- MeSH
- dítě MeSH
- lidé MeSH
- Streptococcus pyogenes patogenita MeSH
- streptokokové infekce * diagnóza farmakoterapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
IMPORTANCE: Continuous kidney replacement therapy (CKRT) is the preferred method of kidney support for children with critical illness in pediatric intensive care units (PICUs). However, there are no data on the current CKRT management practices in European PICUs. OBJECTIVE: To describe current CKRT practices across European PICUs. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey of PICUs in 20 European countries was conducted by the Critical Care Nephrology Section of the European Society of Pediatric and Neonatal Intensive Care from April 1, 2020, to May 31, 2022. Participants included intensivists and nurses working in European PICUs. The survey was developed in English and distributed using SurveyMonkey. One response from each PICU that provided CKRT was included in the analysis. Data were analyzed from June 1 to June 30, 2022. MAIN OUTCOME AND MEASURES: Demographic characteristics of European PICUs along with organizational and delivery aspects of CKRT (including prescription, liberation from CKRT, and training and education) were assessed. RESULTS: Of 283 survey responses received, 161 were included in the analysis (response rate, 76%). The attending PICU consultant (70%) and the PICU team (77%) were mainly responsible for CKRT prescription, whereas the PICU nurses were responsible for circuit setup (49%) and bedside machine running (67%). Sixty-one percent of permanent nurses received training to use CKRT, with no need for certification or recertification in 36% of PICUs. Continuous venovenous hemodiafiltration was the preferred dialytic modality (51%). Circuit priming was performed with normal saline (67%) and blood priming in children weighing less than 10 kg (56%). Median (IQR) CKRT dose was 35 (30-50) mL/kg/h in neonates and 30 (30-40) mL/kg/h in children aged 1 month to 18 years. Forty-one percent of PICUs used regional unfractionated heparin infusion, whereas 35% used citrate-based regional anticoagulation. Filters were changed for filter clotting (53%) and increased transmembrane pressure (47%). For routine circuit changes, 72 hours was the cutoff in 62% of PICUs. Some PICUs (34%) monitored fluid removal goals every 4 hours, with variation from 12 hours (17%) to 24 hours (13%). Fluid removal goals ranged from 1 to 3 mL/kg/h. Liberation from CKRT was performed with a diuretic bolus followed by an infusion (32%) or a diuretic bolus alone (19%). CONCLUSIONS AND RELEVANCE: This survey study found a wide variation in current CKRT practice, including organizational aspects, education and training, prescription, and liberation from CKRT, in European PICUs. This finding calls for concerted efforts on the part of the pediatric critical care and nephrology communities to streamline CKRT education and training, research, and guidelines to reduce variation in practice.
- MeSH
- dítě MeSH
- diuretika MeSH
- heparin MeSH
- jednotky intenzivní péče pediatrické MeSH
- kontinuální metody náhrady funkce ledvin * MeSH
- lidé MeSH
- novorozenec MeSH
- průřezové studie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
PURPOSE: To determine normative data for the inferior vena cava (VCI) diameter in euvolemic children and its correlation with different somatic parameters in a pediatric population at one center in Europe. MATERIALS AND METHODS: This prospective observational study enrolled healthy children aged 4 weeks to 18y that visited our outpatient clinic. Weight, height, body surface area, and age were recorded. The children were grouped according to weight, as follows (80 children/group): < 10 kg, 10-19.9 kg, 20-29.9 kg, 30-59.9 kg, and 60-90 kg. Children were placed in a supine position and, during quiet respiration, the maximum and minimum VCI diameters were measured with M-mode ultrasonography. The collapsibility index (CI) was also automatically calculated for each subject: CI = [VCI maximum (expiratory) diameter - VCI minimum (inspiratory) diameter]/VCI maximum (expiratory) diameter. RESULTS: From May 2016 through November 2018 we retrieved data for 415 children that underwent VCI diameter evaluations. 400 children were included (mean age: 7.8y ± 5.8, mean weight: 32 kg ± 24.4, 46 % girls). The VCImax and the VCImin were significantly correlated with age (r = 0.867, p < 0.001, r = 0.797, p < 0.001), height (r = 0.840, p < 0.001, r = 0.772, p < 0.001), weight (r = 0.858, p < 0.001, r = 0.809, p < 0.001), and BSA (r = 0.878, p < 0.001, r = 0.817, p < 0.001). Correlations between the CI and age, weight, height, and BSA were not statistically significant. CONCLUSION: This prospective study provided reference values for sonographic measurements of VCI diameters in euvolemic children and might greatly assist in assessing fluid status in sick children.
