We compared risk factors, clinical features, neuroimaging data, and outcome between hypertensive and non-hypertensive ischemic stroke patients. Differential features of ischemic stroke patients with hypertension (n = 768) and without hypertension (n = 705) were assessed by bivariate analysis. Independent predictors of hypertensive ischemic stroke were determined by multivariate analysis. Atherothrombotic infarction and lacunar infarct were significantly more common in the hypertensive group, in which older age and a higher occurrence of previous cerebral infarction, hyperlipidemia, acute stroke onset, lacunar syndrome, and pons topography was also observed. Age of 85 years or older, valvular heart disease, and decreased consciousness were more common in non-hypertensive patients. After multivariate analysis, lacunar syndrome, female gender, and previous infarction were directly associated with hypertensive ischemic stroke. Age of 85 years or older and valvular heart disease were inversely associated with hypertensive ischemic stroke. Hypertension was the main cardiovascular risk factor only for lacunes and atherothrombotic infarction, that is, ischemic stroke associated with small- and large-artery disease.
Candida yeasts are ubiquitous commensals, which can cause opportunistic infection in any location of the body. The source of infection may be both endogenous and exogenous. Invasive candidiasis encompasses different entities ranging from invasive candidiasis to disseminated multiorgan infection. Invasive candidiasis is the third leading cause of nosocomial bloodstream infection and the fourth of all nosocomial infections. It is also the most common invasive fungal infection in non-neutropenic critically ill patients, with a remarkable increase in the last 20 years owing to the increased survival of these patients and to more complex diagnostic, therapeutic and surgical procedures. Its incidence in infants, according to recent reviews, stands at 38.8 cases/100,000 children younger than 1 year. Candida albicans remains the most frequent isolate in invasive infections, although infections caused by other species have risen in the last years, such as C. kruzsei, C. glabrata and C. parapsilosis; the latter causing invasive candidiasis mainly associated with central venous catheter management, especially in neonatal units. The overall mortality of invasive candidiasis is high, with 30-day mortality reaching 20-44% in some series involving paediatric patients. This report provides an update on incidence, epidemiology, clinical presentation, diagnosis, treatment and outcome of invasive infection by Candida spp. in the paediatric patient.
As a result of the increased incidence of osteopenia and osteoporosis in HIV-infected patients, numerous publications have suggested that there may be a link between bone metabolism alterations and HIV infection. The early bone loss seen in these patients was initially attributed to the use of highly active antiretroviral treatment (HAART) that included protease inhibitors. Recent studies, however, have suggested that it may be a direct consequence of the viral infection on bone metabolism, persistent activation of pro-inflammatory cytokines (TNFa), or altered vitamin D metabolism secondary to the virus, combined with subsequent factors (e.g., antiretroviral treatment) that aggravate the bone demineralization. We present an antiretroviral-naive 6-year-old girl with vertically transmitted HIV infection who presented with severe osteoporosis and multiple pathological fractures of the vertebrae, ribs, and upper and lower limbs. The child was treated with HAART, appropriate nutritional support for her age, physiotherapy and rehabilitation, calcium and vitamin D supplements, and alendronate therapy. After 6 weeks of treatment, the intense pain and muscle atrophy had disappeared and she was able to walk unassisted. At 6 months, bone mass had increased by 72%. The interest of this case lies in the presence of severe osteoporosis and multiple pathological fractures in an HIVinfected naive child. To date, this condition has only been described in patients treated with antiretrovirals. Moreover, this is the first reported HIV-positive pediatric patient treated with bisphosphonates, which proved to be highly successful.
BackgroundSerious burns produce plasma extravasation which develops an important loss of immunoglobulins (Ig). In patients with a burned surface area (BSA) >15% IgG plasmatic levels decrease until 40 hours’ post-burn.PurposeTo evaluate the use of non-specific Ig in burned paediatric patients based on the current protocol of the hospital.Material and methodsRetrospective observational study, which includes all paediatric patients with ≥15% BSA hospitalised between August 2012 and July 2017.Biodemographic data were registered as: (sex, age, weight), burn data (BSA) and Ig administration data (plasmatic levels, dose and number of administrations).The existing protocol about the use of Ig in burned paediatric patients (BSA ≥15%) was analysed. It recommends the determination of IgG 24 to 48 hours’ post-burn and the infusion of non-specific Ig (400 mg/kg) if patients have below-normal levels.ResultsThirty-one patients (12 females) with a median age of 2 years (8 m – 15 y) and a weight of 13 kg (7.5–67 kg) were enrolled in the study. The median BSA was 20% (15%–55%).Eighteen patients (58%) accomplished all the recommendations specified in the protocol.Determination of IgG levels was made in 26 patients (83.9%). Eighteen (69.2%) had below-normal levels and a median BSA of 23.5% (15–55). In the subgroup of patients with BSA ≥20% (20–55) the determination was done in the 94% (15/16) and 14 (93%) who had below-normal levels.Non-specific Ig was administered in 61% (19) of the patients at a dose of 400 mg/kg. No IgG determination was repeated after the first infusion in six patients (31.6%). Seven patients with a median BSA of 46% (16–55) needed more than one Ig infusion.ConclusionAll patients received the dose of Ig indicated in the protocol (400 mg/kg).In patients with BSA>20%, determination of plasmatic levels is essential because it was detected that more than 90% of the patients had below–normal levels of IgG.No IgG determination after the first infusion was repeated in more than 30% of the patients, therefore a proposal to improve the protocol is the need to repeat IgG determination in all the patients who have received an infusion to corroborate the achievement of normal IgG levels.References and/or AcknowledgementsThanks to all authorsNo conflict of interest
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