Коклюш у взрослого пациента (клиническое наблюдение в эпидемический сезон 2023–2024 гг.)

Global Pneumococcal Disease and Policies for Control

It is well established that the average blood sugar level of normal and healthy full-term and premature infants is lower than in older children, although the individual variations in, and range of the level during, the neonatal period are considerable (Baens, Lundeen and Cornblath, 1963; Farquhar, 1954; Pedersen, 1952; Smith, 1959; Wolf, 1960; Zetterstrom, 1961, among others). In addition the glucose tolerance, measured by oral or intravenous tests, seems to be lower in normal newborn infants than in older children and adults (Baird and Farquhar, 1962; Bowie, Mulligan and Schwartz, 1963; Stegmann and Beck, 1955). These observations do not fully agree with the conception that 'the normal term or premature infant has essentially normal (if perhaps a little slow or imprecise) regulatory mechanisms for carbohydrate metabolism' (Smith, 1959). It was, therefore, the purpose of the present study to reinvestigate glucose tolerance during the newborn period and in older infants and children in order to establish at what age the possibly low tolerance of the newborn reaches the adult level.

There is growing recognition and understanding of the entities that cause interstitial lung disease (ILD) in infants. These entities are distinct from those that cause ILD in older children and adults. A multidisciplinary panel was convened to develop evidence-based guidelines on the classification, diagnosis, and management of ILD in children, focusing on neonates and infants under 2 years of age. Recommendations were formulated using a systematic approach. Outcomes considered important included the accuracy of the diagnostic evaluation, complications of delayed or incorrect diagnosis, psychosocial complications affecting the patient's or family's quality of life, and death. No controlled clinical trials were identified. Therefore, observational evidence and clinical experience informed judgments. These guidelines: (1) describe the clinical characteristics of neonates and infants (<2 yr of age) with diffuse lung disease (DLD); (2) list the common causes of DLD that should be eliminated during the evaluation of neonates and infants with DLD; (3) recommend methods for further clinical investigation of the remaining infants, who are regarded as having "childhood ILD syndrome"; (4) describe a new pathologic classification scheme of DLD in infants; (5) outline supportive and continuing care; and (6) suggest areas for future research. After common causes of DLD are excluded, neonates and infants with childhood ILD syndrome should be evaluated by a knowledgeable subspecialist. The evaluation may include echocardiography, controlled ventilation high-resolution computed tomography, infant pulmonary function testing, bronchoscopy with bronchoalveolar lavage, genetic testing, and/or lung biopsy. Preventive care, family education, and support are essential.

Background: Coarctation of the aorta occurs in newborns as a primary condition, and in most cases it is critical and associated with other congenital heart defects. Besides, coarctation of the aorta may be first detected in older children, adolescents, and adults; this pathology is diagnosed both as an isolated heart defect and in combination with other heart defects (congenital or acquired), or as a consequence of restenosis of a previously operated aorta. In the adults, coarctation of the aorta is often associated with severe comorbidities and decompensated conditions, such as decreased left ventricular myocardial contractility, congestive heart failure, and high pulmonary hypertension. The choice of surgical tactics in such patients remains controversial; although in case of native coarctation of the aorta, as well as in the case of recoarctation, if technically feasible, stenting is considered the preferred method of choice in many specialized centers. Objective: The study aimed to present clinical experience of involving endovascular methods for correction of coarctation of the aorta in adult patients using a series of four cases as an example. Methods: From 2021 to 2025, specialists of our clinical unit performed aortic coarctation stenting in four adult patients, aged 26 to 51 years, with comorbidities. In all cases, the chosen tactic was stenting of aortic coarctation by puncture access through the common femoral artery on the right under local anesthesia. Results: All patients had been under long-term monitoring for hypertension with no positive effect achieved due to high doses of antihypertensive medications. Further examinations revealed a congenital heart defect: coarctation of the aorta. Due to the severity of the condition in three cases and at the patient’s request in one case, all of them underwent stenting of the coarctation of the aorta. The postoperative period was without complications, and a positive effect was noted immediately after the procedure. In two cases, no recurrence of aortic restenosis was recorded during a three-year follow-up. Conclusion: Stenting of aortic coarctation in adult patients is currently the method of choice, offering high safety and efficacy, with advantages over open surgical interventions in terms of the degree of trauma and rehabilitation timeframe.

