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   Table of Contents - Current issue
October-December 2019
Volume 3 | Issue 4
Page Nos. 65-80

Online since Monday, September 28, 2020

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From acute respiratory infection, chronic atelectasis, to intensive hemodynamic assessment p. 65
Yu-Tsun Su
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Viral and atypical bacterial infection in young children hospitalized due to acute lower respiratory tract infection in Southern Thailand p. 67
Kanokpan Ruangnapa, Phatthareeda Kaeotawee, Pornapat Surasombatpattana, Marisa Kemapunmanus, Utcharee Intusoma, Kantara Saelim, Wanaporn Anuntaseree
Background: The etiology of acute lower respiratory tract infection (ALTI) in Thailand is not well established. Aims: This study aims to determine the prevalence of viral and atypical bacterial infections in young children hospitalized due to ALTI. Settings and Design: This was a retrospective study. Subjects and Methods: Eighty-two leftover nasopharyngeal specimens obtained from children with ALTI admitted from May to October 2017 in Songklanagarind Hospital were analyzed. Multiplex polymerase chain reaction and the bead hybridization method (NxTAG® Respiratory Pathogen Panel) were used to detect 18 instances of respiratory virus and atypical bacteria. The clinical data for the children were retrospectively reviewed and analyzed from the medical records. Results: From a total of 82 ALTI patients, 60% were male. The median (interquartile range) age was 14.8 (8.0–38.1) months. Seventy-six percent of the patients were positive for at least one viral pathogen. The three most identified pathogens were respiratory syncytial virus (RSV) B (39.0%), RSV A (20.7%), and hRV (12.2%), while atypical bacteria were not found. Patients with RSV infection had significantly higher fever on admission (P < 0.01) and a longer duration of fever (log-rank P < 0.001) compared to the non-RSV group. Conclusions: Viral pathogens were detected in 76% of the children hospitalized due to ALTI. Further, 79% were positive for RSV with significantly high-grade fever.
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Chronic right middle lobe atelectasis in ambulatory children p. 72
Kin-Sun Wong, Chih-Yung Chiu
Background: Intrinsic obstruction and extrinsic compression of the airway are the main causes of pulmonary atelectasis. The differential diagnoses of right middle lobe atelectasis (MLA) in children are lengthy, and practicing pediatricians usually are frustrated by the diagnostic possibilities in the clinic. Objective: The aim of our study is to present the experience of a children facility with chronic MLA in ambulatory children and guide a pragmatic approach. Materials and Methods: Retrospective chart analysis was performed by a computer search for discharge diagnosis of right MLA or MLA between January 2006 and December 2017 in a pediatric department in Northern Taiwan. Demographic data, underlying diseases, clinical symptoms, radiographic features, and course of treatment were collected and analyzed by descriptive statistics. Results: A total of 30 pediatric patients with chronic MLA were recruited in this study. Isolated MLA was identified in four (13.3%) patients. The remaining 26 patients had associated atelectasis or bronchiectasis in other parts of the lung. The most common causes of chronic MLA identified in our patients were postinfectious bronchiectasis (40%) and immunodeficiency (23.3%). Asthma was an uncommon cause of MLA in this study. Conclusions: Tumors, tuberculosis, retained foreign body, and asthma were all uncommon in the children identified with MLA. While chronic cough was common in the children studied, most were associated with bronchiectasis in other pulmonary segments. When faced with evidence of right MLA, one should consider a chronic suppurative lung disease with or without bronchiectasis, either postinfectious or related with recurrent aspiration.
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Correlation between variation of aortic peak blood flow velocity, inferior vena cava diameter variation and stroke volume variation in children p. 76
Wicharn Boonjindasup, Rujipat Samransamruajkit
Background: Non-invasive monitoring using ultrasound or Doppler assists in quick haemodynamic assessment and helps to improve outcomes in critical care. Parameters including aortic peak blood flow velocity variation (ΔVpeak), inferior vena cava diameter variation (ΔIVC) and stroke volume variation (SVV) have been commonly used in children. Objectives: The aim of this study was to assess the correlations between ΔVpeak from transthoracic echocardiography, ΔIVC from abdominal ultrasound and SVV from ultrasonic cardiac output monitoring. Settings and Design: A prospective observational cohort study was undertaken in the paediatric intensive care unit in a tertiary university hospital. Methods: ΔVpeak, ΔIVC and SVV were measured in mechanically ventilated children using ultrasound- or Doppler-based monitoring. Statistical Analysis Used: Pearson correlation coefficient was computed to assess the relationship. Results: A convenient sample of 55 patients with a median age of 31 months (range 6 months to 5 years) was enrolled. ΔVpeak, ΔIVC and SVV showed significant positive correlations between the three variables, i.e., ΔVpeak and ΔIVC (r = 0.415 with P = 0.002), ΔVpeak and SVV (r = 0.539 with P < 0.001) and ΔIVC and SVV (r = 0.524 with P < 0.001). Conclusions: In mechanically ventilated children, there is a positive correlation between ΔVpeak, ΔIVC and SVV. ΔVpeak and SVV provided the best, though moderate, correlation.
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