scholarly journals Bacterial corneal ulcers in pediatric patients. Algorithms of pharmacotherapy. Part II

2021 ◽  
Vol 16 (3) ◽  
pp. 43-48
Author(s):  
L. A. Kovaleva
Keyword(s):  
Pediatric Patients ◽  
Diagnostic Methods ◽  
Rapid Progression ◽  
Diagnostic Features ◽  
Antibacterial Drugs ◽  
Corneal Ulcers ◽  
Causative Agents ◽  
Diagnostic Signs ◽  
High Degree ◽  
Systemic Antibacterial

Part I of the article presents a review of publications highlighting current exogenous and endogenous risk factors contributing to the occurrence of bacterial corneal ulcers, laboratory diagnostic methods, clinical differential diagnostic features of bacterial corneal ulcers. A wide variety of objective symptoms characterizes the clinical picture of bacterial corneal ulcers. Still, objective differential diagnostic signs make it possible with a high degree of probability to assume the etiology of the disease during the first biomicroscopy and immediately begin etiotropic therapy, on the timing of which the outcome of the disease depends. Standard laboratory examination of patients with bacterial corneal ulcers includes the bacterioscopic and cultural examination of the contents of the conjunctival sac. However, the absence of etiotropic therapy while waiting for the results of microbiological research methods, which takes from 3 to 7 days, contributes to the rapid progression of the disease, the development of endophthalmitis, and corneal perforation, up to the loss of an eye in children. In this regard, treatment must be started immediately. Therefore, the choice of a drug is determined not only by the causative agent, proven laboratory but, first of all, based on clinical differential diagnostic signs of the disease. The traditional, undeniable approach to the conservative treatment of bacterial corneal ulcers is conventional etiotropic therapy using local and systemic antibacterial drugs. In addition, timely intensive specific drug therapy prevents the destruction of all layers of the cornea, and the use of metabolic drugs that improve regeneration and trophism promotes epithelialization of corneal ulcers. Attention should be given to the necessity and validity of the choice of antibacterial drugs for various etiological forms of bacterial corneal ulcers in children. An individual approach is a basis for effective antibiotic therapy in pediatric ophthalmology. The article presents an up-to-date review of publications and modern algorithms for treating bacterial corneal ulcers in children, the main causative agents of which are: Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Neisseria gonorrhoeae.

scholarly journals Bacterial corneal ulcers in pediatric patients: Clinical and laboratory diagnostics. Part I

2021 ◽  
Vol 16 (2) ◽  
pp. 23-30
Author(s):  
Ludmila Kovaleva
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Neisseria Gonorrhoeae ◽  
Pediatric Patients ◽  
Corneal Ulcer ◽  
Adverse Outcomes ◽  
Diagnostic Methods ◽  
Laboratory Diagnostics ◽  
Progression Rate ◽  
Corneal Ulcers ◽  
Diagnostic Signs

Bacterial corneal ulcer is the second most common complication of herpetic ulcer, but it is the most severe complication and has the highest progression rate. The main causative agents of bacterial corneal ulcers are Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Neisseria gonorrhoeae. The frequency of the detection of corneal ulcers caused by gram-negative Pseudomonas aeruginosa has increased, which is characterized by a lightning-fast course and a high frequency of complications and adverse outcomes. Gonococcal corneal ulcer caused by Neisseria gonorrhoeae is less common in pediatric patients than in adult patients, but it has the most aggressive disease course, which does not change with age. Bacterial corneal ulcers are one of the main causes of corneal blindness and can lead to endophthalmitis, corneal perforation, and eye loss within a short time. Clinical differential diagnostic signs allow us to assume, with a high degree of probability, the etiology at the first biomicroscopy and immediately begin etiotropic therapy, which is crucial for the outcomes of bacterial corneal ulcer. The standard laboratory examination of patients with bacterial corneal ulcer includes bacterioscopic and culture examinations of the contents of the conjunctival sac. This paper presents an up-to-date review of publications, clinical features, differential diagnostic criteria, laboratory diagnostic methods of bacterial corneal ulcers in pediatric patients

scholarly journals Community-Acquired Pneumonia of Bacterial Etiology and the Spectrum of Pathogen Sensitivity to Antibiotics in Corona-Positive and Corona-Negative Patients in Rostov-on-Don