Respiratory syncytial virus (RSV) causes a substantial disease burden among infants. In older children and adults, incidence is underestimated due to nonspecific symptoms and limited standard-of-care testing. We aimed to estimate RSV-attributable hospitalizations and deaths in Spain during 2016-2019. Nationally representative hospitalization and mortality databases were obtained from the Ministry of Health and the National Statistical Office. A quasi-Poisson regression model was fitted to estimate the number of hospitalizations and deaths attributable to RSV as a function of periodic and aperiodic time trends and viral activity, while allowing for potential overdispersion. In children, the RSV-attributable respiratory hospitalization incidence was highest among infants aged 0-5months (3998-5453 cases/100,000 person-years, representing 72% of all respiratory hospitalizations) and decreased with age. In 2019, estimated rates in children 0-5, 6-11, 12-23months and 6-17years were approximately 1.3, 1.4, 1.5, and 6.5 times higher than those based on standard-of-care RSV-specific codes. In adults, the RSV-attributable cardiorespiratory hospitalization rate increased with age and was highest among persons ≥ 80years (1325-1506 cases/100,000, 6.5% of all cardiorespiratory hospitalizations). In 2019, for persons aged 18-49, 50-59, 60-79, and ≥ 80years, estimated rates were approximately 8, 6, 8, and 16 times higher than those based on standard-of-care RSV-specific codes. The RSV-attributable cardiorespiratory mortality rate was highest among ≥ 80 age group (126-150 deaths/100,000, 3.5-4.1% of all cardiorespiratory deaths), when reported mortality rate ranged between 0 and 0.5/100,000. When accounting for under-ascertainment, estimated RSV-attributable hospitalizations were higher than those reported based on standard-of-care RSV-specific codes in all age groups but particularly among older children and older adults. Like other respiratory viruses, RSV contributes to both respiratory and cardiovascular complications. Efficacious RSV vaccines could have a high public health impact in these age and risk groups.

Bronchoalveolar lavage studies in children without parenchymal lung disease: cellular constituents and protein levels.

Hepatitis A virus (HAV) infection results in a debilitating, multi-week illness in older children and adults that can be avoided with pre-exposure immunisation. Inactivated HAV vaccines are safe, highly effective and induce long-lasting protection. Immunisation has typically been recommended only for groups at highest risk of infection or complications, with variable success. This paper reviews the outcomes of several new programmes of universal HAV immunisation of children and/or adolescents. These programmes were associated with substantial disease rate reductions, extending beyond the immunised individuals and age groups (herd immunity), and promise additional benefits as immunised cohorts enter adulthood risk groups. Universal programmes are cost-effective, especially when a combined hepatitis A and B vaccine can be used to minimise incremental costs, and deserve wider co-nsideration in developed countries.

Pediatric Regional Anesthesia: Beyond the Caudal

Urinary and bowel management in cloacal exstrophy: A long-term multi-institutional cross-sectional study

Expanding Pediatric Emergency Physician's Scope of Practice in Response to the COVID-19 Pandemic

