BACKGROUND: Even though electrical injuries are common in the emergency room, guidelines, consensus, and general recommendations for the management of these patients do not exist in Europe. Documented cases of delayed arrhythmias are rare and their connection with electrical injury has not been fully confirmed. We also use cardio-specific markers for the risk stratification of myocardial injury, but there is no significant study referring to their utility in this clinical situation. These reasons led us to retrospectively analyze all cases of electrical injuries over 23 years to determine the prevalence of cardiac arrhythmias (mainly malignant arrhythmias and delayed arrhythmias). METHODS: We retrospectively searched all patients admitted to the University Hospital in Pilsen, CZ, with a diagnosis of electric injury (ICD diagnostic code T754) from 1997 to 2020. The hospital ́s information system was used to research the injury; data were drawn from patient medical records. RESULTS: We identified 333 cases of electrical injury in our hospital. Men accounted for about two-thirds, and women one-third. Children accounted for about one-third of cases. Most were low-voltage injuries (< 1000 V, 91.6%). All participants had an initial ECG, and 77.5% of patients had continuous ECG monitoring, usually lasting 24 h. Cardiac arrhythmias were noticed in 39 patients (11.7%). The most frequent arrhythmias were: ventricular fibrillation, sinus tachycardia, bradycardia and arrhythmia, atrial fibrillation, and supraventricular tachycardia. The ECG showed cardiac conduction abnormalities in 28 patients (8.1%), and ten patients (3%) had supraventricular or ventricular extrasystoles. In ten cases (3%), we found changes in ST segments and T waves on the initial ECG. Thirty-one patients (9.3%) suffered a loss of consciousness and 50 patients (15.02%) reported paresthesia. The most frequent ion disbalances were hypokalemia (18%) and hypocalcemia (3.3%). Patients with an ion disbalance had significantly more arrhythmias and newly diagnosed cardiac conduction abnormalities. Troponin levels (cTnI or hs-cTnT) were measured in 258 cases (77.48%) and found to be elevated above the 99th percentile in 19 cases (5.7%). Almost one-third of patients had burns of various degrees of seriousness, and 41 patients (12.3%) had concomitant traumatic injuries. Eleven patients underwent pre-hospital resuscitation, three died in the hospital, and another died as result of intracranial hemorrhage. CONCLUSION: All malignant arrhythmias occurred immediately after the electrical injury, delayed life-threatening arrhythmias were not observed, and no predictive factors of malignant arrhythmias were found. While elevations of cardiac troponins were observed sporadically, they did not appear helpful for risk stratification. In patients with arrhythmias, ion disbalance may be more critical. We concluded that asymptomatic, uninjured adult and pediatric patients with normal initial ECG findings do not need continuous ECG monitoring and may be discharged home. Recommendations for high-risk patients and patients with mild ECG abnormalities at admission are less obvious.
- MeSH
- Child MeSH
- Adult MeSH
- Electrocardiography MeSH
- Atrial Fibrillation * complications MeSH
- Humans MeSH
- Cardiac Conduction System Disease complications MeSH
- Electric Injuries * complications diagnosis epidemiology MeSH
- Retrospective Studies MeSH
- Tachycardia, Sinus MeSH
- Accidents MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
OBJECTIVES: Stroke volume (SV) and cardiac output monitoring is a cornerstone of hemodynamic assessment. Noninvasive technologies are increasingly used in children. This study compared SV measurements obtained by transcutaneous Doppler ultrasound techniques (ultrasonic cardiac output monitor [USCOM]), transthoracic echocardiography jugular (TTE-J), and parasternal (TTE-P) views performed by pediatric intensivists (OP-As) with limited training in cardiac sonography (20 previous examinations) and pediatric cardiologists (OP-Bs) with limited training in USCOM (30 previous examinations) in spontaneously ventilating children. METHODS: A single-center study was conducted in 37 children. Each operator obtained 3 sets of USCOM SV measurements within a period of 3 to 5 minutes, followed with TTE measurements from both apical and jugular views. The investigators were blinded to each other's results to prevent visual and auditory bias. RESULTS: Both USCOM and TTE methods were applicable in 89% of patients. The intraobserver variability of USCOM, TTE-J, and TTE-P were less than 10% in both investigators. The SV measurements by OP-As using USCOM, TTE-J, and TTE-P were 46.15 (25.48) mL, 39.45 (20.65) mL, and 33.42 (16.69) mL, respectively. The SV measurements by OP-Bs using USCOM, TTE-J, and TTE-P were 43.99 (25.24) mL, 38.91 (19.98) mL, and 37.58 (19.81) mL, respectively.The percentage error in SV with USCOM relative to TTE-J was 36% in OP-As and 37% in OP-Bs. The percentage error in SV with TTE-P was 33% relative to TTE-J in OP-As and 21% in OP-Bs. CONCLUSIONS: Our findings show that the methods are not interchangeable because SV values by USCOM are higher in comparison with the SV values obtained by TTE. Both methods have low level of intraobserver variability. The SV measurements obtained by TTE-P were significantly lower compared with the TTE-J for the operator with limited training in echocardiography. The TTE-P requires longer practice compared with the TTE-J; therefore, we recommend to prefer TTE-J to TTE-P for inexperienced operators.
