scholarly journals Clinical Analysis of Micafungin Treatment in Children with Candida Infection: A Single Center Experiment

2020 ◽  
Vol 54 (4) ◽  
pp. 201-207
Author(s):  
Ayşe Şahin ◽  
Nazan Dalgıç ◽  
Ayşe Barış ◽  
Banu Özata Abanoz
Keyword(s):  
Risk Factors ◽  
Side Effects ◽  
Clinical Characteristics ◽  
Pediatric Patients ◽  
Laboratory Data ◽  
Case Series ◽  
Venous Catheter ◽  
Clinical Analysis ◽  
Candida Infection ◽  
Candida Infections

Objective: For the treatment of invasive candidiasis (IC) which is confirmed or suspected in adults, echinocandins are usually recommended. In children; however, very little is known about using echinocandins for IC management. Micafungin (MCFG) is approved for both treatment and prevention (prophylaxis) of invasive Candida infections. In this study, pediatric patients diagnosed with Candida infection and treated with MCFG were evaluated retrospectively. Clinical characteristics of the patients and the results of MCFG treatment were discussed in light of the literature. Material and Methods: The study included 10 pediatric patients aged between 28 days and 16 years. They were diagnosed with Candida infection between January 01, 2017 and January 01, 2019, and were treated with MCFG. The patients’ microbiological and laboratory data, demographic and clinical characteristics, risk factors for IC, MCFG treatment characteristics and the side effects were recorded retrospectively from electronic records. Results: The median age of the patients in the study was 22 months (range 1.5 to 178 mo). Candida species isolated from the patients were C. parapsilosis, C. orthopsilosis, C. tropicalis, C. albicans, C. kefyr and C. guilliermondii. The most common underlying disease was gastrointestinal anomaly and related problems. The most common risk factors included the use of broad-spectrum antibiotics, total parenteral nutrition, mechanical ventilation, and central venous catheter. The median dose of MCFG was 2 mg/ kg per day (d) and was applied to the patients for a minimum of 3 days and a maximum of 23 days. There were no side effects observed. Conclusion: In our limited case series of pediatric patients, MCFG was found effective in treating both proven and suspected invasive Candida infections and no adverse side effects were observed.

scholarly journals Clinical Analysis of Micafungin Treatment in Children with Candida Infection: A Single Center Experiment

2020 ◽  
Vol 54 (4) ◽  
pp. 181-187
Author(s):  
Ayşe Şahin ◽  
Nazan Dalgıç ◽  
Ayşe Barış ◽  
Banu Özata Abanoz
Keyword(s):  
Risk Factors ◽  
Side Effects ◽  
Clinical Characteristics ◽  
Pediatric Patients ◽  
Laboratory Data ◽  
Case Series ◽  
Venous Catheter ◽  
Clinical Analysis ◽  
Candida Infection ◽  
Candida Infections

Objective: For the treatment of invasive candidiasis (IC) which is confirmed or suspected in adults, echinocandins are usually recommended. In children; however, very little is known about using echinocandins for IC management. Micafungin (MCFG) is approved for both treatment and prevention (prophylaxis) of invasive Candida infections. In this study, pediatric patients diagnosed with Candida infection and treated with MCFG were evaluated retrospectively. Clinical characteristics of the patients and the results of MCFG treatment were discussed in light of the literature. Material and Methods: The study included 10 pediatric patients aged between 28 days and 16 years. They were diagnosed with Candida infection between January 01, 2017 and January 01, 2019, and were treated with MCFG. The patients’ microbiological and laboratory data, demographic and clinical characteristics, risk factors for IC, MCFG treatment characteristics and the side effects were recorded retrospectively from electronic records. Results: The median age of the patients in the study was 22 months (range 1.5 to 178 mo). Candida species isolated from the patients were C. parapsilosis, C. orthopsilosis, C. tropicalis, C. albicans, C. kefyr and C. guilliermondii. The most common underlying disease was gastrointestinal anomaly and related problems. The most common risk factors included the use of broad-spectrum antibiotics, total parenteral nutrition, mechanical ventilation, and central venous catheter. The median dose of MCFG was 2 mg/kg per day (d) and was applied to the patients for a minimum of 3 days and a maximum of 23 days. There were no side effects observed. Conclusion: In our limited case series of pediatric patients, MCFG was found effective in treating both proven and suspected invasive Candida infections and no adverse side effects were observed.

scholarly journals Acute Megakaryocytic Leukemia with or Without Acquired Trisomy 21 in 15 Pediatric Patients

