Academic literature on the topic 'Pediatric malaria'
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Journal articles on the topic "Pediatric malaria"
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Patel, Abhishek, Srinivasa K., and Manjunath G. A. "Species wise incidence of malaria in pediatric age group of Raichur district, India." International Journal of Contemporary Pediatrics 5, no. 4 (June 22, 2018): 1334. http://dx.doi.org/10.18203/2349-3291.ijcp20182460.
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Background: The incidence of malaria is on the raise in Raichur district of Karnataka in the recent years and there is not much studies on malaria from this region. A hospital and community-based study was conducted to know the species wise incidence of malaria in pediatric age group of Raichur district and to know the efficacy of rapid diagnostic test for the diagnosis of malaria, against the gold standard ‘Microscopic examination’ of thick and thin smear.Methods: Blood samples from 676 children with clinical suspicion of malaria were tested by PBS study and RDT. Differentiation of malaria parasite is based on antigenic differences between pLDH isoforms. Results from the RDT were compared to those obtained by PBS.Results: A total of 302 (44.67%) samples were positive by PBS method of which 54 (8.0%) are Plasmodium falciparum, 248 (36.9%) are Plasmodium vivax and, while 218 (32.2%) were positive by RDT 37 (5.5%) Plasmodium falciparum, 181 (26.8%) Plasmodium vivax. In present study the overall incidence of Plasmodium vivax in Raichur district is 36.69% and Plasmodium falciparum incidence is 7.99% and none of the samples have tested positive for Plasmodium malariae and Plasmodium ovale species among the study group. The RDT showed sensitivities of 53.70% and 66.13% and specificities of 98.71% and 96.03%, respectively for the detection of Plasmodium falciparum and Plasmodium vivax.Conclusions: Plasmodium vivax species remains the most common malarial parasite among the positive case by PBS method in Raichur district, but the incidence of plasmodium falciparum is on the rise which is a matter of concern. The RDT method has a low sensitivity and specificity for the diagnosis of malaria since the identification of the four-parasite species is not possible. The careful examination of a well-prepared and well-stained blood film currently remains the "gold standard" for malaria diagnosis.
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Washam, Matthew C., Katalin I. Koranyi, and Nicole F. O’Brien. "Imported Pediatric Malaria." Clinical Pediatrics 54, no. 3 (April 24, 2014): 286–89. http://dx.doi.org/10.1177/0009922814532310.
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Guenther, Geoffrey, Daniel Muller, Dominic Moyo, and Douglas Postels. "Pediatric Cerebral Malaria." Current Tropical Medicine Reports 8, no. 2 (January 25, 2021): 69–80. http://dx.doi.org/10.1007/s40475-021-00227-4.
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De, Sangeeta, Pragnadyuti Mandal, Dipak K. Sarkar, Indranil Biswas, Arijit Kayal, Arunansu Talukdar, and Kalyanbrata Mandal. "Assessment of anti-malarial drug prescribing pattern in pediatric and adult malaria patients in a tertiary care hospital in Eastern India." International Journal of Advances in Medicine 6, no. 4 (July 24, 2019): 1247. http://dx.doi.org/10.18203/2349-3933.ijam20193279.
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Background: Kolkata, one of the major metropolitan cities of India, is also the capital of the state West Bengal, contributes largest number of malaria cases reported from West Bengal. The present study was undertaken to assess the anti-malarial prescribing pattern in a tertiary care teaching hospital in Kolkata.Methods: This was an observational, prospective, cross-sectional study for a period of one year (from March 2017 to February 2018) in which prescriptions of diagnosed pediatric and adult malaria patients were scanned and reviewed for anti-malarial use pattern. Core drug use indicators were also analyzed to assess the rational prescribing pattern.Results: During one-year study period, 122 adult and 24 child malaria patient encounters were screened. Among adult patients, 48(39.3%) patients had P. falciparum and 74(60.7%) patients had P. vivax malaria; in children, 9(37.5%) patients had P. falciparum and 15(62.5%) patients had P. vivax malaria. All adult and pediatric P. vivax malaria patients were treated with chloroquine. Artemisinin derivatives were prescribed to 91.67% of adult and 88.88% of pediatric falciparum malaria patients, 77.09% of adults and 66.67% of children received ACT. Artemether- lumefantrine was the most commonly prescribed ACT (33.34% in adults and 55.56% in children). Prescriptions were usually in generic name and from National EDL. Percentage of encounters with antibiotics was high in both age group but percentage of encounters with injections was low in adults and children. Conclusion: Chloroquine was used rationally for treatment of P. vivax malaria patients. Artemether-lumefantrine was the most common ACT used for treatment of P.falciparum malaria cases though the National guideline for treatment of malaria does not recommend Artemether-lumefantrine for this state and region for treatment of falciprum cases.
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MCCASLIN, R. IAN, ANDREAS PIKIS, and WILLIAM J. RODRIGUEZ. "Pediatric Plasmodium falciparum malaria." Pediatric Infectious Disease Journal 13, no. 8 (August 1994): 709–15. http://dx.doi.org/10.1097/00006454-199408000-00006.
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Milner, Danny Arnold. "Pediatric cerebral malaria pathology." Pathology 46 (2014): S27. http://dx.doi.org/10.1097/01.pat.0000454144.17275.18.
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White, Valerie A. "Malaria in Malawi: Inside a Research Autopsy Study of Pediatric Cerebral Malaria." Archives of Pathology & Laboratory Medicine 135, no. 2 (February 1, 2011): 220–26. http://dx.doi.org/10.5858/135.2.220.
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Abstract Context.—Malaria is still a major cause of death in sub-Saharan Africa. Objectives.—To describe my participation as a pathologist in a research autopsy study in Malawi and to examine retinal pathologic findings in cerebral malaria and correlate them with those in the brain. To describe the challenges of conducting a research study in sub-Saharan Africa and the personal and scientific benefits resulting from this. Design.—Children with coma are admitted to the pediatric research ward, classified according to the clinical definition of severe malaria or another cause of coma, evaluated, and treated systematically. The eyes are examined by indirect ophthalmoscopy after dilatation. If a child dies and permission is given, a standardized autopsy is carried out. The patients' condition is then reclassified pathologically. Results.—Ninety autopsies have been completed, with the cause of death confirmed as cerebral malaria in 64 cases (71.1%). These patients showed heavy parasite sequestration and often extravascular pathologic findings in the brain, retina, gastrointestinal tract, and subcutaneous fat. Clinical and pathologic findings in the retina correlated with those in the brain, and ophthalmoscopy has become a useful tool in the diagnosis and prognosis of children with cerebral malaria. Twenty-eight percent of patients clinically classified as having cerebral malaria showed another cause of death and no malarial pathologic process or retinopathy. Conclusions.—The human, financial, and transportation resources and organization required for this autopsy project are substantial. The scientific benefits are now becoming evident after sufficient autopsies have been completed for detailed comparisons. Personal benefits include the opportunity to work and travel in an African setting and to develop collaborations world-wide.
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Rivera-Matos, Idalia R., A. Clinton White, Cynthia A. Doerr, and Jane T. Atkins. "Pediatric Malaria in Houston, Texas." American Journal of Tropical Medicine and Hygiene 57, no. 5 (November 1, 1997): 560–63. http://dx.doi.org/10.4269/ajtmh.1997.57.560.
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Pradhan, Subal Ku, Pawan Mutalik, Tirumal Subudhi, Arakhita Swain, and Niranjan Mohanty. "Outcomes of paediatric malarial hepatopathy: a study from Eastern India." Paediatrica Indonesiana 54, no. 5 (October 30, 2014): 256. http://dx.doi.org/10.14238/pi54.5.2014.256-9.
