Penicillin Therapy in Children with Acute Rheumatic Fever: Side Effects, Malpractice and Anaphylactic Reactions

Acute rheumatic fever (ARF) is more common in developing countries. ARF is a systemic disorder, which develops in children following group A streptococcal (GAS) pharyngitis. Rheumatic valvular disease is caused by autoimmune responses. Penicillin is used in the treatment of GAS tonsillopharyngitis and in primary and secondary prophylaxis against ARF. A single intramuscular (IM) injection of benzathine penicillin or oral penicillin V (phenoxymethylpenicillin) is administered as primary prophylaxis for 10 days. In the presence of rheumatic valvular disease, secondary prophylaxis with the injection of benzathine penicillin is required for life, or at least until the age of 40. IM injection of penicillin may cause fear and pain in children. Lidocaine or lidocaine-prilocaine (EMLA) creams can be used to decrease pain associated with IM injections. The most serious side effect of penicillin is, however, the anaphylactic reaction. This reaction can be caused by minor or major determinants of penicillin. Patients should be questioned about the past history of the penicillin allergy, and penicillin skin testing should be performed and interpreted appropriately in order to prevent anaphylactic reaction related to penicillin administration. In the presence of the suspicion of a penicillin allergy, skin testing should be avoided, and the patient should be tested by a pediatric allergy specialist using major and minor determinants to confirm a penicillin allergy. Patients who are allergic to penicillin can undergo desensitization in the absence of an alternative drug. It is a medical and legal obligation to perform and interpret the skin test appropriately, to keep the necessary equipment and drugs available for possible anaphylactic reactions, and to treat the patient appropriately in the case of an anaphylactic reaction. Penicillin is commonly used in pediatrics and pediatric cardiology

Assessment of Atrial Electromechanical Delay Using Tissue Doppler Echocardiography in Children with Asthma

Right ventricular (RV) dysfunction, pulmonary hypertension, atrial enlargement, and cor pulmonale may be associated with asthma. These pathological conditions may disturb the electrophysiological properties of the right atrium. This study investigated the atrial electromechanical delay and P-wave dispersion (PWD) in patients with asthma. Thirty-four children aged 8-16 years who were being followed up for asthma constituted the patient group, and 34 age- and body mass index-matched patients constituted the control group. Both groups underwent RV tissue Doppler measurements, intra-right atrial conduction time (IRCT-echo) determination, intra-left atrial conduction time (ILCT-echo) determination, inter-atrial conduction time (IACT-echo) determination, and PWD measurement. The IRCT-echo (14.38 +/- A 5.46 and 8.20 +/- A 3.90 ms; p < 0.001) and IACT-echo (28.97 +/- A 6.58 and 22.79 +/- A 6.28 ms; p < 0.001) were higher in patients with asthma than in the control group. The PWD (44.58 +/- A 17.51 and 38.11 +/- A 13.50 ms; p = 0.09), maximum P-wave duration (87.94 +/- A 18.20 and 82.44 +/- A 16.36 ms, p = 0.19), minimum P-wave duration (43.58 +/- A 9.95 and 44.79 +/- A 9.13 ms; p = 0.60), and ILCT-echo (15.88 +/- A 5.40 and 14.58 +/- A 4.94 ms; p = 0.30) were similar between the two groups. The IRCT-echo was positively correlated with the isovolumetric relaxation time of the lateral tricuspid annulus (r = 0.60; p < 0.001) and with the myocardial performance index of the lateral tricuspid annulus (r = 0.59; p < 0.001) in patients with asthma. The IRCT-echo and IACT-echo were higher in patients with asthma than in the control group. The deterioration of the electrophysiological properties of the right atrium may result in a risk of atrial fibrillation in patients with asthma

Inhaled Iloprost in Preterm Infants with Severe Respiratory Distress Syndrome and Pulmonary Hypertension

Objective Many vasodilator drugs, including inhaled iloprost, are used to treat insufficient pulmonary vasodilatation, which is the main issue in pulmonary hypertension in newborns

Sodium Nitroprusside Treatment for Control of Decompensated Heart Failure

Hypertensive crisis is thought to be initiated by an abrupt increase in systemic vascular resistance, likely related to humoral vasoconstrictors. Left ventricular dilatation and failure may develop as a result of increased afterload due to hypertension. Left heart failure may result in secondary pulmonary hypertension by increasing pulmonary venous pressure. Here, we report the effects of sodium nitroprusside for treatment of hypertensive crisis complicated with acute left ventricular dilatation, heart failure, and pulmonary hypertension in a 10-year-old female patient. This article presents a complex clinical case treated by simple medication. [Med-Science 2014; 3(2.000): 1269-76

Evaluation of carotid intima-media thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy

Background: Adenotonsillar hypertrophy can produce cardiopulmonary disease in children. However, it is unclear whether adenotonsillar hypertrophy causes atherosclerosis. This study evaluated carotid intima-media thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy

Efficacy and safety of endotracheal instillation of iloprost for persistent pulmonary hypertension of the newborn

Objective: To determine the efficacy and safety of endotracheal instillation of iloprost as a rescue therapy for persistent pulmonary hypertension of the newborn. Methods: Neonates diagnosed with persistent pulmonary hypertension who were unresponsive to standard treatment protocol applied for persistent pulmonary hypertension in our unit, and who were being followed up with mechanical ventilation, were included in the study. Iloprost was instilled endotracheally as a rescue treatment. Systolic pulmonary artery pressure, oxygen saturation index, mean airway pressure, fraction of inspired oxygen, preductal and postductal venous oxygen saturation, heart rate, and blood pressure were recorded before and after 30 minutes of endotracheal iloprost instillation. Adverse events after endotracheal iloprost were recorded. Results: Twenty neonates were included. The median gestational age and birth weight were found to be 37 (30.5-38) weeks and 2975 (2125-3437.5) grams, respectively. When compared to the period before endotracheal iloprost instillation, systolic pulmonary artery pressure, oxygen saturation index, mean airway pressure, and fraction of inspired oxygen values significantly decreased (p < 0.001, p < 0.001, p = 0.021, p = 0.001, respectively), whereas preductal and postductal oxygen saturation values significantly increased 30 minutes after the endotracheal iloprost instillation (p = 0.002, p < 0.001, respectively). There were no significant differences in heart rate and blood pressure values before and after the iloprost administration. No adverse events were observed. Conclusion: Endotracheal instillation of iloprost was found to be an effective and safe therapy for persistent pulmonary hypertension unresponsive to conventional treatment

Assessment of heart rate variability in breath holding children by 24 hour Holter monitoring

Purpose: Previous studies have shown that the underlying pathophysiologic mechanism in children with breath holding may be generalised autonomic dysregulation. Thus, we performed cardiac rhythm and heart rate variability analyses using 24-hour Holter monitoring to evaluate the cardiac effects of autonomic dysregulation in children with breath-holding spells. Methods: We performed cardiac rhythm and heart rate analyses using 24-hour Holter monitors to evaluate the cardiac effects of autonomic dysregulation in children during a breath-holding spell. Our study group consisted of 68 children with breath-holding spells -56 cyanotic type and 12 pallid type -and 39 healthy controls. Results: Clinical and heart rate variability results were compared between each spell type - cyanotic or pallid - and the control group; significant differences (p 50 ms, and square root of the mean of the sum of squares of the differences between adjacent NN intervals values were found between the pallid and cyanotic groups. Conclusions: Holter monitoring for 24 hours and heart rate variability parameters, particularly in children with pallid spells, are crucial for evaluation of cardiac rhythm changes

Oral Sildenafil and Inhaled Iloprost in the Treatment of Pulmonary Hypertension of the Newborn

ObjectiveThis study was performed to examine the effectiveness and safety of oral sildenafil and inhaled iloprost in term newborns with persistent pulmonary hypertension of the newborn (PPHN)

Dilated cardiomyopathy secondary to rickets-related hypocalcaemia: eight case reports and a review of the literature

Introduction: Dilated cardiomyopathy is usually idiopathic and may arise secondary to infections or metabolic or genetic causes. Another rare cause is hypocalcaemia. Owing to the fact that calcium plays an essential role in excitation and contraction of myocardial muscle, myocardial contractility may decline in patients with hypocalcaemia. Materials and Methods: Patients with symptoms of congestive heart failure and rickets-related hypocalcaemia were assessed clinically and by echocardiography in a paediatric cardiology clinic. Echocardiography was performed for all patients. Rickets was diagnosed according to the clinical, laboratory, and radiologic findings. Maternal lifestyle and living conditions were investigated, and the maternal 25-OH vitamin D-3 blood level was measured. Results: We evaluated eight patients who developed heart failure as a result of severe hypocalcaemia associated with rickets between August, 1999 and June, 2012. The age distribution of the patients was 3-12 months. Laboratory results were consistent with advanced-stage rickets. Severe hypocalcaemia was detected in all patients. The maternal 25-OH vitamin D-3 levels were low. Echocardiography revealed increased pre-treatment left ventricle end-systolic and end-diastolic diameters for age and reduced ejection fraction and fractional shortening. After clinical improvement, the patients were discharged. Conclusions: Severe hypocalcaemia associated with rickets must always be kept in mind among the causes of dilated cardiomyopathy and impaired cardiac function in infants. If diagnosed and treated in time, dilated cardiomyopathy and severe heart failure related to rickets respond well

Fasting and postprandial glucose, insulin, leptin, and ghrelin values in preterm babies and their mothers: relationships among their levels, fetal growth, and neonatal anthropometry

Objective: To investigate relationship between anthropometric values of premature babies with their's glucose, insulin, leptin, and ghrelin at birth and on day 15