- MeSH
- dítě MeSH
- lidé MeSH
- prospektivní studie MeSH
- referenční hodnoty MeSH
- ultrasonografie MeSH
- vena cava inferior * diagnostické zobrazování MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Geografické názvy
- Evropa MeSH
Akutní lymfoblastická leukemie (ALL) je nejčastějším maligním nádorovým onemocněním v dětském věku. Léčba ALL je založena na kombinované chemoterapii. Trvalého vyléčení lze v dnešní době dosáhnout až u 90 % pacientů. Onemocnění často doprovází řada komplikací. Mezi nejčastější komplikace patří bakteriální a mykotické infekce způsobené běžnými i oportunními patogeny. Mykotické infekce tvoří až 40 % všech infekčních komplikací. Prezentujeme případ dvouletého děvčátka asijského původu s projevy invazivní kandidózy diagnostikované během indukční fáze léčby ALL komplikovaného život ohrožujícím multiorgánovým selháním.
Acute lymphoblastic leukemia (ALL) represents 25 % of childhood tumors and it ́s the most frequent cancer in children. ALL treatment is based on combined chemotherapy. Long-lasted treatment is now achieved in up to 90 % of patients. The disease is accompanied by a number of complications. The most prevalent complications include bacterial and fungal infections caused by common and opportunistic pathogens. Fungal infections make up 40 % of all infectious complications. We present the case of a 2year-old girl of Asian origin with manifestations of invasive candidiasis diagnosed during the induction phase of treatment of ALL complicated by life-threatening multiorgan failure.
- MeSH
- akutní lymfatická leukemie * diagnóza farmakoterapie komplikace MeSH
- antibakteriální látky terapeutické užití MeSH
- antifungální látky terapeutické užití MeSH
- bakteriemie farmakoterapie MeSH
- fungemie farmakoterapie MeSH
- kandidóza invazivní * diagnóza farmakoterapie MeSH
- kombinovaná farmakoterapie metody MeSH
- lidé MeSH
- multiorgánové selhání terapie MeSH
- předškolní dítě MeSH
- progrese nemoci MeSH
- Check Tag
- lidé MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Background: Factor H-related protein 5 (FHR-5) is a member of the complement Factor H protein family. Due to the homology to Factor H, the main complement regulator of the alternative pathway, it may also be implicated in the pathomechanism of kidney diseases where Factor H and alternative pathway dysregulation play a role. Here, we report the first observational study on CFHR5 variations along with serum FHR-5 levels in immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) and C3 glomerulopathy (C3G) patients together with the clinical, genetic, complement, and follow-up data. Methods: A total of 120 patients with a histologically proven diagnosis of IC-MPGN/C3G were enrolled in the study. FHR-5 serum levels were measured in ELISA, the CFHR5 gene was analyzed by Sanger sequencing, and selected variants were studied as recombinant proteins in ELISA and surface plasmon resonance (SPR). Results: Eight exonic CFHR5 variations in 14 patients (12.6%) were observed. Serum FHR-5 levels were lower in patients compared to controls. Low serum FHR-5 concentration at presentation associated with better renal survival during the follow-up period; furthermore, it showed clear association with signs of complement overactivation and clinically meaningful clusters. Conclusions: Our observations raise the possibility that the FHR-5 protein plays a fine-tuning role in the pathogenesis of IC-MPGN/C3G.
- MeSH
- aktivace komplementu MeSH
- alely MeSH
- biologické markery * MeSH
- dospělí MeSH
- ELISA MeSH
- genetická predispozice k nemoci MeSH
- genetická variace * MeSH
- imunokomplex imunologie MeSH
- jednonukleotidový polymorfismus MeSH
- komplement C3 imunologie MeSH
- komplement genetika metabolismus MeSH
- lidé MeSH
- management nemoci MeSH
- membranoproliferativní glomerulonefritida krev diagnóza etiologie mortalita MeSH
- mladiství MeSH
- mladý dospělý MeSH
- náchylnost k nemoci MeSH
- prognóza MeSH
- ROC křivka MeSH
- studie případů a kontrol MeSH
- určení symptomu MeSH
- vyšetření funkce ledvin MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