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Background Severe malaria causes multi-organ involvement ,including hepatic dysfunction.Jaundice in severe malaria is foundmore commonly in adults than in children. It is important toassess the factors associated with malarial hepatopathy, the variedclinical presentations, as well as the complications in order toinitiate early interventional measures. There are a limited numberof studies in the pediatric population on malarial hepatopathy.Objective To assess the factors associated with malarialhepatopathy, the varied clinical presentations, as well as itscomplications.Methods This prospective study was conducted in the Departmentof Paediatrics, Sardar Vallabh Bhai Patel Post Graduate Institute ofPaediatrics (SVPPGIP), Cuttack, Odisha, India from January 20 10to June 2013, and included 70 children with malaria and jaundice,aged 6 months to 14 years. Malaria was confirmed by microscopicexamination of blood smears. Detailed clinical evaluations andinvestigation s were carried out to find multi-organ afflictions,with a special emphasis on hepatic involvement.Results Of218 children with malaria admitted during this period,70 (32%) children had fever and jaundice on presentation. Allchildren who had both Plasmodium faldparum and vivax infectionhad malarial hepatopathy. Complications, including acutekidney injury (AKI), disseminated intravascular coagulation(DIC), cerebral malaria, and mortality, were significantlyhigher among children with malarial hepatopathy compared tochildren without hepatopathy. Howevei; there was no significantdifference of hypoglycemia, respiratory distress syndrome (RDS),convulsions or severe anemia, between children with and withouthepatopathy.Conclusion Hepatopathy is more common with mixed malariainfections. The incidence of AKI, DIC, cerebral malaria, andmortality are significantly higher in patients with hepatopathy.Malarial hepatopathy should be considered in patients presentingwith acute febrile illness and jaundice so that specific treatmentcan be initiated early to prevent increased morbidity and mortality.
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Bhanushali, Minal, Terrie E. Taylor, Malcolm E. Molyneux, Monica Sapuwa, Eunice Mwandira, and Gretchen L. Birbeck. "Evoked potentials in pediatric cerebral malaria." Neurology International 3, no. 3 (December 6, 2011): 14. http://dx.doi.org/10.4081/ni.2011.e14.
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Cortical evoked potentials (EP) provide localized data regarding brain function and may offer prognostic information and insights into the pathologic mechanisms of malariamediated cerebral injury. As part of a prospective cohort study, we obtained somatosensory evoked potentials (SSEPs) and brainstem auditory EPs (AEPs) within 24 hours of admission on 27 consecutive children admitted with cerebral malaria (CM). Children underwent follow-up for 12 months to determine if they had any long term neurologic sequelae. EPs were obtained in 27 pediatric CM admissions. Two children died. Among survivors followed an average of 514 days, 7/25 (28.0%) had at least one adverse neurologic outcome. Only a single subject had absent cortical EPs on admission and this child had a good neurologic outcome. Among pediatric CM survivors, cortical EPs are generally intact and do not predict adverse neurologic outcomes. Further study is needed to determine if alterations in cortical EPs can be used to predict a fatal outcome in CM.
Dissertations / Theses on the topic "Pediatric malaria"
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Nyberg, Tove, and Madeleine Nilsson. "Experiences in the care of malaria infected children in a pediatric inpatient ward in Tanzania." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-192595.
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Background: The number of children under the age of five who dies of malaria per thousand births is sixteen in Tanzania. Even though improvements have been made there are still many challenges in the care of malaria infected children. Aim: The aim of this study was to investigate the experiences that nurses and relatives to malaria infected children have regarding the pediatric malaria care at Kilimanjaro Christian Medical Centre, Tanzania. Method: Semi structured interviews were conducted among three nurses and three relatives to malaria infected children within a pediatric ward at Kilimanjaro Christian Medical Centre, Tanzania. The interviews were recorded, transcribed and then analysed. Result: All the nurses agreed that the major challenge in the care of malaria infected children is the lack of knowledge from the relatives about prevention of malaria. This results in a lack of adherence among the relatives concerning prevention. The relatives agreed about their lack of knowledge about malaria and they wished for more education. They also considered the workload to be an issue for the nurses at the ward. The availability for the child to get treatment depends whether they are from a rural area or city. Conclusion: To continue the fight against malaria among children it is of great importance to focus on the relatives lack of knowledge about malaria, the workload issue and the long distance to hospital.
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Johansson, Emily White. "Beyond “test and treat” : Malaria diagnosis for improved pediatric fever management in sub-Saharan Africa." Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-273678.
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This thesis examined malaria test use, adherence and integration into clinical practice for improved pediatric fever management in sub-Saharan African countries and explored Access, Facility Readiness and Clinical Practice bottlenecks to achieve this program goal. Study I examined diagnostic testing rates and its determinants for pediatric fevers across 13 countries in 2009-2012 including Access bottlenecks. Study II evaluated the effect of testing on treatment decisions at the population level in 12 countries in 2010-2012 and explored reasons for varying country results across Access, Facility Readiness and Clinical Practice bottlenecks. Study III explored Facility Readiness and Clinical Practice bottlenecks for using malaria diagnosis for improved pediatric fever management in Mbarara District Uganda. Study IV examined integrated pediatric fever management using RDT and IMCI in Malawi health facilities in 2013-2014 including Facility Readiness and Clinical Practice bottlenecks. Malaria testing of pediatric fevers was low (17%) and inequitable at the outset of new guidelines with febrile children in least poor household more often tested than in poorest (OR: 1.63, 95% CI: 1.39-1.91) (Study I). Significant variability was found in the effect of testing on ACT use across countries (e.g. Uganda OR: 0.84, 95% CI: 0.66-1.06; Mozambique OR: 3.54, 95% CI: 2.33-5.39). Four main themes explained varying results: available diagnostics and medicines; quality of care; care-seeking behavior; and malaria epidemiology (Study II). In Mbarara District Uganda malaria over-treatment for RDT-negative results reportedly occurred and was driven by RDT perceptions, system constraints and provider-client interactions (Study III). In Malawi health facilities, there was common compliance to malaria treatment guidelines in sick child consultations. 72% were tested or referred for malaria diagnosis and 85% with RDT-confirmed malaria were prescribed first-line anti-malarials. Yet integrated pediatric fever management was sub-optimal in terms of other assessments completed and antibiotic targeting. 28% with IMCI-pneumonia were not prescribed any antibiotic and 59% ‘without antibiotic need’ were prescribed any antibiotic. Few eligible clients had respiratory rates counted to identify antibiotic need for IMCI-pneumonia (18%). RDT-negative children had 16.8 (95% CI: 8.6-32.7) times higher antibiotic over-treatment odds compared to positive cases and this effect was conditioned by cough or difficult breathing complaints (Study IV). Thesis findings highlight Access, Facility Readiness and Clinical Practice bottlenecks that need to be addressed to use malaria diagnosis for improved pediatric fever management. Programs must move beyond malaria-focused ‘test and treat’ strategies towards ‘IMCI with testing’ in order to conceptualize RDT as one part of the established algorithm for managing sick children in an integrated manner. RDT should also be viewed as an important entry point for contributing to ongoing health system strengthening efforts.
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Morris, Carrie Ann. "Population pharmacokinetics of artesunate and dihydroartemisinin in children and pregnant women with malaria." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1367.
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Artemisinin derivatives are key to the current global treatment approach for malaria. However, much remains unknown regarding the pharmacokinetics of these agents, particularly in children and pregnant women, two groups highly vulnerable to development of severe malaria infection. In this thesis, nonlinear mixed effects modeling is used to characterize the pharmacokinetics of the artemisinin derivative artesunate and its active metabolite, dihydoartemisinin (DHA), in children and in pregnant women.
Chapter 1 of this thesis contains a general review of the clinical pharmacokinetic findings for artesunate and DHA following artesunate administration by the intravenous, intramuscular, oral and rectal routes. Chapter 2 presents a population pharmacokinetic model utilizing both pediatric and adult data from one Phase II and four Phase III clinical trials evaluating the combination agent pyronaridine tetraphosphate/artesunate. The focus of the modeling described in this chapter is the evaluation of the effects of body size and gender on the pharmacokinetics of artesunate and DHA in pediatric patients with uncomplicated malaria. Chapter 3 consists of a population pharmacokinetic model built utilizing plasma artesunate and DHA concentrations from 26 parasitemic second and third trimester pregnant women and 25 parasitemic non-pregnant female controls in the Democratic Republic of Congo who received 200 mg oral artesunate.
