Growth and differentiation factor-15 as a potential prognostic biomarker for status-epilepticus-associated-with-fever: A pilot study

ObjectiveBiomarkers predicting poor outcomes of status-epilepticus-associated-with-fever (SEF) at an early stage may contribute to treatment guidance. However, none have been reported thus far. We investigated the dynamics of serum growth and differentiation factor (GDF)-15 after seizure onset in patients with SEF and determined whether GDF-15 can predict poor outcomes, particularly in the first 6 h after seizure onset.MethodsWe enrolled 37 pediatric patients with SEF and eight patients with simple febrile seizures (SFS) and collected their blood samples within 24 h of seizure onset and eight febrile control patients between March 1, 2017 and September 30, 2020. All patients were aged ≤15 years.ResultsIn the SEF group, the median post-seizure serum GDF-15 values were 1,065 (<6h), 2,720 (6–12 h), and 2,411 (12–24 h) pg/mL. The median serum GDF-15 in the first 6 h was measured in patients with SEF without a significant past medical history (n = 21) and was found to be statistically significantly higher (1,587 pg/mL) than in the febrile control (551 pg/mL) and SFS (411 pg/mL) groups. The median serum GDF-15 was statistically significantly higher in patients with SEF with sequelae (n = 5) and patients with acute encephalopathy with biphasic seizures/reduced diffusion/hemorrhagic shock and encephalopathy syndrome (n = 6) than in patients with SEF without sequelae (n = 16) (15,898 vs 756 pg/mL) and patients with prolonged FS (n = 15) (9,448 vs 796 pg/mL).ConclusionsThis study demonstrates the dynamics of serum GDF-15 in patients with SEF and indicates the potential of GDF-15 as an early predictor of poor outcomes.     

热性惊厥、GEFS＋、Dravet综合征与疫苗接种的关系

对患有神经系统疾病儿童进行疫苗接种决策对于人们尤其是儿科医生来说是个棘手的问题,医生和家长们担心出现不良反应(如惊厥、疫苗脑病等)或考虑患儿存在热敏感性惊厥疾病的病史,担心疫苗接种导致惊厥发作,从而倾向于不给或不推荐其接种疫苗,而热性惊厥、GEFS＋、Dravet综合征这类热敏感性疾病是最常见的惊厥性疾病之一,其发病机制被证实多与SCN 钠离子亚通道基因突变导致功能缺失相关。对于FS、GEFS、以及Dravet综合征的患儿,疫苗接种可能会导致发热,引起惊厥,但疫苗接种并不会使他们的预后变差。     

Risk of chemotherapy-induced febrile neutropenia with same-day versus next-day pegfilgrastim prophylaxis among patients aged ≥65 years: a retrospective evaluation using Medicare claims

Background: Two recent evaluations reported that risk of febrile neutropenia (FN) may be higher when pegfilgrastim prophylaxis (PP) is administered on same day as chemotherapy rather than per recommendation (1–3 days following chemotherapy). Such evidence is based largely on the experience of younger privately insured adults and may not be generalizable to older patients in US clinical practice.

Methods: A retrospective cohort design and data from Medicare Claims Research Identifiable Files (January 2008–September 2015) were employed. Patients were aged ≥65 years, had breast cancer or non-Hodgkin’s lymphoma, received chemotherapy with intermediate/high risk for FN, and received PP in ≥1 cycle; cycles with PP were stratified based on administration day (same-day [“Day 0”] vs. 1–3 days following chemotherapy [“Days 1–3”]) and were pooled for analyses. Adjusted odds ratios (ORs) for FN during the cycle were estimated for patients who received PP on Day 0 versus Days 1–3.

Results: Study population included 65,003 patients who received PP in 261,184 cycles; in 5% of cycles, patients received PP on Day 0. Incidence proportion for FN in cycle 1 was 11.4% for Day 0 versus 8.4% for Days 1–3; adjusted OR was 1.4 (p?p?p?p?Conclusions: Among Medicare patients receiving chemotherapy and PP in US clinical practice, PP was administered before the recommended timing in 5% of cycles and FN incidence was significantly higher in these cycles. Along with prior research, study findings support recently updated US practice guidelines indicating that PP should be administered the day after chemotherapy.     

慢性肾功能不全患者使用头孢哌酮钠他唑巴坦钠致抽搐6例报道

目的：探讨肾功能不全患者在使用头孢哌酮钠他唑巴坦钠时可能会引起抽搐,引起有关医务人员关注。方法通过临床药师收集肾功能不全患者在正常用法用量下使用头孢哌酮钠他唑巴坦钠时引起抽搐的6例案例,分析其可能原因。结果6例慢性肾功能不全患者,因感染给予头孢哌酮钠他唑巴坦钠静脉滴注。连续用药后数天,患者突发抽搐,停用头孢哌酮钠他唑巴坦钠后,对症处理后上述症状消失。结论肾功能不全患者使用头孢哌酮钠他唑巴坦钠时须根据内生肌酐清除率调整给药剂量,同时药物的疗程不宜过长,高龄患者更应谨慎,密切关注临床症状,警惕该药不良反应的发生。     

Girl with a PRRT2 mutation and infantile focal epilepsy with bilateral spikes

This paper documents the case of a female Japanese patient with infantile focal epilepsy, which was different from benign infantile seizures, and a family history of infantile convulsion and paroxysmal choreoathetosis. The patient developed partial seizures (e.g., psychomotor arrest) at age 14 months. At the time of onset, interictal electroencephalography (EEG) showed bilateral parietotemporal spikes, but the results of neurologic examination and brain magnetic resonance imaging were normal. Her seizures were well controlled with carbamazepine, and she had a normal developmental outcome. EEG abnormalities, however, persisted for more than 6 years, and the spikes moved transiently to the occipital area and began to resemble the rolandic spikes recognized in benign childhood epilepsy. Her father had paroxysmal kinesigenic dyskinesia, with an onset age of 6 years, and her youngest sister had typical benign infantile seizures. Genetic analysis demonstrated that all affected members had a heterozygous mutation of c.649_650insC in the proline-rich transmembrane protein-2 (PRRT2) gene. This case indicates that the phenotypic spectrum of infantile seizures or epilepsy with PRRT2-related pathology may be larger than previously expected, and that genetic investigation of the effect of PRRT2 mutations on idiopathic seizures or epilepsy in childhood may help elucidate the pathological backgrounds of benign childhood epilepsy.     