2021 ◽  
Vol 66 (1-2) ◽  
pp. 26-32
Author(s):  
N. V. Pavlovich ◽  
М. V. Tsymbalistova ◽  
N. V. Aronova ◽  
A. S. Anisimova ◽  
S. О. Vodopyanov ◽  
...  
Keyword(s):  
Multiple Drug Resistance ◽  
Healthcare Facility ◽  
Community Acquired Pneumonia ◽  
Diffusion Method ◽  
Multiple Drug ◽  
Disk Diffusion Method ◽  
Antibacterial Drugs ◽  
Treatment Regimens ◽  
Causative Agents ◽  
High Degree

Relevance. In the context of the ongoing pandemic of coronavirus infection, the course of viral pneumonia is often complicated by the addition of bacterial microflora due to a decrease in the body's immune status. The causative agents of such a co-infection can exhibit multiple drug resistance, which significantly reduces the effectiveness of etiotropic therapy. In this regard, it seems expedient to provide microbiological support to patients in order to select the most optimal treatment regimens. Aim. To study the composition of bacterial pathogens’ species, that cause community-acquired pneumonia (CAP) in corona-positive (COVID-19+) and corona-negative (COVID-19–) patients and to determine the spectrum of their sensitivity/resistance to antibacterial drugs. Material and methods. The species composition of microorganisms in sputum samples from 723 patients with CAP, who were admitted from the healthcare facility in Rostov-on-Don in August and December 2020 were studied. The isolated cultures were identified using bacteriological and mass spectrometric methods. The sensitivity of bacteria to antibiotics was determined by the disk diffusion method. Results. It was shown that in August pneumococci and  staphylococci prevailed in the spectrum of CAP pathogens, while in December the percentage of excretions of Acinetobacter spp. and S. haemolyticus increased. Various types of p. Candida yeast were found with a high degree of isolation, COVID-19 + patients showed a tendency towards greater contamination (I104 mcl/ml). Some pathogens (A.baumannii, S.haemolyticus, P.aeruginosa, S.maltophilia) are characterized by polydrug resistance, and some strains of these species are pan-resistant to all groups of antibiotics. Conclusion. The data obtained demonstrate that severe forms of community-acquired pneumonia can be caused by viral-bacterial and viral-bacterial-yeast combinations of pathogens, including bacteria with a narrow spectrum of sensitivity to antibacterial drugs. 

The Physician’s Task and the Problem of Documentation

1964 ◽  
Vol 03 (01) ◽  
pp. 11-19 ◽  
Author(s):  
A. Proppe
Keyword(s):  
Statistical Evaluation ◽  
Age Groups ◽  
Diagnostic Methods ◽  
Early Age ◽  
Case Histories ◽  
Lupus Vulgaris ◽  
Pathological Conditions ◽  
Clinical Methods ◽  
Corpus Hippocraticum ◽  
High Degree

SummaryCase histories suitable for statistical evaluation can be found even as far back as in the Corpus Hippocraticum. Such simple data as the patient’s age, body weight, size, the date of menarche, etc. are practically always included in the case records, and it is demonstrated that, when such data are recorded in a system of documentation suitable for mechanical sorting, it may enable us to draw conclusions of very great importance. Mechanical registration methods have revealed that, in the determination and recording of data as hitherto carried out. there has been a surprisingly large number of errors and a high degree of unreliability. This view has a considerable influence on modern clinical methods; it renders a more democratic relation between physician and patient necessary and makes clear the need for measures to enhance the reliability of diagnosis and treatment of pathological conditions. The author illustrates this view with reference to the mechanical falsification of the thesis of the proneness of early age groups to lupus vulgaris, furthermore with reference to the mechanical rationalization of modern routine diagnostic methods, to the constant surveillance of adverse effects on public health and to the protection against allergic reactions with the aid of recording systems of personal allergy and intolerance data with mechanical sorting and computer techniques.