The model described in Chapter 2 is a simultaneously implemented parent-metabolite model consisting of a one compartment model for artesunate, a one compartment model for DHA, and first-order artesunate absorption. Various approaches for incorporating body size on artesunate and DHA apparent clearance and volume of distribution parameters were evaluated, with a linear body surface area model and an allometric scaling model both proving satisfactory. The effect of gender was modeled on artesunate and DHA apparent clearance and volume terms. Only the effect of gender on DHA apparent clearance could be estimated with reasonable precision, with the 95% confidence interval for the effect being almost wholly contained within the predefined 0.75 to 1.25 no relevant clinical effect interval. The model described in Chapter 3 consists of a one compartment model for artesunate, a one compartment model for DHA, and mixed zero-order, lagged first order absorption of artesunate. In this model, pregnancy was found to have a marked effect on DHA apparent clearance, with a pregnancy-associated increase in DHA apparent clearance of 42.3%.
The models described in this thesis indicate that, for a given mg/kg dose of artesunate, both young children and pregnant women would be expected, on average, to display lower DHA concentrations than would be observed following administration of the same mg/kg dose to non-pregnant adults. Suboptimal dosing has clinical implications for the individual as well as potential implications regarding parasite susceptibility. Given this, the findings of the research described in this thesis highlight the necessity of investigations designed to comprehensively characterize the pharmacokinetics of artesunate and DHA in these two highly susceptible populations.
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Añez, Valdez Arletta. "Resistencia a las drogas antimaláricas en Bolivia." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/587143.
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La cloroquina (CQ) sigue siendo el medicamento de primera línea en todo el mundo para el tratamiento de la malaria por Plasmodium vivax. La dosis recomendada por la OMS es de 25 mg/kg/peso, independientemente de la edad del paciente. Por otro lado, la farmacocinética y la farmacodinámica de los medicamentos; diferente en los niños en relación que los adultos, puede influir en la concentración del fármaco en la sangre y convertirse en factor de riesgo para el fracaso terapéutico y /o resistencia a CQ.
Objetivo: Evaluar la eficacia terapéutica de la cloroquina en infecciones por Plasmodium vivax y la dosis pediátrica como factor de riesgo, asociado al fracaso terapéutico y/o resistencia.
Métodos: A todos los pacientes que cumplieron con los criterios de inclusión y exclusión se les administro 25mg/kg de CQ por tres días, bajo estricta supervisión, los cuales fueron seguidos por 28 días. La concentración de CQ+desetilcloroquina (DCQ) en sangre ha sido determinada en los días 7 y 28 de seguimiento y/o en el día del fracaso terapéutico (FT), y solo al final del seguimiento se les administró primaquina. Modelos de regresión y correlación se utilizaron para evaluar y comparar la dosis CQ tomada por mg/kg/peso (dosis real), la dosis de CQ calculada en base al área de superficie corporal (ASC) (dosis teórica), con los niveles de CQ en la sangre en el día 7 y la edad en años de la población. Los contrastes de hipótesis se han evaluado con un riesgo alfa de 5% y las estimaciones con un intervalo de confianza del 95%.
Resultados: Entre mayo y noviembre del 2011, cien pacientes fueron adheridos al estudio, dos se perdieron durante el seguimiento y otros dos fueron excluidos más tarde por violar el protocolo. De los 96 pacientes que completaron el seguimiento, 10 presentaron FT; uno de ellos presento parasitémia continua hasta el día 7, tres en el día 21, y seis en el día 28 del seguimiento. La media geométrica de CQ+DCQ el día 7 fue 321,7 ng/ml (rango 197-535 ng/ml).En seis pacientes con FT las concentraciones de CQ+DCQ en sangre en el día de FT ha sido >100 ng/ml. La tasa de resistencia fue del 6,5% en la población en general.
La diferencia entre las dosis real y teórica fue de: -181.206 mg (IC95%: -195,39; -167,02 mg) en los 5-9 años de edad y -71,39 mg (IC95%:-118,61;-23,99 mg) en el 10-14 años de edad. La concentraciones de CQ en la sangre en el día 7 ha sido diferente en mayores y menores de 15 años (p= 0,008). Se ha encontrado una correlación negativa entre la dosis real y teórica y la edad (R2= 0,529, p= 0,001). También se encontró una correlación negativa entre la diferencia de estas dosis (mg) y concentraciones de CQ en el día 7 del seguimiento (ng/ml) (r= -0,337, p= 0,001). De la misma manera en los niños menores de 15 años la tasa de FT ha sido mayor que los adultos. (28% vs. 4,2%, respectivamente) (Kaplan-Meier p= 0,005).
Conclusión: Se comprueba resistencia de la CQ en infecciones por P. vivax en la población general de la zona amazónica de Bolivia, la resistencia se encuentra más acentuada en jóvenes que en adultos, cuya edad media es <15 años. La dosis de cloroquina real es menor que la dosis teórica calculada por ASC en <15 años, mientras que no se encontró esta diferencia en adultos. Con la dosis de 25 mg/kg/peso los menores de 15 años no alcanzan los
mismos niveles de cloroquina en sangre del día 7 del seguimiento, que los adultos. Por estos resultados decimos que existe una sub-dosificación de Cloroquina en <15 años la que podría ser uno de los factores de riesgo que esté influenciando en la tasa de fracaso terapéutico y/o resistencia encontrada en niños; estos resultados sugieren la necesidad de revisar las dosis pediátricas de CQ utilizadas actualmente.Chloroquine (CQ) remains the world's first-line drug for the treatment of Plasmodium vivax malaria. The dose recommended by WHO: 25mg/kg/weight, regardless of the age of the patient. Methods: All patients received 25mg/kg/weight for three days, followed for 28 days. The concentration of CQ+ decytilcloroquine (DCQ) in blood was measured on days 7 and 28 of the follow-up and / or the day of therapeutic failure (FT). Regression and correlation models are used to evaluate and compare the CQ dose taken by mg /kg/ weight (actual dose), the CQ dose calculated based on the body surface area (ASC) (theoretical dose), with the levels of CQ in the blood on day 7 and age. Results: Between May and November 2011, 100 patients were adherent and 96 completed the study. The geometric mean of CQ+DCQ on day 7 was 321.7 ng/ml (range 197-535 ng/ml). In six patients with FT the concentrations of CQ+DCQ in blood on FT day were>100 ng/ml. The rate of resistance of 6.5% in the general population. The difference between the actual and theoretical doses was -181.206 mg (95% CI: -195.39; -167.02 mg) at 5-9 years of age and -71.39 mg (95% CI: -118.61; -23.99 mg) at 10 -14 years old. Blood concentrations of CQ at day 7 were different in older and younger than 15 years (p= 0.008). (R2= 0.529, p= 0.001). A negative correlation was found between the difference of these doses (mg) and concentrations of CQ on day 7 of follow-up (ng/ml) (r= -0.337, p= 0.001). Similarly, in children younger than 15 years the FT rate has been higher than adults. (28% versus 4.2%, respectively) (Kaplan-Meier p= 0.005). Conclusion: CQ resistance is confirmed in P. vivax infections in the general population of the Amazonian zone of Bolivia, also there is sub-dosage of Chloroquine in <15 years which could be one of the risk factors that is influencing the rate of therapeutic failure and/or resistance, found in children; These results suggest the need to review the pediatric doses of CQ currently used.
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Carrasco, Colom Jaume. "Influència de la resposta immunitària innata en la malaltia pneumocòccica invasiva greu: polimorfismes genètics en la via de senyalització Toll-IL1R i expressió de la L-selectina en leucòcits." Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/456370.
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INTRODUCCIÓ:
La malaltia pneumocòccica invasiva (MPI) pot tenir una elevada morbimortalitat, condicionada pel pneumococ i per factors de l’hoste com els receptors Toll-like (TLRs) i la seva via de senyalització intracel·lular comuna Toll-IL1R (TIR). El desenvolupament d’una MPI greu (MPIG) podria estar condicionat per polimorfismes genètics (SNPs) en regions crítiques de la via de senyalització comuna TIR. Aquests SNPs podrien influenciar també l’evolució i el pronòstic de la MPI.
