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Τετάρτη 15 Ιουνίου 2022

Giant solitary synovial osteochondromatosis of the temporomandibular joint: A case report

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Publication date: Available online 15 June 2022

Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology

Author(s): Hisashi Ozaki, Masatoshi Chiba, Yoshioki Hamamoto, Mitsuyoshi Iino

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Clinical and laboratory responses to tigecycline in children

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Clinical and laboratory responses to tigecycline in children

Resistant bacterial infections have become more common in recent years, its treatment becomes a difficult problem. Tigecycline has a broad-spectrum antibacterial activity including resistant pathogens. Tigecycline may be a safe and important option in pediatric nosocomial infections due to resistant bacteria. Paediatric patients treated with tigecycline from 1 January 2010 to 31 October 2018 were analysed retrospectively to assess the efficacy and safety of tigecycline in children. Clinical response was considered cure in patients with all clinical signs of tigecycline-induced infection disappearing, a complete laboratory response, and improvement without further antibacterial therapy. The clinical response in patients who were not cured but recovered to the extent deemed appropriate by the researcher was evaluated as remission. Clinical response was considered failure in patients with no clinical improvement, culture positivity, acute-phase reactant elevation, and need for additi onal antibacterial therapy. There was a total of 25,251 patients, 1301 of whom were hospitalized in paediatric intensive care during the study. Paediatric patients who received tigecycline for at least 2 days (at least four doses) were analysed. This study included 91 children who received tigecycline treatment and met the inclusion criteria, aged 7 months to 17.5 years (median 8 years). The median length of hospital stay was 62 days (14–251 days). The median duration of antibiotic treatment before tigecycline treatment was 27 days (4–30 days). Among the most common were glycopeptides (95.6%) and carbapenems (89%). There were no significant differences in clinical response between tigecycline as monotherapy and as combined therapy (p = 0.742). Studies on the efficacy of tigecycline in children are not prospective due to safety concerns but contain data from limited cases in which it was used as salvage therapy. In our study, tigecycline was gi ven to 73.6% of patients as monotherapy, and this is the largest series involving monotherapy. The fact that the patients used long-term and multiple antimicrobial agents before tigecycline treatment (95.6% glycopeptides and 89% carbapenems) limited the options of antibiotics. Therefore, the rate of monotherapy was high, and clinical success did not differ significantly between patients who started tigecycline as monotherapy and combination therapy.


Abstract

What is known and objective

The frequency of multidrug-resistant bacterial infections is increasing worldwide. Tigecycline may be an important option for children with life-threatening nosocomial infections due to multidrug-resistant bacteria. However, there are few published data on the use of tigecycline in paediatric patients. By examining the results of tigecycline use in children, we aimed to draw attention to the fact that tigecycline may be an alternative in the treatment of resistant infections in children.

Methods

Paediatric patients treated with tigecycline from 1 January 2010 to 31 October 2018 at Eskişehir Osmangazi University Medical Faculty, which is a tertiary hospital, were analysed retrospectively to assess the efficacy and safety of tigecycline treatment in children. Patients using tigecycline were identified using the pharmacy database. Clinical and laboratory data were obtained from the files.

Results and discussion

This study included 91 children aged 7 months to 17.5 years; 52 were female (57.1%). At least one predisposing factor was present in 98.9% of the patients. Fifty-one bacteria were isolated from 44 patients. The tigecycline resistance rate was 3.9%. Only 2 of 91 patients experienced one or more side effects of tigecycline. Tigecycline can be used as salvage therapy in resistant infections where options are limited, although definitive conclusions about the efficacy and safety of tigecycline in children cannot be reached.

What is new and conclusion

Tigecycline may be a safe and important option in paediatric nosocomial infections due to resistant bacteria. Resistant bacterial infections have become more common in recent years, its treatment becomes a difficult problem. Tigecycline has a broad-spectrum antibacterial activity including resistant pathogens.

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Thrombosis and hemorrhage experienced by hospitalized children with SARS‐CoV‐2 infection or MIS‐C: Results of the PICNIC registry

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Abstract

Introduction

Coagulopathy and thrombosis associated with SARS-CoV-2 infection are well defined in hospitalized adults and leads to adverse outcomes. Pediatric studies are limited.