The Accuracy of ACR TI-RADS Classification of Neck Ultrasound as a First-Line Diagnostic Approach for Thyroid Neoplasms in Pediatric Patients: A Retrospective Study

2018 ◽  
Vol 5 (1) ◽  
pp. 13-23
Author(s):  
Nikolai S. Grachev ◽  
Elena V. Feoktistova ◽  
Igor N. Vorozhtsov ◽  
Natalia V. Babaskina ◽  
Ekaterina Yu. Iaremenko ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Thyroid Neoplasms ◽  
Diagnostic Methods ◽  
Diagnostic Approach ◽  
First Line ◽  
Neck Ultrasound

Background.Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis.Objective.Our aim was to evaluate the effectiveness of ACR TI-RADS classification of neck ultrasound as a first-line diagnostic approach for thyroid neoplasms in pediatric patients.Methods.A retrospective analysis was made of FNA and US protocols in 70 patients who underwent the examination and treatment at Dmitry Rogachev National Research Center between January 2012 and August 2017. In the retrospective series 70% (49/70) of patients undergone FNA and 43% (30/70) of them undergone repeated FNA. All US protocols were interpreted according to ACR TI-RADS system by the two independent experts. The clinical judgment was assessed using the concordance test and the reliability of preoperative diagnostic methods was analized.Results.According to histologic examination protocols, benign nodules reported greater multimorbidity 29% (20/70), compared with thyroid cancer 17% (12/70), complicating FNA procedure. A statistically significant predictor of thyroid cancer with a tumor size ACR TI-RADS showed a significant advantage of ACR TI-RADS due to higher sensitivity (97.6 vs 60%), specificity (78.6 vs 53.8%), positive predictive value (87.2 vs 71.4%), and negative predictive value (95.7 vs 41.2%). Concordance on the interpreted US protocols according to ACR TI-RADS classification between two experts was high, excluding accidental coincidence.Conclusion.The data support the feasibility of US corresponding to the ACR TI-RADS classification as a first-line diagnostic approach for thyroid neoplasm reducing the number of unnecessary biopsies for thyroid nodules.

scholarly journals A phasianid bird from the Pleistocene of Tainan: the very first avian fossil from Taiwan

2021 ◽  
Author(s):  
Cheng-Hsiu Tsai ◽  
Gerald Mayr
Keyword(s):  
Fossil Birds ◽  
Phasianus Colchicus ◽  
Diagnostic Features ◽  
Physical Evidence ◽  
Evolutionary Origins ◽  
Geological Past ◽  
Fossil Bird ◽  
New Perspective ◽  
High Degree ◽  
Unambiguous Assignment

AbstractTaiwan accommodates more than 600 avian species, including about 30 endemic ones. As yet, however, no fossil birds have been scientifically documented from Taiwan, so that the evolutionary origins of this diversified avifauna remain elusive. Here we report on the very first fossil bird from Taiwan. This Pleistocene specimen, a distal end of the left tarsometatarsus, shows diagnostic features of the galliform Phasianidae, including an asymmetric plantar articular facet trochlea metatarsi III. Our discovery of a Pleistocene phasianid from Taiwan opens a new perspective on studies of the evolution of the avifauna in Taiwan because the fossil shows that careful search for fossils in suitable localities has the potential of recovering avian remains. In general, East Asia has an extremely poor avian fossil record, especially if terrestrial birds are concerned, which impedes well-founded evolutionary scenarios concerning the arrival of certain groups in the area. The Phasianidae exhibit a high degree of endemism in Taiwan, and the new fossil presents the first physical evidence for the presence of phasianids on the island, some 400,000–800,000 years ago. The specimen belongs to a species the size of the three larger phasianids occurring in Taiwan today (Syrmaticus mikado, Lophura swinhoii, and Phasianus colchicus). Still, an unambiguous assignment to either of these species is not possible due to the incomplete nature of the left tarsometatarsus. Because the former two species are endemic to Taiwan, the fossil has the potential to yield the first data on their existence in the geological past of Taiwan if future finds allow identification on species-level.

scholarly journals Evaluation of Children's Appendicitis Score Compared With Pediatric Appendicitis Score in Diagnosis of Pediatric Appendicitis