La determinació de la pèrdua d’expressió de la L-selectina (CD62L) “in vivo” en la superfície dels granulòcits podria ser útil en l’avaluació de la via de senyalització TIR en pacients amb MPIG.
OBJECTIUS:
Descriure els SNPs en proteïnes de la via de senyalització TIR (IRAK1, IRAK4, IRAKM i MyD88) en pacients amb MPIG. Determinar si aquests SNPs s’associen a la presència de MPIG. Determinar si aquests SNPs condicionen l’evolució dels pacients amb MPIG. Analitzar si la determinació de CD62L “in vivo” és útil com a cribratge inicial de les variacions de funció de la via de senyalització TIR en pacients amb MPIG.
METODOLOGIA:
Estudi prospectiu observacional de casos i controls. Casos: 60 pacients amb MPI i síndrome de resposta inflamatòria sistèmica. Controls: 120 pacients sense infecció aguda ni antecedent d’infecció greu. Criteris d’exclusió: immunodeficiència coneguda. Variables independents: 1) freqüències genotípiques i al·lèliques dels SNPs rs1059701, rs1059702, rs1059703 (IRAK1); rs1624395, rs1370128 (IRAKM); rs1141168, rs4251513, rs1461567 (IRAK4); rs7744, rs6853 (MyD88). 2) Nivell d’expressió de CD62L en superfície de neutròfils, limfòcits i monòcits en fase aguda de la infecció i en fase basal. Altres variables: demogràfiques, antecedents personals i dades evolutives clíniques, analítiques i microbiològiques de la MPIG.
RESULTATS:
Associació significativa entre la presència de MPIG i: rs1059701-CC (IRAK1) [p=0,0067, OR 1,430 (IC95%: 1,140-1,795)], rs4251513-CC (IRAK4) [p<0,0001, OR 2,183 (IC95%: 1,578-3,019)], rs4251513-C (IRAK4) [p<0,0001, OR 1,468 (IC95%: 1,404-1,535)], rs1461567-T (IRAK4) [p=0,0158, OR 1,500 (IC 95%: 1,132-1,987)], rs6853-AA (MyD88) [p<0,0001, OR 2,125 (IC95%: 1,787-2,526)] i rs6853-A (MyD88) [p<0,0001, OR 1,935 (IC95%: 1,462- 2,563)].
En els pacients amb MPIG: associació significativa entre leucocitosi >15000/mmc i rs1059702- noTT (IRAK1) [p=0,0460, OR 7,500 (IC95%: 1,862-30,214)], pleuropneumònia i rs1624395-G (IRAKM) [p=0,0147, OR 1,834 (IC95%: 1,230-2,736)] i rs1370128-C (IRAKM) [p=0,0055, OR 2,060 (IC95%: 1,367-3,105)], seqüeles i rs4251513-noGG (IRAK4) [p=0,0010, OR 7,066 (IC95%: 2,645-18,872)], exitus i rs6853-noAA (MyD88) [p=0,0054, OR 16,086 (3,336- 77,574)] i rs6853-G (MyD88) [p=0,0064, OR 8,388 (IC95%: 2,472-28,455)].
Estudi d’expressió de CD62L : només s’han obtingut dades completes en 21 pacients. Entre els 3 grups cel·lulars, diferències significatives en el grup de monòcits entre fase aguda i basal (p=0,0343). En els monòcits, diferències significatives en rs4251513-CG (IRAK4) entre fase aguda i basal (p=0,0391).
CONCLUSIONS:
Alguns SNPs d’IRAK1, IRAK4 i MyD88 estan associats a un risc incrementat de desenvolupar MPIG en comparació amb la població general. Altres SNPS d’IRAK1, IRAKM, IRAK4 y MyD88 condicionen l’evolució de la MPIG. La identificació de SNPs que predisposin a malalties infeccioses greus com la MPIG podria ajudar a estratificar els pacients i dissenyar tractaments específics. Nous estudis amb mida mostral major podrien ajudar a entendre les conseqüències funcionals d’aquestes associacions a través de la determinació dels nivells de CD62L en monòcits abans i després de la MPIG.INTRODUCTION: Invasive pneumococcal disease (IPD) may have high morbidity and mortality, conditioned by pneumococcus and host factors such as Toll-like (TLRs) receptors andtheir common intracellular signaling pathway Toll-IL1R (TIR). Development of severe IPD (SIPD) could be conditioned by genetic polymorphisms (SNPs) in critical regions of the common signaling pathway TIR. These SNPs could also have influence on the evolution and prognosis of IPD. Determination "in vivo" of loss of expression of L-selectin (CD62L) on surface of granulocytes could be useful in the evaluation of the TIR signaling pathway in patients with SIPD. OBJECTIVES: To describe SNPs in proteins of the TIR signaling pathway (IRAK1, IRAK4, IRAKM and MyD88) in patients with SIPD. To determine whether these SNPs are associated with presence of SIPD. To determine whether these SNPs condition the evolution of patients with SIPD. To analyze if determination of CD62L "in vivo" is useful as an initial screening of variations in function of TIR signaling pathway in patients with SIPD. METHODS: Observational prospective case-control study. Cases: 60 patients with IPD and systemic inflammatory response syndrome. Controls: 120 patients without acute infection nor history of severe infection. Exclusion criteria: known immunodeficiency. Independent variables: 1) Genotypic and allelic frequencies of SNPs rs1059701, rs1059702, rs1059703 (IRAK1); rs1624395, rs1370128 (IRAKM); rs1141168, rs4251513, rs1461567 (IRAK4); rs7744, rs6853 (MyD88). 2) Level of expression of CD62L on surface of neutrophils, lymphocytes and monocytes in acute phase of infection and in basal phase. Other variables: demographic, personal history and clinical, analytical and microbiological evolutionary data of SIPD. RESULTS: Significant association between presence of SIPD and: rs1059701-CC (IRAK1) [p = 0.0067, OR 1,430 (IC95%: 1,140-1,795)], rs4251513-CC (IRAK4) [p <0.0001, OR 2,183 ( IC95%: 1,578-3,019)], rs4251513-C (IRAK4) [p <0.0001, OR 1,468 (IC95%: 1,404-1,535)], rs1461567-T (IRAK4) [p = 0.0158, OR 1,500 ( IC 95%: 1,132-1,987)], rs6853-AA (MyD88) [p <0.0001, OR 2,125 (IC95%: 1,787-2,526)] and rs6853-A (MyD88) [p <0.0001, OR 1,935 (IC95%: 1,462-2,563)]. In patients with SIPD: significant association between leukocytosis> 15000 / mmc and rs1059702- noTT (IRAK1) [p = 0.0460, OR 7,500 (IC95%: 1,862-30,214)], pleuropneumonia and rs1624395-G (IRAKM) [p = 0.0147, OR 1,834 (IC95%: 1,230-2,736)] and rs1370128-C (IRAKM) [p = 0.0055, OR 2,060 (IC95%: 1,367-3,105)], sequelae and rs4251513-noGG (IRAK4) [p = 0.0010, OR 7,066 (IC95%: 2,645-18,872)], exitus and rs6853-noAA (MyD88) [p = 0.0054, OR 16,086 (3,336-77,574)] and rs6853-G (MyD88) [ p = 0.0064, OR 8,388 (IC95%: 2,472-28,455)]. CD62L expression study: complete data were obtained in 21 patients. Among the 3 cell groups, significant differences in group of monocytes between acute and basal phase (p = 0.0343). In monocytes, significant differences in rs4251513-CG (IRAK4) between acute phase and basal phase (p = 0.0391). CONCLUSIONS: Some SNPs from IRAK1, IRAK4 and MyD88 are associated with an increased risk of developing SIPD compared to general population. Other SNPS from IRAK1, IRAKM, IRAK4 and MyD88 condition the evolution of SIPD. Identification of SNPs that predispose to serious infectious diseases such as SIPD could help stratify patients and design specific treatments. New studies with a larger sample size could help to understand functional consequences of these associations through the determination of CD62L levels in monocytes before and after SIPD.
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Ventura, Marcielle Teixeira. "Emulsões pediátricas de artesunato associado com cloridrato de mefloquina no tratamento da malária: desenvolvimento e estudo de estabilidade." Niterói, 2017. https://app.uff.br/riuff/handle/1/3350.