复方小儿退热栓治疗小儿高热惊厥56例疗效及安全性观察

目的观察复方小儿退热栓治疗小儿高热惊厥的疗效及安全性。方法将112例患儿随机均分为2组,对照组予镇静、抗感染等对症处理,观察组在对照组基础上加用复方小儿退热栓治疗。结果对照组患儿治疗前平均惊厥次数为（4.3±1.8）次,治疗5 min后为（2.8±2.3）次（P〈0.05）。观察组患儿治疗前平均惊厥次数为（4.2±2.0）次,治疗后5 min后为（1.1±2.1）次（P〈0.05）,且治疗5 min后平均惊厥次数较对照组明显减少（P〈0.05）。与对照组相比,观察组患儿惊厥症状好转迅速,症状改善明显,患儿体温下降幅度超过1℃及住院治疗时间均明显缩短（P〈0.05）。观察组患儿治疗显效率和总有效率明显高于对照组患儿（P〈0.05）。两组患儿治疗过程中不良反应发生率比较未见明显差异（P〉0.05）。结论联合复方小儿退热栓治疗小儿高热惊厥的疗效确切、稳定、安全,值得临床推广。     

Les complications respiratoires de la transfusion

Respiratory complications of blood transfusion have several possible causes. Transfusion-Associated Circulatory Overload (TACO) is often the first mentioned. Transfusion-Related Acute Lung Injury (TRALI), better defined since the consensus conference of Toronto in 2004, is rarely mentioned. French incidence is low. Non-hemolytic febrile reactions, allergies, infections and pulmonary embolism are also reported. The objective of this work was to determine the statistical importance of the different respiratory complications of blood transfusion. This work was conducted retrospectively on transfusion accidents in six health centers in Champagne-Ardenne, reported to Hemovigilance between 2000 and 2009 and having respiratory symptoms. The analysis of data was conducted by an expert committee. Eighty-three cases of respiratory complications are found (316,864 blood products). We have counted 26 TACO, 12 TRALI (only 6 cases were identified in the original investigation of Hemovigilance), 18 non-hemolytic febrile reactions, 16 cases of allergies, 5 transfusions transmitted bacterial infections and 2 pulmonary embolisms. Six new TRALI were diagnosed previously labeled TACO for 2 of them, allergy and infection in 2 other cases and diagnosis considered unknown for the last 2. Our study found an incidence of TRALI 2 times higher than that reported previously. Interpretation of the data by a multidisciplinary committee amended 20 % of diagnoses. This study shows the imperfections of our system for reporting accidents of blood transfusion when a single observer analyses the medical records.     

优质护理干预对高热惊厥患儿预后的影响

目的分析优质护理干预对高热惊厥患儿预后的影响。方法选取我院收治的84例高热惊厥患儿作为研究对象,采用随机数字表法将其分为对照组(42例,常规护理)与观察组(42例,优质护理)。比较两组的临床相关指标、并发症发生情况及护理满意度。结果观察组患儿护理30 min后的体温低于对照组,惊厥消失时间及住院时间均短于对照组(P<0.05)。观察组患儿的并发症总发生率低于对照组(P<0.05)。观察组患儿家属的护理满意度高于对照组(P<0.05)。结论优质护理干预用于高热惊厥患儿,护理可有效缩短其惊厥消失时间,降低并发症发生率,改善预后,提升护理满意度。     

Pleuro-pulmonary ultrasound in the diagnosis and follow-up of lung infections in children with cancer: a pilot study

PurposeFebrile neutropenia and lung infections are common and potential fatal complications of pediatric cancer patients during chemotherapy. Lung ultrasound (LUS) has a good accuracy in the diagnosis of pneumonia in childhood, but there is no data concerning its use in the diagnosis and follow-up of pulmonary infection in children with cancer. The goal of this pilot study is to verify the feasibility of lung ultrasonography for the diagnosis and follow up of pneumonia in children and adolescents with cancer.Material and methodsThis is a prospective observational case–control monocentric study conducted in the Pediatric Hematology and Oncology Department of University Hospital of Catania in patients aged < 18 years with cancer. Attending Physician used ultrasonography to detect pneumonia in cancer children with fever. As control group, cancer patients with no infection suspicion were also tested. LUS results were compared to chest X-ray (CXR) and/or chest CT scan, when these imaging techniques were performed, according to clinical indication.ResultsThirty-eight patients were studied. All underwent LUS, 16 underwent CXR, 3 chest CT. Statistical analysis showed LUS specificity of 93% (95% CI 84–100%), and sensitivity of 100%; CXR, instead, showed a specificity of 83% (95% CI 62–100%) and a sensitivity of 50% (95% CI 1–99%).ConclusionThis study shows for the first time that LUS allows physicians to diagnose pneumonia in children and young adults with cancer, with high specificity and sensitivity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40477-021-00650-3.