2020 ◽  
Author(s):  
Mohammad Khaasteh ◽  
Fariba Heidari ◽  
Akram Motamedi ◽  
Kafieh Aslani ◽  
Masoud Jamshidi ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Clinical Findings ◽  
Diagnostic Methods ◽  
Diagnostic Tools ◽  
Diagnostic Challenge ◽  
Diagnostic Features ◽  
Surgical Field ◽  
Us Findings ◽  
Pathology Reports ◽  
Appendicitis Score

Introduction: Identification and promotion of diagnostic methods has been a continuous effort to reduce disease and its complications and reduce costs associated with treatment. Despite all these efforts and improving our knowledge of diseases and diagnostic tools, pediatric appendicitis remains part of the diagnostic challenge in the surgical field. The aim of this is to compare the two diagnostic criteria of appendicitis (Children's Appendicitis Score [PAS] Versus Pediatric Appendicitis Score [CAS]) and evaluation of the diagnostic features of them. Methods: A retrospective cohort study was conducted on all children admitted to the hospital's emergency center with a possible diagnosis of appendicitis (270 patients) during 2018 and 2019 at Tabriz Pediatric Hospital. Based on the clinical examinations and para-clinical findings some of the patients were underwent the surgical intervention (220 cases) and some discharged and followed up for a period of 2 and 4 weeks later (50 cases). The data were analyzed through SPSS ver. 16 software. Results: The results of the present study indicated that if CAS was associated with ultrasound, the specificity of these criteria would improve and could be more acceptable compared with the PAS. In addition, it was revealed that WBC≥11000, as well as PMN≥65% and guarding were very specific for diagnosis and complication of acute appendicitis. There was a significant relationship between US findings and pathology reports (P<0.05). Conclusion: In conclusion, the CAS criteria were more sensitive and the PAS was more specific in diagnosing pediatric acute appendicitis.

scholarly journals Clinical and microbial characterization of toxigenic Clostridium difficile isolated from antibiotic associated diarrhea in Egypt

2020 ◽  
Author(s):  
Sherein G. Elgendy ◽  
Sherine A. Aly ◽  
Rawhia Fathy ◽  
Enas A.E. Deaf ◽  
Naglaa H. Abu Faddan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Pediatric Patients ◽  
Direct Detection ◽  
Diagnostic Methods ◽  
Adult Patients ◽  
Specific Method ◽  
Healthcare Associated Infection ◽  
Direct Pcr ◽  
Antibiotic Associated Diarrhea

Background and Objectives: Clostridium difficile infection (CDI) has become a significant healthcare-associated infection throughout the world and is particularly important in developing countries. This study aimed to investigate clinical characterization and risk factors related to toxigenic C. difficile infection in adult and pediatric patients, antimicrobial susceptibility pattern. Also, to evaluate different diagnostic methods for rapid detection of C. difficile associated diarrhea (CDAD) in Egypt. Materials and Methods: Stool samples were collected from 95 pediatric patients and 37 adult patients suffering from antibiotic associated diarrhea and were subjected to direct toxin immunoassay and culture on cycloserine/cefoxitin/fructose agar. The presence of tcdA and tcdB genes was tested by PCR. Results: Toxigenic C. difficile was isolated from pediatric and adult patients at a rate of 17.89% (17/95) and 27% (10/37) respectively. The sensitivity and specificity of direct PCR from stool are (100%, 100% and 82.4%, 100%) in adult and pediatric samples respectively. The susceptibility of C. difficile to vancomycin and metronidazole were found to be 66.7% and 48.2% respectively. Conclusion: Diabetes mellitus, prior antibiotic treatment, hematological malignancy on chemotherapy, malnutrition, neutropenia and Ryle feeding are risk factors for development of CDAD. Tight restriction of unnecessary antibiotic uses is necessary in our locality. Direct detection of toxin genes in stool by PCR is sensitive and specific method for early detection of C. difficile.