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A Malária é uma doença tropical muito importante em saúde pública devido às altas taxas de morbidade e mortalidade no mundo. Essa doença ocorre principalmente nas regiões africanas, sudeste asiático e mediterrâneo oriental. No Brasil, a Malária é predominante na região amazônica. Essa doença se manifesta nas formas mais graves principalmente em crianças menores de 5 anos. De forma semelhante, no Brasil, a maior prevalência da doença ocorre em crianças na faixa etária de 0 a 14 anos. A terapêutica antimalárica em crianças tem uma prática difícil, pois não existem apresentações farmacêuticas dos fármacos recomendados em dosagens flexíveis por via oral. O Guia de Tratamento da Malária no Brasil (2010) preconiza que a terapia de Malária falciparum em crianças de 06 a 11 meses de idade seja com comprimidos de Artesunato/Cloridrato de Mefloquina (AS/MQ) 25/55 mg durante 3 dias. Nessa faixa etária, formas farmacêuticas líquidas são as mais adequadas para serem utilizadas em pediatria devido à dificuldade desses pacientes em deglutir comprimidos e cápsulas, além dessas preparações apresentarem maior flexibilidade no ajuste da dose e são mais fáceis de administrar. O presente trabalho realizou o desenvolvimento farmacotécnico e estudo de estabilidade de uma formulação de emulsão a/o a partir de comprimidos de AS/MQ 25/55mg, através de transformação de forma farmacêutica (TFF), a ser manipulada em ambiente hospitalar. Para atender as condições necessárias para estabilidade de AS e mascaramento do sabor desagradável da MQ foi necessário o desenvolvimento de um veículo que pudesse receber os comprimidos de AS e MQ na forma de uma emulsão a/o. O veículo obtido teve como restrição técnica à utilização de substâncias que, nas concentrações utilizadas, não apresentassem efeitos tóxicos a pacientes pediátricos. O veículo emulsionado obtido apresenta em sua formulação sílica coloidal, óleo de girassol, sacarina, butil hidroxi tilueno (BHT), Span 80 e água destilada apresentando o aspecto, homogeneidade e consistência que permite a administração oral em copos dosadores ou seringas. O estudo de estabilidade físico do veículo emulsionado indicou que ele permaneceu estável por 30 dias quando armazenado a temperatura de 4ºC (± 2). No estudo analítico requerido para este trabalho, foi desenvolvida e validada a metodologia cromatográfica que permite a identificação e quantificação concomitante de AS e MQ. A metodologia cromatográfica desenvolvida apresenta todos os critérios necessários para o método válido aplicado em CLAE e demonstrou que pode ser utilizado nas duas formas farmacêuticas testadas, comprimidos e emulsão. A emulsão medicamentosa foi preparada pela incorporação dos comprimidos pulverizados ao veículo emulsionado, sem a adição de adjuvantes técnicos, obtendo-se uma emulsão medicamentosa de AS/MQ a 25/55mg por 3mL. Essa emulsão medicamentosa, durante o estudo de estabilidade, demonstrou que as características físicas estudadas são mantidas durante o período de 3 dias, tempo de tratamento da Malária em crianças de 06 a 11 meses com estes fármacos preconizado pelo Ministério da Saúde do Brasil e apresenta condições de manter a estabilidade química tanto do AS quanto do MQ. Para tanto, a emulsão medicamentosa de AS/MQ a 25/55mg por 3mL desenvolvida neste trabalho deve ser mantida a temperatura entre 4 e 25 ºC
Malaria is an important tropical disease in public health due to high rates of morbidity and mortality worldwide. This disease occurs mainly in Africa, Southeast Asia and Eastern Mediterranean. In Brazil, Malaria is prevalent in the Amazon region. This disease manifests in more severe forms mostly in children less than 5 years. Similarly, in Brazil, the highest prevalence of the disease occurs in children aged 0 to 14 years. Antimalarial therapy in children is a difficult practice because there are no pharmaceutical presentations of recommended dosages in flexible oral drugs. The Guide Treatment of Malaria in Brazil (2010) recommends that therapy of falciparum malaria in children 06-11 months of age either with tablets Artesunate / Mefloquine Hydrochloride (AS/MQ) 25/55 mg for 3 days. In this age range, liquid dosage forms are most suitable for use in pediatric patients due to difficulty these patients have in swallowing these tablets, in addition to these preparations having greater flexibility in adjusting the dose and they are easier to administer. The present work the pharmaceutics development and stability study of a w/o emulsion formulation from tablets of AS/MQ 25/55 mg through transformation of pharmaceutical forms (TPF) to be handled in a hospital environment. To meet the necessary stability of AS and masking of unpleasant taste of MQ, conditions required the development of a vehicle could receive the tablets of AS and MQ in the form of w/o emulsion. The vehicle was obtained as a technical restriction on the use of substances, at the concentrations used, it did not show any toxic effects to pediatric patients. The emulsified vehicle has obtained in the formulation colloidal silica, sunflower oil, sugar, butyl hydroxy toluene (BHT), Span 80 and distilled water have all the appearance, uniformity and consistency that allow oral administration in feeders cups or syringes. The study of the physical stability of the emulsified vehicle indicated that it remained stable for 30 days when it stored at 4ºC (± 2). In the analytical study required for this work, was developed and validated chromatographic method that allows the identification and simultaneous quantification of AS and MQ. The developed chromatographic method presents all necessary criteria for a valid method applied in HPLC and it demonstrated that can be used in tested dosage forms, tablets and emulsion. The drug emulsion was prepared by incorporation of the powdered tablets emulsified vehicle, without the addition of adjuvant technical, obtaining a drug emulsion AS/MQ 25/55mg by 3mL. This drug emulsion during the stability study showed that the physical properties studied are maintained during the 3 days, malaria treatment time in children 06-11 months on these drugs recommended by the Ministry of Health of Brazil. This drug emulsion presents conditions to maintain the chemical stability of both: the AS and MQ. Therefore, the drug emulsion AS/MQ 25/55mg by 3mL developed in this work, the temperature should be kept between 4 and 25ºC
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Nweneka, Chidi Victor. "Chloroquine as a therapeutic option for mild post malaria anaemia." Thesis, University of Glasgow, 2011. http://theses.gla.ac.uk/2622/.