Methods

An international multicentered (n = 15) retrospective registry collected information on the clinical manifestations of SARS-CoV-2 and multisystem inflammatory syndrome (MIS-C) in hospitalized children from February 1, 2020 through May 31, 2021. This sub-study focused on coagulopathy. Study variables included patient demographics, comorbidities, clinical presentation, hospital course, laboratory parameters, management, and outcomes.

Results

Nine hundred eighty-five children were enrolled, of which 915 (93%) had clinical information available; 385 (42%) had symptomatic SARS-CoV-2 infection, 288 had MIS-C (31.4%), and 242 (26.4%) had SARS-CoV-2 identified incidentally. Ten children (1%) experienced thrombosis, 16 (1.7%) experienced hemorrhage, and two (0.2%) experienced both thrombosis and hemorrhage. Significantly prevalent prothrombotic comorbidities included congenital heart disease (p-value .007), respiratory support (p-value .006), central venous catheter (CVC) (p = .04) in children with primary SARS-CoV-2 and in those with MIS-C included respiratory support (p-value .03), obesity (p-value .002), and cytokine storm (p = .012). Comorbidities prevalent in children with hemorrhage included age >10 years (p = .04), CVC (p = .03) in children with primary SARS-CoV-2 infection and in those with MIS-C encompassed thromb ocytopenia (p = .001) and cytokine storm (p = .02). Eleven patients died (1.2%), with no deaths attributed to thrombosis or hemorrhage.

Conclusion

Thrombosis and hemorrhage are uncommon events in children with SARS-CoV-2; largely experienced by those with pre-existing comorbidities. Understanding the complete spectrum of coagulopathy in children with SARS-CoV-2 infection requires ongoing research.

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BCAP31 is involved in modulating colorectal cancer cell proliferation via the Emerin/β-catenin axis

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Publication date: Available online 15 June 2022

Source: Experimental Cell Research

Author(s): Liping Han, Junyang Shi, Lili Zhao, Jiaqiang Deng, Yan Li, Hong Zhao, Huani Wang, Yan Yan, Fangdong Zou

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Primary tumor volume and prognosis for patients with p16-positive and p16-negative oropharyngeal squamous cell carcinoma treated with radiation therapy

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The prescribed radiation dose to patients with oropharyngeal squamous cell carcinoma (OPSCC) is standardized, even if the prognosis for individual patients may differ. Easy-at-hand pre-treatment risk stratific...
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Analgesia for Retinopathy of Prematurity Screening: A Systematic Review

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Abstract

Background and Aims

Premature neonates require regular ophthalmological examination, generally indirect ophthalmoscopy, to screen for retinopathy of prematurity (ROP). Conventional analgesia is provided with topical anaesthetic eyedrops and oral sugar solution, but neonates still experience significant pain. Here, the literature base was examined to evaluate the usefulness of other pharmacological analgesics.

Materials and Methods

A systematic review was undertaken, adhering to a PROSPERO preregistered protocol in accordance with PRISMA guidelines (identifier CRD42022302459). Electronic databases were searched for primary research articles on pharmacological pain interventions used for ROP screening in neonates. The primary outcome measure was pain scores recorded using validated pain scoring tools, with and without pharmacological interventions in neonates during eye examination. For analysis, studies were separated into two categories: topical anaesthesia and alternative pharmacological treatments.

Results

Eleven studies met the inclusion criteria. Topical analgesia, oral paracetamol, and intranasal fentanyl were found to be effective in reducing the pain of eye examination. Oral morphine and inhaled nitrous oxide had no significant effect on premature infant pain profile (PIPP) scores during indirect ophthalmoscopy.

Discussion

In addition to topical anaesthesia, premedication with oral paracetamol is recommended during screening examination for ROP. The routine use of fentanyl is not recommended due to the risk of potential side effects. Non-pharmacological measures, such as sweet oral solutions and comfort techniques may also be employed. Further research is required to determine whether the use of nitrous oxide has a role, and to develop a safe and effective analgesic strategy to fully ameliorates the pain of ROP screening.

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