Intussusception Treatment in Children. Single Center Experience

Studying the treatment of 822 children diagnosed with intussusception from 1995 to 2013 in the Regional Clinic Children’s Hospital of Dnepropetrovsk. From 1995 to 2007, 576 children took a cure. In 506 (87.8%) cases, classic conservative reduction with air was successful. Laparotomy was applied in 70 (12.2%) cases. For 22 children intestine was not viable and excision was executed. Forty-eight patients had surgical reductions. In connection with the analysis results, we have been using laparoscopy more widely since 2008. From 2008 to 2013, there were 246 patients with intussuscept. For 204 (82.9%) children non-operative reduction seceded. After unsuccessful non-operative deduction, 42 (17.1%) children received one more laparoscopic assisted reduction. In 25' (59.5%) cases, an intestine was found viable. In 11 (26.2%) cases after the reduction, laparoscopic examination showed intestine necrosis. In six (14.3%) cases, intussusceptum was caused by the Meckel’s diverticulum. In all the 17 cases laparoscopic assisted excision of the Meckel’s diverticulum or nonviable mte'sljinej was performed. When non-operative reduction fails a succeeding laparoscopic assisted intussusception combined with pneumocolon is optimal to provide: a good treatment result. Проведен ретроспективный анализ лечения 572 Детей с острой инвагинацией кишечника, находившихся на лечении в ОДКБ г. Днепропетровска с 1995 по 2007 г. В 70 (12,2%) случаях проведено хирургическое лечение (лапаротомия), у 22 (31,4%) детей была выполнена резекция кишечника. У остальных 48 (68,6%) осуществляли мануальною дезинвагинацию кишечника. На основании полученных результатов оперативного лечения - в случае неэффективной консервативной дезинвагинации использовали лапароскопичёскмй метод лечения. Проспективный этап исследования выполнен с 2008 по 2013 г. на 246 детях с инвагинацией кишечника, у которых использовалась лапароскопия. В 204 (82,9%) случаях проведена консервативная дезинвагинация (р<0,001). У 42 (17,1%) детей после неэффективного консервативного лечения проводилось расправление инвагината под контролем лапароскопа. При этом в 25 (59,5%) случаях кишечник был жизнеспособным. У 11 (26,2%) детей после лапароскопической оценки был определен некроз участка кишки, входящей в инвагинат. В 6 (14,3%) случаях причиной инвагинации был дивертикул Меккеля. У всех 17 пациентов выполнена лапароскопически ассистированная резекция сегмента нежизнеспособной кишки или дивертикула Меккеля. Таким образом, при неэффективности консервативной дезинвагинации проведение лапароскопического вмешательства позволяет получить хорошие результаты лечения у детей с инвагинацией кишечника

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease

BACKGROUND We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events. (Funded by Bayer; COMPASS ClinicalTrials.gov number, NCT01776424.

Reflections of Pediatrician on Pathogenetic Validity of Phytotherapy in Children with ARVI

The article discusses the pathogenetic validity of phytotherapy by complex herbal preparation Sinupret at the onset of first symptoms of acute respiratory viral infection in children over 2 years. Evidence of antiviral, immunomodulatory, anti-inflammatory, decongestive, secretolytic effect of the drug is shown. The results of experimental and clinical studies on the efficacy and safety of Sinupret as monotherapy in children with acute respiratory viral infections of mild and moderate severity are provided

Features of Macro- and Micronutrients Level in Cardiovascular Diseases

The work has generalized the results of the researches of a role of macro- and microelements in cardiovascular pathology genesis (congenital and acquire heart valvular diseases, heart rhythm disorders, dilatation cardiomyopathy, endomiocardial fibrosis, primary arterial hypertension, metabolic syndrome, ischemic heart disease, myocardial infarction). The results testify to presence of changes of chemical elements level in patients with various cardiovascular pathologies. The most perspective direction is to determine the trace elements level in children with cardiovascular diseases and to reveal their role in etiology, pathogenesis and sanogenesis of cardiovascular pathology. All these will allow develop corresponding measures of preventive and medical-rehabilitation actions

Acute Streptococcal Tonsillitis in a Child. Questions asked by Life (Scientific Answers to the Question Put by the Practice)

The problem of acute tonsillitis remains relevant in clinical pediatrics. A special role in its etiology belongs to group A β-hemolytic streptococcus (Streptococcus pyogenes), which is found in every fourth child with acute bacterial tonsillitis. In this article there is presented an analysis of the clinical case of streptococcal tonsillitis in children and the pathogen, epidemiology and prognosis of the disease are described. The authors reviewed the current diagnosis criteria and international treatment approaches. There has been grounded the use of cefuroxime axetil for eradication of Streptococcus pyogenes

Mastocytosis in Children: Literature Review and Own Clinical Observation

The review of literature presents the data on neoplastic disease — mastocytosis. We provide the modern information of the etiopathogenesis, classification, clinical presentation, methods of diagnosis and treatment in children. We presented own experience of 20-month follow-up of female patient with cutaneous mastocytosis