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Background: The relative importance of malaria anaemia as a cause of childhood morbidity and mortality varies between and within regions. However, malaria anaemia remains an important cause of childhood morbidity and mortality. It has been estimated that globally, severe malaria anaemia occurs 1.42 to 5.66 million times per annum and kills an estimated 190,000 to 974,000 under-5 children. Studies from different countries endemic for malaria have emphasised the importance of anaemia in malaria-associated morbidity and mortality. Most of these studies have conclusively shown that severe malaria anaemia increases the risk of death in children with malaria; and in many reports, children with severe malaria anaemia often die before blood transfusion could be commenced. In addition, blood transfusion, which is the standard management for severe malaria anaemia, apart from not being available in many rural clinics, exposes the child to transfusion related infections such as human immunodeficiency virus (HIV). Better understanding of the pathogenesis of malaria anaemia therefore will enhance its prevention and management. The pathogenesis of malaria anaemia is multifactorial and involves such mechanisms as immune and non-immune mediated haemolysis of parasitized and non-parasitized erythrocytes, bone marrow dysfunction, altered cytokine balance, nutritional deficits and interactions with common haemoglobinopathies and red cell defects such as glucose-6-phosphate dehydrogenase (G6PD) deficiency. An important component of the pathogenesis of malaria anaemia is iron delocalisation characterised by the sequestration of iron by the reticulo-endothelial tissues (the monocyte-macrophage system) as a result of malaria-induced inflammation. Iron sequestration creates a state of false iron deficiency which recovers after the inflammation has subsided. Therefore if the malaria-induced inflammation can be resolved more quickly, the degree and duration of malaria anaemia will be reduced. In addition, since the destruction of non-parasitized erythrocytes accounts for more than 90% of erythrocyte loss, use of anti-inflammatory drugs could minimize red cell loss. Chloroquine is an antimalarial with proven anti-inflammatory properties. In addition, it is cheap, safe and has been shown to reduce iron delocalisation in vitro. A proof of concept study was designed to investigate its potential use in the management of children with mild malaria anaemia. Aims and hypothesis: The goal of the study was to investigate the effect of acute and continuing administration of chloroquine on haemopoietic response after a malaria episode. My hypothesis was that the anti-inflammatory and anti-macrophageal iron-loading effects of chloroquine will enhance erythropoietic recovery after a malaria episode. Methodology: The study was designed as a randomised placebo controlled trial and was conducted over two malaria seasons. In the first year, the study consisted of four arms with a 2x2 design and only two arms in the second year. In the first year, the participants were initially randomised to receive antimalarial treatment with either chloroquine-sulphadoxine-pyrimethamine or co-artemether. All children with negative peripheral smear for malaria parasite by day three were subsequently randomised to receive either weekly chloroquine or weekly placebo until day 90. In the second year of the study, all the children were initially treated with co-artemether; subsequently, those with negative peripheral smear for malaria parasites were randomised to weekly chloroquine or weekly placebo as in the first year. Children randomised to weekly chloroquine and weekly placebo were followed up for three months. Various clinical and laboratory measurements were conducted on days 0, 3, 7, 15, 30, 45, 70 and 90. In year two of the study, no data were collected on days seven and 70. The main outcome measure was change in haemoglobin from day three to day 30 and from day three to day 90. Other outcome measures were 1. Changes in Hb in the placebo arms of the CQ-SP and ACT treatment groups 2. Changes in measures of inflammation – neopterin and cytokines 3. Changes in markers of iron status 4. Prevalence of sub-microscopic parasitaemia Results: In 2007, 1445 children were placed under malaria surveillance, of which 105 malaria cases were recorded and 61 completed the 90 days follow-up. In 2008, of 1220 children under surveillance, 49 malaria cases were recorded, and 31 completed 90 days follow-up. There was no difference in Hb change from day three to day 30 and from day three to day 90 between the weekly chloroquine and weekly placebo arms. Although not statistically significant, the Hb change in children treated CQ-SP in 2007 was nearly twice the change in children treated with ACT at both days 30 and 90. The changes in the markers of iron status – MCV, MCH and ZnPP did not differ by treatment group and by randomisation group. During the acute malaria phase, neopterin concentration was high but by day 15, the levels had fallen to near zero levels and remained at this low level until day 30. Prevalence of sub-microscopic parasitaemia in the group was 15.1% and was similar in both randomisation arms. Iron deficiency was highly prevalent among the study participants. The independent predictors of Hb change were Hb at day 0, presence of iron deficiency, age of the child and height-for-age z score. Conclusions: Giving weekly chloroquine at a dose of 5mg/kg to children with mild anaemia associated with malaria did not confer any advantage to bone marrow recovery compared to children who received placebo. The data, however, suggests that the initial therapeutic dose of chloroquine (10mg/kg/day over three days) could have some positive effects on bone marrow recovery post malaria. The Hb recovery following treatment for malaria is determined by the age of the child, the Hb at diagnosis, the presence or absence of iron deficiency, and the height-for-age z score.
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Launes, Montaña Cristian. "Grip A (H1N1) PDM09: Malaltia moderada i greu en el pacient pediàtric. Utilitat de la càrrega viral com a biomarcador de gravetat." Doctoral thesis, Universitat de Barcelona, 2012. http://hdl.handle.net/10803/91062.
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INTRODUCCIÓ
L’abril de 2009 s’identifica un nou virus de la grip, l’A (H1N1) pdm09, en humans. El juny del mateix any, l’Organització Mundial de la Salut declara l’estat de pandèmia a nivell mundial. La malaltia pel nou virus va afectar centenars de nens al nostre medi durant la temporada 2009-2010.
OBJECTIUS
- Descriure l'espectre de malaltia per grip A (H1N1) pdm09 moderat i greu (aquells casos que requeriren ingrés en un hospital pediàtric de tercer nivell) en la població pediàtrica en el nostre medi.
- Descriure la malaltia per grip A (H1N1) pdm09 en pacients pediàtrics en tractament per leucèmia limfàtica aguda, tant els ingressats com els que es va optar per tractar i seguir ambulatòriament.
- Descriure els valors de càrrega viral de grip A (H1N1) pdm09 al moment del diagnòstic en relació amb variables epidemiològiques i clíniques en els pacients ingressats amb clínica respiratòria.
PACIENTS I MÈTODES
- Es dissenyen tres estudis amb recollida prospectiva de dades epidemiològiques, clíniques, analítiques i microbiològiques de nens amb malaltia confirmada amb detecció del material genètic del virus de la grip A (H1N1) pdm09 en aspirat nasofaringi. Els tres estudis es realitzen en un hospital pediàtric de tercer nivell (Hospital Sant Joan de Déu, Universitat de Barcelona) i els resultats es presenten en la memòria d’aquesta tesi. La recollida de dades es porta a terme durant la temporada pandèmica 2009-2010. S'efectuen els procediments estadístics pertinents per al tractament de dades.
RESULTATS
- El perfil del nen ingressat amb malaltia per grip A (H1N1) pdm09 és el d'un nen prèviament sa preescolar o bé el d'un nen d'edat escolar amb malaltia de base. La dificultat respiratòria i la hipoxèmia són el motiu principal d'ingrés, encara que també s'observen manifestacions extrapulmonars (neurològiques i cardíaques principalment). Les malalties cròniques pulmonars i neurològiques són els grups més importants de pacients que tenen malaltia de base i que requereixen ingrés. D'entre ells, els pacients amb malalties neurològiques suposen el principal grup de malalties cròniques d'entre els que requereixen ingrés a la Unitat de Cures Intensives Pediàtriques (UCIP). En els pacients que requereixen ingrés en UCIP trobem un major temps d'evolució de la malaltia abans d'iniciar el tractament amb oseltamivir i aquest retard en l'inici del tractament antiviral es relaciona amb una major risc d'ingrés en UCIP en el model multivariant.
- Els nens amb leucèmia limfàtica aguda en fases de tractament més intensiu presenten una malaltia per grip més greu (broncopneumònia). Els nens en tractament de manteniment no presenten cap complicació amb tractament amb oseltamivir.
- Els valors de càrrega viral al diagnòstic es correlacionen negativament amb el temps de durada de la clínica en el moment de fer la recollida de la mostra. Tenir una càrrega viral alta havent passat 5 o més dies des de l'inici de la clínica es relaciona amb un major risc de malaltia greu per grip A (H1N1) pdm09 (necessitat de tractament amb ventilació mecànica invasiva o no invasiva).“INFLUENZA A(H1N1)PDM09: MODERATE AND SEVERE DISEASE IN THE PEDIATRIC PATIENT. VIRAL LOAD AT DIAGNOSIS AS A BIOMARKER OF SEVERITY.” TEXT: INTRODUCTION A new influenza virus was identified in April 2009 in humans. The influenza A (H1N1) pdm09 disease affected hundreds of children in our country during the pandemic season (2009-2010). OBJECTIVES - To describe the moderate and severe influenza A (H1N1) pdm09 disease (cases requiring for admission in a tertiary pediatric hospital) in children of our setting. - To describe the influenza A (H1N1) pdm09 disease in pediatric patients with acute lymphatic leukemia. - To describe the influenza A (H1N1) pdm09 viral load values at diagnosis in hospitalized children with respiratory symptoms and their relations with epidemiological and clinical variables. PATIENTS AND METHODS - Three different studies were designed and their results are presented. The studies were performed in a tertiary pediatric hospital (Hospital Sant Joan de Déu, University of Barcelona). Data collection was carried out during the pandemic season (2009-2010) in children with confirmed infection with a real-time RT-PCR. RESULTS - A previously healthy infant or a school-aged patient with underlying disease was the profile of the hospitalized child with influenza A (H1N1) pdm09 infection. Respiratory distress and hypoxemia were the main reasons for admission, although extrapulmonary manifestations were also observed (mainly neurological and cardiac). Children with chronic pulmonary diseases or with neurological disorders were the most important groups of patients with an underlying disease of those who required hospitalization. Patients with neurological chronic diseases more often required admission to the Pediatric Intensive Care Unit (PICU). Delays in starting treatment with oseltamivir were associated with an increased risk of admission to PICU in a multivariate model. - Children with acute lymphatic leukemia in intensive treatment phases developed a more severe influenza disease. Children in maintenance treatment phase had not complications. All of them were treated with oseltamivir. - The values of viral load at diagnosis were correlated negatively with the duration of the symptoms at the moment of sampling. To have a high viral load after 5 or more days of the onset of clinical symptoms was associated with an increased risk of severe illness (requiring for mechanical ventilation) due to influenza A (H1N1) pdm09 infection.