2020 ◽  
Author(s):  
Wenzhi ZHANG ◽  
Hui LI ◽  
Jingzhen LIU ◽  
Jiawei XU ◽  
Jinjin HAO ◽  
...  
Keyword(s):  
Trisomy 21 ◽  
Poor Prognosis ◽  
Clinical Characteristics ◽  
Pediatric Patients ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
The Other ◽  
Hematopoietic Stem ◽  
Acute Megakaryocytic Leukemia

Abstract The knowledge of clinical characteristics and prognosis of pediatric acute megakaryocytic leukemia (AMKL) with or without acquired +21 was limited. We reported 15 AMKL pediatric patients without Down Syndrome (four cases with acquired +21 and 11 cases without acquired +21) with the clinical manifestations, laboratory data, and prognosis. The clinical features and laboratory data between patients with acquired +21 and patients without acquired +21 are similar. As for prognosis, three of the 11 cases without acquired +21 obtained complete remission (CR) after 1st induction. The median follow-up time of the 11 cases was 9 months. Among four cases with acquired +21, one case gave up treatment during 1st induction, one obtained CR after 1st induction and was still alive after 49 months of follow-up. One case obtained CR after 2nd induction and was still alive for 15 months of follow-up after bone marrow transplantation, the other patient was planning for allogeneic hematopoietic stem cell transplantation (HSCT) without CR. The median follow-up time of the four cases was 12 months. None relapsed in our study. In conclusion, acquired trisomy 21 may not be an indicator for poor prognosis. Cytogenetics analysis can help us for diagnosis stratification, prognostic judgment and individualized treatment of AMKL.

Isolated tricuspid valve endocarditis in immunocompetent juvenile patients: a series of three cases

2021 ◽  
Vol 14 (8) ◽  
pp. e244312
Author(s):  
Atanu Chandra ◽  
Shrestha Ghosh ◽  
Uddalak Chakraborty ◽  
Debojyoti Ray
Keyword(s):  
Risk Factors ◽  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Age Groups ◽  
Case Series ◽  
Venous Catheter ◽  
Diagnostic Challenge ◽  
Native Valve ◽  
Younger Age ◽  
High Index Of Suspicion

Right-sided native valve infective endocarditis is common in patients with congenital or valvular heart disease, intracardiac device, central venous catheter and intravenous drug abuse, usually manifesting in adulthood. However, in the absence of predisposing risk factors and in younger age groups, this disease may pose a diagnostic challenge. We report a case series of three juvenile patients with isolated tricuspid valve infective endocarditis without any risk factors and paucity of cardiovascular findings in two of them, in an attempt to highlight the importance of maintaining a high index of suspicion to arrive a timely diagnosis.

Central Venous Catheter Salvage in Ambulatory Central Line–Associated Bloodstream Infections

PEDIATRICS ◽  
2021 ◽  
Author(s):  
William J.H. Ford ◽  
David G. Bundy ◽  
Suzette Oyeku ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Secondary Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Type Number ◽  
Central Venous ◽  
Medical Centers ◽  
Associated Risk Factors

BACKGROUND Guidelines for treatment of central line–associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients <22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

Recurrent Onychomadesis of the Toenails in Children and Adults: A Case Series

2021 ◽  
pp. 1-3
Author(s):  
Dana Sous ◽  
Michela V.R. Starace ◽  
Lu Chen ◽  
Elizabeth L. Nieman ◽  
Milan J. Anadkat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Side Effects ◽  
Treatment Strategy ◽  
Viral Infections ◽  
Nail Plate ◽  
Case Series ◽  
Drug Side Effects ◽  
Case Presentation ◽  
Nail Bed ◽  
Physical Trauma

<b><i>Introduction:</i></b> Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. <b><i>Case Presentation:</i></b> We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. <b><i>Discussion/Conclusion:</i></b> For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.

scholarly journals Clinical analysis of microbiologically proven fungal keratitis according to prior topical steroid use: a retrospective study in South Korea

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chan-Ho Cho ◽  
Sang-Bumm Lee
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Clinical Characteristics ◽  
Significant Risk ◽  
Topical Steroid ◽  
Clinical Analysis ◽  
Fungal Keratitis ◽  
Topical Steroids ◽  
Deep Infiltration

