts were reviewed, and determinations regarding whether the result influenced the POC were confirmed by a provider.ResultsWe were unable to differentiate patients with clinically valuable NGS cfDNA results (Fig 1 & 2). Among those with NGS cfDNA results valuable to the POC (n=22), both negative and positive testing guided POC (13 valuable negative vs. 9 diagnostic cases). In the total sample, 5 cases (10%) had a clinically relevant pathogen identified through conventional testing, but not through NGS cfDNA and 2 cases had antimicrobial resistance on culture, which is not detected by NGS cfDNA. ConclusionWhile we did not find a specific clinical profile for NGS cfDNA use, positive results were essential to the diagnosis in 18% of cases with otherwise negative laboratory evaluation for the pathogen identified in NGS cfDNA. Negative tests affected the POC in 26% of cases by avoiding unnecessary antimicrobials in high risk immunocompromised patients and patients that presented with low-risk of infection, but unclear disease process. Caution must be exercised with reliance on this test with respect to antimicrobial resistance and risk of false negative results. Disclosures All Authors: No reported disclosures

Щодо ефективності застосування пантопразолу при кислотозалежних захворюваннях у дітей

У статті розглядається місце пантопразолу в терапії кислотозалежних захворювань у дітей. Підкреслено, що в практичній гастроентерології окрім оригінальних інгібіторів протонної помпи (брендів) використовують також препарати-генерики, які, на відміну від оригінальних інгібіторів протонної помпи, є набагато доступнішими для більшості пацієнтів. Метою висвітленої в статті роботи було вивчення клінічної ефективності генеричного препарату пантопразолу (Золопент) при лікуванні кислотозалежних захворювань у дітей. Золопент проявив себе як високоефективний антисекреторний препарат для лікування кислотозалежних захворювань (хронічного гастродуоденіту, виразкової хвороби, гастроезофагеальної рефлюксної хвороби) у дітей, що добре переноситься дітьми й не викликає побічних реакцій.

Хронічна хвороба нирок у дітей (огляд літератури)

У статті наводяться сучасні уявлення про хронічну хворобу нирок у дітей як про стан, що розвивається внаслідок необоротного зниження ниркових гомеостатичних функцій при будь-якому тяжкому прогресуючому захворюванні нирок. Показані епідеміологічні дані про поширеність, етіологічні фактори, методи діагностики, стадії і клінічний перебіг хронічної хвороби нирок у дітей. Крім того, зазначено, що раннє виявлення і своєчасне лікування хронічної хвороби нирок у дітей є важливою передумовою для запобігання або віддалення від її несприятливого результату. Більш того, показані високий ступінь інвалідизації і значне зниження якості життя пацієнтів, складність і висока вартість терапії хворих із термінальною хронічною нирковою недостатністю, що робить дуже актуальним запобігання її розвитку в пацієнтів із нефропатіями. Викладено основні принципи патогенетичної терапії, засновані на аналізі вітчизняних і зарубіжних керівництв із лікування хронічної хвороби нирок у дітей. Наведено схеми лікування білково-енергетичної недостатності, артеріальної гіпертензії, анемії, корекції порушень мінерального обміну. Обговорюються питання про зниження рівня азотемії різними препаратами і розробка нових препаратів із метою раннього початку лікування і запобігання розвитку тяжких форм хронічної хвороби нирок у дітей. Пошук потрібних літературних джерел проводився в базах даних Scopus, MedLine, The Cochrane Library, CyberLeninka, РІНЦ.

Світовий досвід з питань діагностики інтерстиціальних захворювань легень у дітей (up-date 2017)

статті наведені сучасні принципи класифікації, діагностики та лікування інтерстиціальних захворювань легень у дітей, що необхідно для практики педіатрів, сімейних лікарів, дитячих пульмонологів, торакальних хірургів, трансплантологів. Інтерстиціальні захворювання легень входять у структуру дифузних паренхіматозних захворювань легень, до якої на сьогодні включено понад 80 нозологічних форм. Об’єктивне дослідження, визначення фізичного розвитку, пульсоксиметрія, рентгенографія органів грудної клітки, комп’ютерна томографія високої роздільної здатності, ехокардіографія, генетичне тестування, бронхоальвеолярний лаваж і біопсія легень є важливими компонентами в установленні діагнозу інтерстиціального захворювання легень у дитини. Рекомендований Американським торакальним товариством алгоритм діагностики інтерстиціального захворювання легень у дитини залежно від віку та сімейної й особистої історії, вважаємо, буде корисним у повсякденній практиці. В статті визначено диференціально-діагностичні підходи до виявлення захворювань із групи дифузних паренхіматозних захворювань легень. У публікації подано графік моніторингу пацієнтів протягом року та довготривале спостереження з визначенням прогнозу інтерстиціального захворювання легень у хворої дитини.