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Bautista, Rodríguez Carles. "Relació entre la malaltia pneumocòccica invasiva i el dèficit genètic de MBL (mannose-binding lectin)." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/471529.
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INTRODUCCIÓ. La susceptibilitat a la malaltia pneumocòccica invasiva (MPI) es correlaciona amb l’edat i els nens són el grup amb major inicidéncia de malaltia. El paper del sistema immunològic innat, concretament la MBL (mannose-binding lectin) i la seva relació amb la MPI no està ben definit.
OBJECTIUS. Els objectius d’aquesta tesi doctoral son determinar la prevalença de genotips responsables de nivells baixos de MBL sèrica en pacients amb MPI segons els grup d’edat i el potencial invasiu associat al serotip de pneumococ.
MATERIAL I MÈTODE. Es realitzen dos estudis. El primer és un estudi prospectiu de 2 anys on s’inclouen pacients amb MPI i s’avalua el potencial invasiu del pneumococ causant d’infecció i els genotips associats a nivells sèrics baixos de MBL. El segon estudi és un retrospectiu de 16 anys on es valoren les mateixes variables en una cohort de nens diagnosticats de meningitis pneumocòccica.
RESULTATS. Els nens menors de 2 anys tenen una freqüència major de genotips associats a dèficit sèric de MBL en comparació amb altres grups d’edat (31.0% vs 11.9%; p=0.031). També existeix una proporció major d’aquest tipus de genotips en nens menors de 2 anys amb MPI causada per serotips de baix potencial invasiu en comparació amb altres grups d’edat (46.2% vs 13.2%; p=0.02).
Els nens menors de 12 mesos amb meningitis pneumocòccica tenen 7 vegades més risc de tenir un genotip associat a dèficit sèric de MBL en comparació amb altres grups d’edat (p<0.01). A mes, la proporció de nens amb dèficit genètic de MBL fou significativament major en els menors de 12 mesos amb meningitis pneumocòccica causada per serotips oportunistes (p<0.05).
CONCLUSIONS. Els nens menors de 2 anys amb genotips associats a dèficit sèric de MBL tenen major risc de MPI i, en particular, malaltia causada per serotips de baix potencial invasiu.
El dèficit de MBL determinat genèticament augmenta el risc de meningitis pneumocòccica en nens menors de 12 mesos, especialment si estan colonitzats per serotips de baix potencial invasiu a nivell nasofaringi.INTRODUCTION. Children <2 years of age have higher risk of Invasive pneumococcal disease (IPD) than adult population. The complex interaction between host factors and virulence determinants of the pneumococcus may be responsible for developing IPD. MBL is a human serum protein of the innate immune system. The objective of this Thesis is to evaluate the prevalence of MBL genotypic deficiency in patients with IPD according to age, serotype attack rate characteristics and clinical manifestations. METHODS: The first study is a 3-year prospective study (February 2010-March 2013) including patients with IPD attended in two Hospitals from Catalonia, Spain. The second study is a 16-year retrospective study (January 2001 to March 2016) including patients ≤ 18 years with PM. Variables including attack rate of pneumococcal serotype and MBL2 genotypes associated with low serum MBL levels were recorded. RESULTS: 147 patients were included in the first study. Children <2 years showed a higher frequency of MBL-low genotypes compared to the other patients (31.0% vs. 11.9% p=0.031). A sub-analysis of patients considering age and attack rate of serotype revealed a significantly high proportion of MBL-low genotypes in children <2 years with IPD caused by opportunistic serotypes vs other patients 46.2% vs. 13.2%; P=0.02. No significant differences were observed comparing the proportion of MBL-low genotypes in children <2 years infected by high-attack rates serotypes vs. other patients: 18.8% vs 10.0% P=0.59. Forty-eight patients were included in the second study. Children ≤ 12 month-old had a 7-fold risk of having a low-MBL genotype in comparison to other ages (p<0.01). A sub-analysis of patients by age group revealed considerable proportions of carriers of low-MBL genotypes among those ≤ 12 month-old with PM caused by opportunistic serotypes (54.5%), admitted to the PICU (46.7%) and of White ethnicity (35.7%). These proportions were significantly higher than in older children (p<0.05). CONCLUSION: These data suggest that pneumococcal serotypes with low-attack rate have more opportunities to cause invasive disease in young children with a genetically determined low-MBL production, especially PM in children ≤12 month-old. MBL may have an important role in the episodes caused by non-high invasive disease potential serotypes.
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Selva, Jové Laura. "Real-time PCR per a la vigilància epidemiològica de la malaltia pneumocòccica invasiva (MPI) en pacients pediàtrics." Doctoral thesis, Universitat de Barcelona, 2012. http://hdl.handle.net/10803/92298.
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Streptococcus pneumoniae (S. pneumoniae) és un colonitzador habitual del tracte respiratori superior dels humans. Es tracta d’un patogen comú de l’espècie humana que presenta una elevada taxa de morbiditat i mortalitat arreu del món.
El bacteri pot causar otitis mitjana, sinusitis o infeccions de tracte respiratori superior, (per contigüitat) però també pot causar malaltia invasiva, quan habita en un territori habitualment estèril, produint pneumònia, bacterièmia, septicèmies i meningitis, entre d’altres.
La malaltia pneumocòccica és un important problema de salut pública i és la principal causa individual de mortalitat infantil en el món. Segons dades de la Organització Mundial de la Salut (OMS), s’estima que a l’any 2000 es van produir 14.5 milions d’episodis greus de malaltia pneumocòccica, que va resultar en 826 000 morts en nens menors de dos anys. Un 61% d’aquestes morts es van produir a l’Àfrica subsahariana i al sud-est asiàtic. Tanmateix, en aquests països i, en especial a les zones rurals, les capacitats de diagnòstic són limitades o inexistents i la identificació de l’agent etiològic es basa en signes i símptomes clínics. És molt important aïllar l’agent etiològic causant de malaltia per tal de poder avaluar el millor tractament possible. No obstant, les tècniques actuals per al diagnòstic de la malaltia presenten una limitada sensibilitat i especificitat.
El cultiu microbiològic, com a mètode de diagnòstic clàssic, té una baixa sensibilitat per a detectar el pneumococ. L’objectiu d’aquesta tesi és avaluar el potencial de les tècniques moleculars per al diagnòstic i caracterització de la malaltia pneumocòccica i discernir si l’ús de tècniques moleculars com la reacció en cadena de la polimerasa (PCR) poden suposar un avantatge tant per la rapidesa del mètode com per la detecció del patogen present en una mostra a baixa concentració. L’aplicació d’aquest tipus de tècniques en mostres biològiques impregnades en paper de filtre (dried-spot) i conservades a temperatura ambient poden ser un excel•lent sistema per a la detecció i serotipat de S. pneumoniae en països en vies de desenvolupament on la falta de recursos econòmics esdevé una de les principals limitacions.