- MeSH
- Child MeSH
- Echocardiography * methods MeSH
- Humans MeSH
- Cardiac Output MeSH
- Monitoring, Physiologic methods MeSH
- Prospective Studies MeSH
- Stroke Volume MeSH
- Ultrasonics * MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
Článek shrnuje základní cyanotické srdeční vady. Popisuje jejich anatomii, hemodynamický profil s klinickými projevy a principy jejich korekce. Slouží jako podkladový materiál k přípravě na atestační zkoušku z Pediatrie.
The article summarizes the basic cyanotic heart defects. It describes their anatomy, hemodynamic profile with clinical manifestations and principles of their correction. It serves as a paper for preparation for the certificate exam in Pediatrics.
- MeSH
- Cyanosis physiopathology MeSH
- Child MeSH
- Humans MeSH
- Heart Failure MeSH
- Heart Defects, Congenital * surgery physiopathology MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
The worldwide outbreak of the novel 2019 coronavirus disease (COVID-19) has led to recognition of a new immunopathological condition: paediatric inflammatory multisystem syndrome (PIMS-TS). The Czech Republic (CZ) suffered from one of the highest incidences of individuals who tested positive during pandemic waves. The aim of this study was to analyse epidemiological, clinical, and laboratory characteristics of all cases of paediatric inflammatory multisystem syndrome (PIMS-TS) in the Czech Republic (CZ) and their predictors of severe course. We performed a retrospective-prospective nationwide observational study based on patients hospitalised with PIMS-TS in CZ between 1 November 2020 and 31 May 2021. The anonymised data of patients were abstracted from medical record review. Using the inclusion criteria according to World Health Organization definition, 207 patients with PIMS-TS were enrolled in this study. The incidence of PIMS-TS out of all SARS-CoV-2-positive children was 0.9:1,000. The estimated delay between the occurrence of PIMS-TS and the COVID-19 pandemic wave was 3 weeks. The significant initial predictors of myocardial dysfunction included mainly cardiovascular signs (hypotension, oedema, oliguria/anuria, and prolonged capillary refill). During follow-up, most patients (98.8%) had normal cardiac function, with no residual findings. No fatal cases were reported.Conclusions: A 3-week interval in combination with incidence of COVID-19 could help increase pre-test probability of PIMS-TS during pandemic waves in the suspected cases. Although the parameters of the models do not allow one to completely divide patients into high and low risk groups, knowing the most important predictors surely could help clinical management.
- MeSH
- COVID-19 * complications diagnosis epidemiology MeSH
- Child MeSH
- Humans MeSH
- Pandemics MeSH
- Prospective Studies MeSH
- Retrospective Studies MeSH
- SARS-CoV-2 * MeSH
- Systemic Inflammatory Response Syndrome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Geographicals
- Czech Republic MeSH
Přes pokroky v medicíně zůstává sepse i v 21. století jedním z hlavních faktorů, které se podílejí na morbiditě a mortalitě v dětském věku. Problematika sepse u dětí má svá specifika. Cílem článku je popsat přehlednou a ucelenou formou definici, etiologii, epidemiologii, patofyziologii, klinický obraz, diagnostiku a úvodní fázi terapie sepse u dětí mimo novorozenecký věk.
Despite advances in medicine, even in the 21st century, sepsis remains one of the main factors contributing to morbidity and mortality in childhood. The issue of sepsis in children has its own specifics. The aim of the article is to describe in a clear and comprehensive form the definition, etiology, epidemiology, pathophysiology, clinical picture, diagnosis and initial phase of treatment of sepsis outside the newborn age.
