Sildenafil for pulmonary hypertension due to left-toright shunt after corrective procedure

Background Pulmonary arterial hypertension (PAH) is a common complication seen in those with a left-to-right shunt congenital heart defect (CHD). Corrective procedures by surgery or catheterization are the therapies of choice for reversible PAH. Since morbidity and mortality due to PAH after correction is high, sildenafil has been used as a selective vasodilator of the pulmonary artery, in order to decrease pulmonary arterial pressure. Objectives To evaluate the effect of sildenafil on pulmonary arterial pressure and clinical outcomes after left-to-right shunt CHD corrective procedures. Methods Left-to-right shunt patients aged < 18 years scheduled for corrective treatment were randomized in a double-blind fashion, to receive either oral sildenafil or placebo, given on days 3 to 30 after the corrective procedure. Clinical and pulmonary arterial pressures were evaluated by echocardiography before, 3 days after, and 30 days after the corrective procedure. Results From July 2013 to June 2014, 36 patients were included in the study: 17 in the placebo and 19 in the sildenafil groups. There were no differences in pulmonary arterial pressure or in clinical outcomes after corrective procedure between the two groups. There were no adverse events during the treatment. Conclusion Sildenafil has little effect on decreasing pulmonary arterial pressure, as most of our subjects seem to have hyperkinetic PAH. As such, pulmonary arterial pressure returns to normal soon after corrective procedures

Clinical Characteristics of Multisystem Inflammatory Syndrome in Children With Severe and Critical Symptoms in the Pediatric Intensive Care Unit

Generally, children infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV-2) have mild symptoms or are asymptomatic. However, some children have severe and critical symptoms affecting several organ systems, including the gastrointestinal, cardiovascular, respiratory, and neurological systems. These severe and critical symptoms are associated with multisystem inflammatory syndrome in children (MISC). This study aimed to describe the clinical features, ventilation modalities usage, and outcome conditions of these children. This was a retrospective study of children with COVID-19 and MISC who were treated in the COVID-19 isolation pediatric intensive care unit (PICU) of Saiful Anwar General Hospital over one year. The data were obtained from medical records and were analyzed descriptively. A total of 491 pediatric patients with suspected COVID-19 were included; 51 had a confirmed COVID-19 diagnosis; 9/491 (1.8%) were patients with MISC who were treated in the PICU; and 7/9 (78%.0) of MISC patients in the PICU used mechanical ventilators. The frequency of MISC patients with gastrointestinal problems was 7/9 (78%) patients, respiratory problems was 9/9 (100%), and myocardial injury (increased troponin) was 5/9 (56%) patients. All MISC patients admitted to the PICU experienced shock with vasoactive drugs including dobutamine, epinephrine, norepinephrine and vasopressin. All MISC patients with severe and critical symptoms had comorbidities. Invasive mechanical ventilation was provided for 7 patients, and 2 patients received non-invasive ventilation. The mean of PEEP used in the invasive ventilation was 7-9 cmH2O. The length of the ventilator usage was 2-21 days, with 2 patients passing away, both with a comorbidity and multiorgan system injuries. It can be concluded that pediatric patients with confirmed COVID-19 may also have MISC with severe and critical symptoms. Early recognition of pediatric patients with MISC is necessary to reduce morbidity and mortality. Keywords: COVID-19, multisystem inflammatory syndrome, childre

Inverse association between positive tuberculin tests and positive allergy skin tests in children

Background  The  association between  Mycobacterium  tuberculosis infection  and  atopy remains controversial. Reaction to tuberculosis infection  is  mediated  by  Th-1  immune responses whereas allergic reactions are mediated  by  Th- 2 immune response. In patients with atopic syndrome who also suffer from tuberculosis infection,  the Th-2  response will be suppressed  and  allergy manifestations will decrease. Therefore, it  is  important to determine the appropriate allergy test and to predict outcome after completing tuberculosis treatment. Objective  To  evaluate the influence  of  a positive tuberculin test on  skin test results in diagnosing atopic disease. Methods  A cross sectional study was  conducted  in  the  pediatric allergy  outpatient  clinic, Soetomo Hospital, Surabaya, Indonesia between 2004  and  2007. Eighty-five patients were enrolled in this study.  The  tuberculin test was performed  on  all patients with allergy.  The  allergy test was carried  out  by  performing a skin scratch test. Results  There  was a weak inverse correlation between positive tuberculin tests and positive allergy skin tests in children (house dust  mite, food  and  pet  allergies).  The  correlation between a positive  tuberculin  test  and  house  dust  mite allergy test was r:  -0.364  (P=O.OOl;  a=O.Ol).  The  correlation  between  the tuberculin  test  and  food allergies was  r:  -0.420  (P=O.OOl; a=O.Ol).  The  correlation between the tuberculin test  and  pet allergies was  r:  -0.344  (P=  0.001;  a=O.Ol). Conclusions  A positive tuberculin test  is  weakly correlated with positive allergy skin test results, suggesting  that  it  is  appropriate  to do allergy skin testing even in children with a positive tuberculin test