La capacitat del pneumococ de causar malaltia depèn de la presència d’una càpsula polisacàrida que impedeix la fagocitosi. Tot i que la presència de la càpsula és un requisit perquè produeixi malaltia, no és suficient per conferir virulència, sinó que són necessaris una varietat de factors determinants addicionals, com ara les adhesines, les proteases, les toxines, els sistemes de transport i enzims que modifiquen el medi extracel•lular. Recentment, s’ha descobert un determinant de virulència del pneumococ que és la proteïna rica en repeticions de serina, PsrP (Pneumococcal-serine rich protein). Es tracta d’una adhesina que intervé en l’adhesió del pneumococ a les cèl•lules pulmonars. PsrP és un important factor de virulència capaç de causar malaltia i un potencial candidat a una nova vacuna proteica.Streptococcus pneumoniae (S. pneumoniae) is a common colonizer of the upper respiratory tract of humans. This is a major human pathogen and leading cause of morbidity and mortality worldwide. The bacteria can cause otitis media, sinusitis or upper respiratory tract infections (contiguity) but can also cause invasive disease, when living in an area usually sterile, causing pneumonia, bacteraemia, sepsis and meningitis, among others. According to the World Health Organization, in 2000, pneumococcal disease was estimated to have caused about 14.5 million severe episodes. There were approximately 826 000 deaths from pneumococcal disease in children under five years and 61% of these deaths occurred in sub-Saharan Africa and Southeast Asia. However, in these countries, especially in rural areas, diagnostic capabilities are limited or nonexistent and agent identification is based on clinical signs and symptoms. It is very important to isolate the etiologic agent of disease in order to assess the best treatment possible. However, present techniques for the diagnosis of the disease have a limited sensitivity and specificity. Microbiological culture, considered the “gold-standard” in microbiological diagnosis has low sensitivity to detect pneumococcus. The aim of this Thesis is to evaluate the potential of molecular techniques for diagnosis and characterization of pneumococcal disease and to discern whether the use of molecular techniques such as PCR, can be an advantage both for the speed of method as for the detection of the pathogen present in a sample in low concentration. The application of these techniques in biological samples impregnated filter paper (dried-spot) and kept at room temperature can be an excellent system for the detection and serotyping of S. pneumoniae in developing countries where lack of financial resources is a major constraint. The ability of the pneumococcus to cause disease depends on the presence of a polysaccharide capsule that prevents phagocytosis. Although the presence of the capsule is a requirement to produce disease, is not sufficient to confer virulence, but need a large number of additional factors such as adhesins, proteases, toxins, transportation systems and enzymes that modify the extracellular medium. One recently identified pneumococcal virulence determinant is the pneumococcal serine-rich repeat protein (PsrP). This is an adhesin involved in adherence of pneumococci to lung cells. PsrP is an important virulence factor capable of causing disease and a potential new vaccine candidate protein.
Books on the topic "Pediatric malaria"
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Bronzan, Rachel. Peripheral parasite density and its relationship to severity of disease in pediatric cerebral malaria. [New Haven, Conn: s.n.], 1995.
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Votre enfant et les médicaments: Informations et conseils. Montréal: Éditions de l'Hôpital Sainte-Justine, 2005.
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Choudhury, Jaydeep. Clinic Consult: Pediatrics (Malaria). Jaypee Brothers Medical Publishers (P) Ltd., 2016. http://dx.doi.org/10.5005/jp/books/12879.
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(Foreword), Fred C. Engh, ed. Tictionary: A Reference Guide to the World of Tourette Syndrome, Asperger Syndrome, Attention Deficit Hyperactivity Disorder and Obsessive Compulsive Disorder for Parents and Professionals. Autism Asperger Publishing Company, 2003.
Find full textBook chapters on the topic "Pediatric malaria"
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Krezanoski, Paul J., and Davidson H. Hamer. "Malaria." In The MassGeneral Hospital for Children Handbook of Pediatric Global Health, 217–41. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4614-7918-5_16.
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Kampondeni, S. D., and M. J. Potchen. "MRI Neuroimaging in Pediatric Cerebral Malaria." In Encyclopedia of Malaria, 1–14. New York, NY: Springer New York, 2015. http://dx.doi.org/10.1007/978-1-4614-8757-9_84-1.
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Holding, Penny, and Michael J. Boivin. "The Assessment of Neuropsychological Outcomes in Pediatric Severe Malaria." In Neuropsychology of Children in Africa, 235–75. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4614-6834-9_12.
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Dhanireddy, Shireesha, and John B. Lynch. "Malaria." In Textbook of Clinical Pediatrics, 1103–13. Berlin, Heidelberg: Springer Berlin Heidelberg, 2012. http://dx.doi.org/10.1007/978-3-642-02202-9_101.
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Clark, Ian A., and Michael J. Griffiths. "The molecular basis of paediatric malarial disease." In Pediatric Infectious Diseases Revisited, 239–72. Basel: Birkhäuser Basel, 2007. http://dx.doi.org/10.1007/978-3-7643-8099-1_9.
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Esposito, C., F. Alicchio, I. Giurin, and P. Montupet. "Trattamento laparoscopico della malattia da reflusso gastroesofageo." In Videochirurgia pediatrica, 231–38. Milano: Springer Milan, 2010. http://dx.doi.org/10.1007/978-88-470-1797-9_28.
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Jasonni, V., S. Avanzini, A. Pini Prato, and G. Mattioli. "Malattia di Hirschsprung: pull-through endorettale secondo Soave-Georgeson." In Videochirurgia pediatrica, 279–86. Milano: Springer Milan, 2010. http://dx.doi.org/10.1007/978-88-470-1797-9_34.
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Mccarthy, Carol A. "Malaria." In Pediatric Clinical Advisor, 349. Elsevier, 2007. http://dx.doi.org/10.1016/b978-032303506-4.10197-x.
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Choudhury, Jaydeep. "Malaria." In FAQs in Pediatric Infectious Diseases, 171. Jaypee Brothers Medical Publishers (P) Ltd., 2014. http://dx.doi.org/10.5005/jp/books/12114_26.
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Soans, Santosh, and Mallikarjun RP. "Malaria." In Practical Approach to Pediatric Intensive Care, 811. Jaypee Brothers Medical Publishers (P) Ltd., 2015. http://dx.doi.org/10.5005/jp/books/12720_84.
Full textConference papers on the topic "Pediatric malaria"
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Goodfriend, Amy C., Tré R. Welch, Jian Wang, Kytai T. Nguyen, Romaine F. Johnson, Chet C. Xu, Surendranath R. Veeram Reddy, Alan Nugent, James Richardson, and Joseph M. Forbess. "Design of a MRI-Visible and Radiopaque Drug Delivery Coating for Bioresorbable Stents." In ASME 2015 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2015. http://dx.doi.org/10.1115/imece2015-52146.
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Cardiovascular stents are currently being used for intraluminal stenting of the trachea for tracheomalacia treatment. These devices composed of permanent materials are controversial due to their limitations at internal reinforcement and biocompatibility, especially in pediatrics. We show in a pediatric tracheomalacia rabbit model, a poly-L-lactic acid (PLLA) Double Opposed Helical bioresorbable stent (DH) elicits a more mild inflammatory response in the malacic airway compared to a control metal stent. To further improve efficacy, a multi-drug delivery, bioresorbable coating was designed. The coating design controllably delivers ciprofloxacin (antibiotic) for one week and dexamethasone (anti-inflammatory agent) for three months. The bioresorbable polymeric components also demonstrate feasible visibility utilizing Magnetic Resonance Imaging (MRI). The local multi-drug delivery and imaging capabilities in this coating design in combination with the bioresorbable DH stent will result in a successful intervention specifically design for pediatric tracheomalacia. This design will eliminate long-term risks associated with current permanent devices and provide necessary theranostic agents to facilitate healing and monitor progress via non-invasive imaging techniques.
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Agarwal-Harding, Kiran J., Elijah Mlinde, Collin J. May, Linda Chokotho, and Lahin Amlani. "Clinical and Functional Outcomes of Nonoperatively Treated Pediatric Supracondylar Humerus Fractures at the Nkhotakota District Hospital, Malawi." In AAP National Conference & Exhibition Meeting Abstracts. American Academy of Pediatrics, 2021. http://dx.doi.org/10.1542/peds.147.3_meetingabstract.235.
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Kortz, Teresa, Elliot Marseille, and Jim Kahn. "Bubble Continuous Positive Airway Pressure in the Treatment of Severe Pediatric Pneumonia in Malawi: A Cost-effectiveness Analysis." In Selection of Abstracts From NCE 2016. American Academy of Pediatrics, 2018. http://dx.doi.org/10.1542/peds.141.1_meetingabstract.485.
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