Hereditary proximal spinal muscular atrophy (SMA) is a severe hereditary neuromuscular disorder, which usually presents in infancy or (early) childhood. SMA is caused by loss of SMN1 gene function, leading to a deficiency of SMN protein. The SMN2 gene in the human genome partially compensates for SMN1 loss, but insufficiently ... read more to prevent pathology. As a result of the SMN protein deficiency, patients suffer from progressive loss of bulbar and spinal cord alpha motor neurons. This causes progressive muscular weakness in patients. Four main SMA types of varying disease severity are distinguished, primarily based upon highest achieved motor function during childhood. SMA type 1 is the most common and most severe form, with a symptom onset in infancy. Infants do not learn to sit without support and without treatment, survival is severely shortened. SMA types 2 and 3 are characterized by an onset in childhood. Patients with type 2 learn to sit without support but not walk, whereas patients with type 3 also learn to walk without support. SMA type 4 is a rare, adult-onset form of SMA. The natural history of SMA is characterized by a progressive decline of muscle strength, motor abilities, and lung function. Until recently, no therapies were available for SMA. In the past couple of years, however, the prospect for patients with SMA has changed considerably following the introduction of several genetic therapies. These therapies improve life expectancy and motor function in infants and young children with SMA in the shorter term. Whether these therapies also work in the longer-term and whether they are effective for older children and adults remains to be elucidated. To further study possible therapy efficacy, but also further improve care and counselling for patients and caregivers, it is important to further delineate the natural history of SMA, as it had not been fully studied prior to this thesis, specifically not for older children and adults with SMA. Most studies in the past decades had focused on infants and younger children, with more severe SMA types. In this thesis we therefore studied several characteristics of SMA’s natural history, with an emphasis on older children, adolescents and adult patients with SMA. This includes studies on survival, patterns of muscle strength and motor function decline, lung function, scoliosis development and associated need for scoliosis surgery. Additionally, we also studies possible involvement of tissues outside the nervous system, i.e. possible non-neuromuscular pathology in SMA. Finally, we studied fatigability, an important characteristic that impedes activities of daily life in many patients. We showed that pyridostigmine can improve patient’s fatigability and may be used as a safe, add-on therapy at low cost. The insights gained in this thesis have improved our insights into the natural history of SMA, may further improve care and counselling for patients and their caregivers, and may aid in further evaluations of (future) therapy efficacy. show less

Streptococcus pneumoniae (pneumococcus) is a leading cause of pneumonia and meningitis in the United States and disproportionately affects young children and the elderly. In 2000, a 7-valent pneumococcal conjugate vaccine (PCV7) was licensed in the United States for routine use in children aged <5 years. Surveillance data from 2001 and 2002 indicated substantial declines in invasive pneumococcal disease (IPD) in children and adults compared with prevaccine years . This report updates assessment of the impact of PCV7 on IPD through 2003 by using population-based data from the Active Bacterial Core surveillance (ABCs) of the Emerging Infections Program Network, a cooperative surveillance program conducted by several state health departments and CDC. The results of this analysis indicated that 1) routine vaccination of young children with PCV7 continued to result in statistically significant declines in incidence of IPD through 2003 in the age group targeted for vaccination and among older children and adults, 2) the vaccine prevented more than twice as many IPD cases in 2003 through indirect effects on pneumococcal transmission (i.e., herd immunity) than through its direct effect of protecting vaccinated children, and 3) increases in disease caused by pneumococcal serotypes not included in the vaccine (i.e., replacement disease) occurred in certain populations but were small compared with overall declines in vaccine-serotype disease. Ongoing surveillance is needed to assess whether reductions in vaccine-serotype IPD are sustained and whether replacement disease will erode the substantial benefits of routine vaccination.