- MeSH
- Anti-Bacterial Agents classification therapeutic use MeSH
- Child MeSH
- Hemodynamics MeSH
- Clinical Laboratory Techniques MeSH
- Humans MeSH
- Sepsis * diagnosis drug therapy physiopathology therapy MeSH
- Shock, Septic diagnosis physiopathology therapy MeSH
- Fluid Therapy MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
Cíl: Cílem studie bylo analyzovat epidemiologii a klinický průběh syndromu multisystémové zánětlivé odpovědi spojeného s infekcí SARS-CoV-2 u dětí a mladistvých (paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2, PIMS-TS) v České republice (ČR). Metody: Do retrospektivně-prospektivní observační celonárodní studie byli zařazeni pacienti s PIMS-TS dle diagnostických kritérií Světové zdravotnické organizace, kteří byli hospitalizováni v ČR v období od 1. 11. 2020 do 31. 5. 2021. Anonymizovaná data těchto pacientů (demografické a klinické údaje) byla získána z lékařských zpráv. Některá data z výše uvedeného sledovaného období byla následně porovnána s výsledky menšího souboru pacientů z další pandemické vlny. Druhá fáze observační celonárodní studie navazovala v období od 1. 6. 2021 do 31. 3. 2022, které bylo charakterizováno převažujícími variantami viru delta a následně omikron. Výsledky: Od 1. 11. 2020 do 31. 5. 2021 bylo na území ČR diagnostikováno 207 pacientů s PIMS-TS. V pediatrické populaci (0–19 let) byla incidence 1 : 10 100 obecné populace, resp. 1 : 1127 ve skupině pozitivně testovaných jedinců. Při následné ambulantní kontrole měli všichni pacienti normální srdeční funkci, pouze u dvou (1,2 %) přetrvávala dilatace koronární tepny. V období 1. 6. 2021 až 31. 3. 2022 byl PIMS-TS diagnostikován u dalších 222 dětí. Zatímco při převažující variantě delta byl výskyt PIMS-TS vysoký, ve fázi převažující varianty omikron poklesl ve vztahu k počtu pozitivně testovaných na čtvrtinu. Celkově tedy onemocnělo 429 dětí, nebyly zjištěny žádné případy úmrtí. Závěry: Nízký výskyt závažných průběhů nemoci a nulovou mortalitu u PIMS-TS lze vysvětlit edukací pediatrů v celé ČR a sjednocením diagnostických a terapeutických postupů s časným podáním kombinované imunosupresivní terapie.
Objective: The aim of this study was to analyse epidemiology and clinical course of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the Czech Republic. Methods: We performed a retrospective-prospective nationwide observational study based on patients hospitalised with PIMS-TS according to World Health Organization definition and who were admitted to a hospital in the Czech Republic between November 1st, 2020, and May 31st, 2021. The anonymised data of patients (demographic and clinical data) were obtained from their medical records. Some of the data from the above-mentioned study period were compared with the results of a smaller set of patients from the next pandemic wave. The second nationwide observation period followed from June 1st, 2021, to March 31st, 2022. This period was characterized by prevailing delta and subsequently omicron variants. Results: Between November 1st, 2020 and May 31st, 2021, the total number of diagnosed patients with PIMS-TS in the Czech Republic was 207. The overall incidence was 1:10,100 of the paediatric population aged 0–19 years; and 1:1,127 out of all children who tested positive for SARS-CoV-2, respectively. During follow-up, only two patients (1.2%) had persistent coronary artery dilation, all patients had normal cardiac function. Between June 1st, 2021 and March 31st, 2022, PIMS-TS was diagnosed in additional 222 children. Whereas PIMS-TS was frequent during the prevailing delta variant, the predominating omicron variant led to its decline to one fourth in relation to numbers of those tested positively for SARS-CoV-2. The total number of children affected by PIMS-TS reached 429, with no reported fatalities. Conclusion: Above expectation outcome with no death could be explained by awareness campaigns and national guidelines with early use of combined immunosuppressive treatment.
Článek pojednává o nové diagnóze v pediatrické populaci v rámci pandemie covidu-19. První část je věnována 2 kazuistikám a zkušenostem s diagnostikou a terapií MIS-C (multisystémový zánětlivý syndrom u dětí a mladistvých) na Dětské klinice Fakultní nemocnice Plzeň, druhá část textu pojednává o etiologii, diagnostice a možnostech terapie MIS-C.
Authors present a new syndrome - MIS-C (multisystem inflammatory syndrome in children) in the pediatric population that has emerged within the COVID-19 pandemic. Firstly the authors share their expiriences with the syndrome on two report cases. Secondly, etiology, diagnostics and therapy of MIS-C is discussed.
- MeSH
- COVID-19 * complications MeSH
- Child MeSH
- Fever MeSH
- Mucocutaneous Lymph Node Syndrome therapy MeSH
- Clinical Laboratory Techniques MeSH
- Infant MeSH
- Humans MeSH
- Systemic Inflammatory Response Syndrome * diagnosis etiology therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Práce popisuje kazuistiku vzácné kombinace dvou výše zmíněných genetických syndromů s familiárním výskytem (obr. 4) diagnostikovaných již prenatálně u novorozence s komplikovanou perinatální anamnézou. Ve vlastní kazuistice a přiložené fotodokumentaci je zdůrazněna přítomnost typických klinických příznaků pro jednotlivá onemocnění.
The paper describes a case study of a rare combination of the two above-mentioned genetic syndromes with familial incidence (Fig. 4) diagnosed prenatally in a newborn with a complicated perinatal history. The actual case report and the attached photographic documentation emphasize the presence of typical clinical symptoms for individual diseases.
- MeSH
- Cardiomyopathy, Hypertrophic diagnosis MeSH
- Humans MeSH
- Myotonic Dystrophy diagnosis physiopathology MeSH
- Infant, Newborn MeSH
- LEOPARD Syndrome * diagnosis genetics MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Publication type
- Case Reports MeSH