Abstract Background To compare the clinical characteristics and treatment outcomes of microbiologically proven fungal keratitis between users and non-users of prior topical steroids (PS and NPS, respectively). Methods Eighty-three cases with microbiologically proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors, clinical characteristics, microbiological profiles, and treatment outcomes were evaluated and compared between the PS and NPS groups. Treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated using multivariate logistic regression in the overall cohort. Results A total of 30 cases with PS group and 53 cases with NPS group were included. Of these, sixteen fungal isolates were identified in the PS group and 14 isolates in the NPS group. Candida was the most common organism in both groups (6 cases, respectively), while Aspergillus (4 cases) was found only in the PS group (p = 0.103). No significant differences were observed in the mean age, sex, occupational distribution, epithelial defect size, hypopyon, and presenting best-corrected visual acuity (BCVA) between the two groups. Differences were observed between the PS and NPS groups in terms of previous ocular surface disease (OSD) (43.3% vs. 22.6%, p = 0.048) and deep infiltration (53.3% vs. 32.1%, p = 0.057). Regarding treatment outcomes, final BCVA < 0.1 (60% vs. 44.2%, p = 0.133), the use of voriconazole (topical 10% vs. 0%, p = 0.044; systemic 23.3% vs. 1.9%, p = 0.003), surgical intervention (43.3% vs. 20.8%, p = 0.029), and treatment failure (46.7% vs. 22.6%, p = 0.023) were more common in the PS group than in the NPS group. The significant risk factors for treatment failure were hypopyon (odds ratio [OR] 6.01, p = 0.005) and deep infiltration (OR 4.38, p = 0.013). Conclusions Previous OSD and deep infiltration were more common in the PS group compared to the NPS group. The PS group also experienced worse disease progression and treatment outcomes. These results highlight the need for paying attention to the use of steroids in clinical practice.

scholarly journals Distinct Clinical Characteristics and Risk Factors for Mortality in Female Inpatients With Coronavirus Disease 2019 (COVID-19): A Sex-stratified, Large-scale Cohort Study in Wuhan, China

2020 ◽  
Author(s):  
Jing Chen ◽  
Hualin Bai ◽  
Jia Liu ◽  
Ge Chen ◽  
Qiuyue Liao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Characteristics ◽  
Large Scale ◽  
Cardiac Injury ◽  
Laboratory Data ◽  
Coagulation Disorder ◽  
Risk Of Death ◽  
Initial Symptoms

Abstract Background As the coronavirus disease 2019 (COVID-19) outbreak accelerates worldwide, it is important to evaluate sex-specific clinical characteristics and outcomes, which may affect public health policies. Methods Patients with COVID-19 admitted to Tongji Hospital between 18 January and 27 March 2020 were evaluated. Clinical features, laboratory data, complications, and outcomes were compared between females and males. Risk factors for mortality in the whole population, females, and males were determined respectively. Results There were 1667 (50.38%) females among the 3309 patients. The mortality rate was 5.9% in females but 12.7% in males. Compared with males, more females had no initial symptoms (11.1% vs 8.3%, P = .008). Complications including acute respiratory distress syndrome, acute kidney injury, septic shock, cardiac injury, and coagulation disorder were less common in females; critical illness was also significantly less common in females (31.1% vs 39.4%, P &lt; .0001). Significantly fewer females received antibiotic treatment (P = .001), antiviral therapy (P = .025), glucocorticoids treatment (P &lt; .0001), mechanical ventilation (P &lt; .0001), and had intensive care unit admission (P &lt; .0001). A lower risk of death was found in females (OR, .44; 95% CI, .34–.58) after adjusting for age and coexisting diseases. Among females, age, malignancy, chronic kidney disease, and days from onset to admission were significantly associated with mortality, while chronic kidney disease was not a risk factor in males. Conclusions Significantly milder illness and fewer deaths were found in female COVID-19 inpatients and risk factors associated with mortality varied among males and females.

scholarly journals Clinical characteristics of a group of deaths with COVID-19 pneumonia in Wuhan, China: a retrospective case series

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tao Yao ◽  
Yan Gao ◽  
Qin Cui ◽  
Bo Peng ◽  
Yan Chen ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Antiviral Treatment ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Case Series ◽  
The Elderly ◽  
Retrospective Case ◽  
Initial Symptoms ◽  
Comorbid Diseases ◽  
Death Cases

Abstract Background With the widespread outbreak of novel coronavirus diseases 2019(COVID-19), more and more death cases were reported, however, limited data are available for the patients who died. We aimed to explore the clinical characteristics of deaths with COVID-19 pneumonia. Methods We abstracted and analyzed epidemiological, demographic, clinical, and laboratory data from 83 death cases with COVID-19 pneumonia in East Hospital of Wuhan University Renmin Hospital, between January 26, 2020, and February 28, 2020. Results Of the 83 deaths, none was the medical staff. The mean age was 71.8 years (SD 13.2; range, 34–97 years) and 53(63.9%) were male. The median from onset to admission was 10 days (IQR 7–14: range, 2–43 days), to death was 17 days (IQR 14–21: range, 6–54 days). Most deaths (66[80%]) had underlying comorbid diseases, the most of which was hypertension [47(57%)]. The main initial symptoms of these 83 deaths were shortness of breath(98.8%), fever(94%), and myalgia or fatigue(90.4%). Laboratory analyses showed the lymphocytopenia in 69(83%) deaths, hypoalbuminemia in 77(93%) deaths, the elevation of lactate dehydrogenase in 79(95%) deaths, procalcitonin in 69(83%) deaths and C-reactive protein in 79(95%) deaths. All 83 patients received antiviral treatment, 81(97.6%) deaths received antibiotic therapy, 54(65.1%) deaths received glucocorticoid therapy, and 20(24.1%) patients received invasive mechanical ventilation. Conclusion Most of the deaths with COVID-19 pneumonia were elderly patients with underlying comorbid diseases, especially those over 70 years of age. The time of death after the onset of the disease was mostly 15–21 days. More care should be given to the elderly in further prevention and control strategies of COVID-19.