The Children's HIV Association (http://www.chiva.org.uk/health/guidelines/immunisation; accessed 22 September 2009) and the Department of Health (http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook; accessed 17 September 2009) strongly recommend that HIV-positive children should receive all routine childhood immunizations. Exceptions are Bacillus Calmette–Guérin (BCG), regardless of CD4 cell count, and measles, mumps and rubella (MMR), if the CD4 cell count is <15% of total lymphocytes. HIV-infected children are at an increased risk of vaccine-preventable diseases. While we acknowledge that some vaccines are less effective in severely immunocompromised children [1], even on highly active antiretroviral therapy (HAART), we believe that efforts should be made to ensure immunization according to published UK guidelines. The aim was to audit the immunization status of HIV-positive children in London. A standardized proforma was used to collect data from children/adolescents attending four paediatric HIV clinics in 2008 (three tertiary level and one secondary level). Data were collected on routine and nonroutine vaccines from clinical notes and supplemented with information from Parent-Held Child Healthcare Records (‘Red Book’) and Primary Care records. Vaccination details supplied by parents, however seldom, were taken into account. Data were collected on 75 children. Fifty-five per cent were UK-born. The median age was 11 years (range 11 months to 20 years). The median CD4 percentage was 26% (range 4–47%) and the median viral load was 185 HIV-1 RNA copies/mL (range 0–2.4 × 105 copies/mL). Although children attended specialist clinics, only 5% had complete documentation of immunization in the medical notes. ‘Complete’ vaccination was determined on the basis of UK guidelines and accounted for age, vaccination history, contraindications, birth country and age of moving to the UK. Figure 1 shows proportions of children fully immunized with primary and booster doses of routine vaccines. Overall, 63% (186 of 297) of primary immunizations and only 41% (61 of 149) of booster immunizations were complete in children eligible to receive the vaccine (P<0.001). Sixty-one per cent (162 of 267) of all immunizations were complete in UK-born children compared with 47% (85 of 179) in non-UK-born children (P=0.006). Proportion of children fully immunized with routine vaccines. Nonroutine vaccinations in the UK include Bacillus Calmette–Guérin (BCG) for tuberculosis and hepatitis B. DTP, diphtheria, tetanus and pertussis; Hib, Haemophilus influenzae type b; Men C, meningococcal group C; MMR, measles, mumps and rubella; PCV, pneumococcal conjugate vaccine. Even though rates of immunization in London are lower than in the UK overall [e.g. 83% vs. 93% completed primary diphtheria, tetanus and pertussis (DTP) by age 5 years (http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/immunisation; accessed 3 September 2009)], rates in HIV-infected children were surprisingly low. HIV-infected children may have other risk factors for incomplete immunization such as residence in disadvantaged areas, history of hospital admission [2] or coming from an immigrant family. Childhood vaccinations are free; however, specialist clinics incur costs if vaccinations are provided through them, and not all have the funding or resources to do so. Additionally, guidelines are based on limited evidence in HIV-infected children, especially those with severe immune deficiency, causing uncertainty as to optimal practice. Approximately 20% of HIV-infected children nationally have a CD4% <20 (http://www.chipscohort.ac.uk/summary_data.asp; accessed 8 July 2010). This may contribute to the incomplete coverage observed for MMR in our study. Few studies have assessed the immunization status of HIV-infected children in industrialized countries. Like ours, recent Swiss and Spanish studies found lower immunization coverage in this population than in the general public [3,4]. A study from Texas found no difference between HIV-infected patients and the general population for diphtheria, tetanus, acellular pertussis and inactivated polio vaccine (DTaP-IPV) and MMR, although vaccine coverage was low overall [5]. We conclude that immunization of HIV-infected children is suboptimal in this London population. Booster doses and nonroutine vaccines are most commonly omitted. Immigrant children are particularly likely to be under-immunized. As life expectancy and the proportion of immigrant HIV-infected children increase, appropriate routine and catch-up immunization becomes more important. Development of evidence-based recommendations and standards for immunization of HIV-infected children, improved accessibility of immunization records, and opportunistic immunization in clinics may all improve this situation.

This study aims to analyze the perspectives of intergenerational relationships between older adults and adult children. For this purpose, a qualitative research was carried out, which analyzes these relations at a cross-national level. Four hundred and twenty four older participants aged 65–97 years, were interviewed. Participants were of three different nationalities and lived in the community. All the interviews went through the process of verbatim transcription and subsequent content analysis. Two dimensions of generational ambivalence were revealed from the study; support and the conflict dimensions. Findings of content analysis produced six themes, which represent intergenerational relations between older adults and adult children: older adults-adult children interaction quality; family integration; care and support; definition of limits; distance and alienation; and communication difficulties. This study highlighted the diversity of experiences in old age, in relation to intergenerational relationships and underlined the conflicting expectations from older adults in relation to their adult children.

Crossmodal spatial distraction across the lifespan