scholarly journals Alveolar Echinococcosis in Children

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Emilija Jonaitytė ◽  
Martynas Judickas ◽  
Eglė Tamulevičienė ◽  
Milda Šeškutė
Keyword(s):  
Surgical Treatment ◽  
Current Literature ◽  
Echinococcus Multilocularis ◽  
Cystic Echinococcosis ◽  
Alveolar Echinococcosis ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Diagnostic Methods

Alveolar echinococcosis (AE) is an infectious zoonotic disease that is caused by Echinococcus multilocularis. The disease is generally identified accidentally because of the long asymptomatic period, has a malignant behaviour, and mainly occurs in the liver. Usually it is diagnosed in adults and is very rare in pediatric patients. We report two cases of AE and 1 differential case between AE and cystic echinococcosis (CE) in children: two of them had lesions in the liver and one had rare extrahepatic presentation of a cyst in the spleen. All our patients received chemotherapy with albendazole because surgical treatment was not recommended. The children were followed-up from 10 to 30 months and no significant improvement was seen. In this report we discuss the difficulties we faced in the treatment and follow-up of these patients. We also review the main clinical manifestations, general diagnostic methods, and treatment options of AE according to the current literature.

Comparison Of a Powered Bone Marrow Aspiration and Biopsy Device To The Traditional Manual Device In Children

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4980-4980
Author(s):  
Maria G. Falcon-Cantrill ◽  
Paul Thomas ◽  
Victor Saldivar ◽  
Thomas E. Philbeck ◽  
Chatchawin Assanasen
Keyword(s):  
Bone Marrow ◽  
Randomized Controlled Trial ◽  
Research Funding ◽  
Pediatric Patients ◽  
Controlled Trial ◽  
Bone Marrow Aspiration ◽  
Procedure Time ◽  
Randomized Controlled ◽  
Patient Pain ◽  
High Degree

Abstract Background In 2007, a battery powered bone marrow aspiration and biopsy system (OnControl, Vidacare Corp, Shavano Park, TX) was developed and cleared by the US FDA for adult patients.  Multiple studies have evaluated the use of the Powered device in adults and found decreased procedure time, decreased patient pain, improved core biopsy specimens and a higher degree of operator satisfaction compared to traditional Manual Jamshidi-type devices; but there have been no studies demonstrating the system's utility for pediatric patients. In a study sponsored by Vidacare, we conducted a randomized controlled trial to compare the Powered bone marrow aspiration and biopsy system to Manual devices in children. Design/Method A randomized controlled trial was developed to enroll a total of 44 patients between ages 2 and 18 years old requiring a bone marrow evaluation.  Patients were assigned to have a single procedure carried out using the Powered device or the Manual device.  Data were also collected for patients needing bilateral marrow evaluations for direct comparison between the two devices.  The time to obtain the aspirate and biopsy were recorded, as was the pain score post-procedure.  A blinded pathologist recorded the length, width, and overall quality of the specimen.  Operators performing the procedure also completed a survey to evaluate the safety of the device, and their satisfaction with the device. Results  Forty-four patients were enrolled in the study and 5 patients received bilateral procedures; for a total of 49 procedures (Powered n=27, Manual n=22). The mean age was 9.8 (±0.8) years and 60% were male. Statistically, there was no difference in device performance in terms of procedure time, patient pain, operator satisfaction, specimen quality or specimen size. There was a significant difference in perceived device safety and specimen width in favor of the Powered device (p=.034 and p=.027, respectively); and a trend toward significance in terms of operator satisfaction, favoring the Powered device (p=.060). For the Powered device, but not the Manual device, procedure times improved with continued experience, as did biopsy core length and operator satisfaction. There was a significant correlation between level of experience and procedure time. No significant complications were observed using either device. Operators commented that the Powered device was useful when performing procedures on older patients and those with blast-packed marrows. Conclusion   In children, the Powered marrow device may provide benefit over Manual methods as reported in previous adult studies.  We found that the OnControl™ biopsies were obtained with a high degree of safety, with good quality and size, and with a high degree of operator satisfaction.  Such benefits may lead to reductions in anesthesia time and overall costs.  Over time and with more procedures, operators performing procedures noted increased satisfaction and better performance with the Powered device than they did with the Manual device, in both clinical use and ease of training future providers. Disclosures: Falcon-Cantrill: Vidacare Corporation: Research Funding. Off Label Use: Study device (OnControl)is cleared for adult patients, but our study using the device involved pediatric patients. Thomas:Vidacare Corporation: Research Funding. Saldivar:Vidacare Corporation: Research Funding. Philbeck:Vidacare Corporation: Employment. Assanasen:Vidacare Corporation: Research Funding.

scholarly journals Performance Assessment Techniques of Liver Fibrosis Non-invasive Diagnostic Methods in an Approach without a “Gold” Standard: Saying Goodbye to Liver Biopsy?