Adherence Rates and Associations with Nonadherence in Patients with Rheumatoid Arthritis Using Disease Modifying Antirheumatic Drugs

2009 ◽  
Vol 36 (10) ◽  
pp. 2164-2170 ◽  
Author(s):  
BART J.F. van den BEMT ◽  
FRANK H.J. van den HOOGEN ◽  
BART BENRAAD ◽  
YECHIEL A. HEKSTER ◽  
PIET L.C.M. van RIEL ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Side Effects ◽  
Clinical Characteristics ◽  
Coping Styles ◽  
Self Report ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Potential Risk Factors ◽  
Disease Modifying

Objective.Nonadherence in patients with rheumatoid arthritis (RA) using disease modifying antirheumatic drugs (DMARD) may result in unnecessarily high levels of disease activity and function loss. The aim of this descriptive study was to assess adherence rates with self-report measures in a large random population, and to identify potential risk factors for nonadherence.Methods.A randomly selected sample of 228 patients with RA using DMARD was invited for a standardised interview. For each medicine, the patients were asked about adherence, consumption and perceived (side) effects. After the interview, the patients received self-report questionnaires to assess adherence [Compliance Questionnaire on Rheumatology (CQR) and the Medication Adherence Scale (MARS)], coping, beliefs about medicines, satisfaction about medicine information, and physical functioning. Subsequently, associations between adherence and demographics, clinical characteristics, and patient attitudes were examined.Results.Depending on the instrument used, 68% (CQR) and 60% (MARS) of the patients were adherent to DMARD. Nonadherence was not associated with demographic and clinical characteristics, satisfaction about information, medication concerns, and coping styles. The disease duration, the number of perceived side-effects, and beliefs about the necessity of the medicine were weakly associated with adherence.Conclusion.In this large study with a random RA population, 32%–40% of the patients did not adhere to their DMARD prescription. As none of the possible risk factors was strongly related to adherence, no general risk factor seems to be powerful enough as a possible screening tool or target for adherence-improving interventions. This implies that nonadherence barriers should be assessed on an individual basis.

scholarly journals Clinical characteristics and risk factors of Fulminant Mycoplasma pneumoniae pneumonia in children

2020 ◽  
Author(s):  
yaoyao ling ◽  
Tongqiang Zhang ◽  
Zhenli Zhu ◽  
Jiao Tian ◽  
yongsheng xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pleural Effusion ◽  
Mycoplasma Pneumoniae ◽  
Clinical Characteristics ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Multivariate Logistic Regression Analysis ◽  
Radiological Findings ◽  
Mycoplasma Pneumoniae Pneumonia ◽  
D Dimer

Abstract BACKGROUND: Analyze the clinical characteristics of Fulminant Mycoplasma pneumoniae pneumonia (FMPP), and explore the related factors predicting FMPP. METHODS: A retrospective case-control study was performed on 345 children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized in our Hospital from January 2017 to June 2019. The clinical features, laboratory data and radiological findings were compared between the FMPP group, refractory Mycoplasma pneumoniae pneumonia (RMPP)group and general Mycoplasma pneumoniae pneumonia (GMPP) group. RESULTS: FMPP patients (n=69) had more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings(P<0.05). And the days of fever and the days in hospital were longer, and FMPP patients also need more complicated treatments(P<0.05). Meanwhile, the levels of white blood cell count(WBC) ,C-reactive protein(CRP), lactic dehydrogenase (LDH), interleukin (IL)-6,ferritin, D-dimer, fibrinogen(FG),alanine aminotransferase(ALT) and the percentage of neutrophils in the FMPP group were significantly higher than those in the RMPP group and the GMPP group (both P<0.05). In ROC curve analysis, the percentage of neutrophils, WBC, CRP, LDH, IL-6, ferritin, D-dimer and ALT were contributed to identify FMPP patients. Multivariate logistic regression analysis showed that ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion had significant predictive effects on the early diagnosis of FMPP (P<0.01). Conclusion: FMPP patients presented more serious clinical manifestations. Ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion were high risk factors for FMPP.

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