2020 ◽  
Vol 1 (10) ◽  
pp. 4-11
Author(s):  
M. Yu. Galushko ◽  
A. Yu. Ishchenko ◽  
S. A. Pozdniakov ◽  
I. G. Bakulin
Keyword(s):  
Liver Fibrosis ◽  
Performance Assessment ◽  
Gold Standard ◽  
Latent Variable ◽  
Diagnostic Methods ◽  
Non Invasive ◽  
Latent Variable Analysis ◽  
High Degree ◽  
Fibrosis Staging

Aims: 1. To evaluate the applicability of The Expert Assessment (EA) based on the algorithm developed by the authors in performance assessment of transient elastography by M-probe (TE-M) and XL-probe (TE-XL), Fibrotest® (FT), shear wave elastography (SWE) and liver biopsy (LB) in fibrosis staging in chronic hepatitis C (CHC) patients in an approach without a «gold» standard; 2. To evaluate the quality of the proposed model (EA efficacy) in comparison with the results of the Rasch Model (MR) being an extension of the Latent Variable Analysis.Material and methods. Using the five studied diagnostic methods liver fibrosis staging was performed in chronic hepatitis C patients. Based on the algorithm developed EA was applied to each patient of the cohort and as a result fibrosis stage was established. That fibrosis stage considered a virtual reference. Sensitivity and specificity estimation as well as AUC calculation for studied methods was performed against the reference standard. The quality of the model (EA efficacy) estimated in the Rasch Model (MR) being an extension of the Latent Variable Analysis.Results. 99 patients with reliable results of each of the five diagnostic methods were included into the study. The main characteristics of the cohort were: 59.6% individuals of male gender, average age of 37 years (21–63), median BMI of 25.8 kg / m2. As per the results of the EA in detecting of mild fibrosis (F1), the values of AUC, sensitivity and specificity were, respectively: 0,972; 94,3; 91,3 for TE-M; 0,964; 90,6; 91,3 for TE-XL; 0,806; 81,1; 73,9 for FT; 0,907; 88,7; 71,7 for SWE; 0,832; 92,5; 37,0 for LB. In detecting of moderate fibrosis (F2), the appropriate values were: 0,981; 93,8; 94,0 for TE-M; 0,967; 90,6; 97,0 for TE-XL; 0,873; 75,0; 80,6 for FT; 0,957; 84,4; 91,0 for SWE; 0,937; 90,6; 94,0 for LB. In detecting of significant fibrosis (F3), the corresponding values were: 0,994; 95,5; 96,1 for TE-M; 0,987; 90,9; 97,4 for TE-XL; 0,870; 63,6; 84,4 for FT; 0,961; 86,4; 97,4 for SWE; 0,990; 90,9; 98,7 for LB. In detecting cirrhosis (F4), the appropriate values were: 0,995; 92,3; 97,7 for TE-M; 0,994; 100,0; 98,8 for TE-XL; 0,874; 38,5; 93,0 for FT; 0,996; 92,3; 100,0 for SWE; 0,964; 69,2; 100,0 for LB. The EA was shown to have high degree of consistency (correlation coefficient = 0,923; p <0,05) when compared to the MR.Conclusion. The EA was shown as a highly informative approach, applicable for performance assessment of the diagnostic methods for liver fibrosis staging without using LB as the “gold” standard. Non-invasive methods have demonstrated higher diagnostic characteristics with changing the standard from the traditional (LB) to virtual (EA). The high degree of consistency of the results of EA and MR confirm the high quality of the algorithm developed by the authors.

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