Tsüstiline fibroos 5aastasel poisil: haigusjuhu kirjeldus

Tsüstiline fibroos ehk mukovistsidoos (TF) on valge rassi hulgas esinev kõige sagedasem geneetiline haigus. Tegemist on autosoom-retsessiivse haigusega, mille tagajärjel tekib eksokriinnäärmete düsfunktsioon. Kliiniliselt võib haiguspilt olla väga erinev, kuid klassikalistel juhtudel esineb progresseeruv obstruktiivne kopsuhaigus, pankrease eksokriinne puudulikkus ja klooriioonide kontsentratsiooni suurenemine higis. Nina polüpoosi esineb 26–56%-l TF-haigetel. Kui lapsel leitakse ninapolüübid, on vajalik edasine uurimine tsüstilise fibroosi suhtes isegi siis, kui patsiendil muid kaebusi ei ole. Artiklis on kirjeldatud haigusjuhtu, kus diagnoositi tsüstiline fibroos 5 aasta vanusel polüüpidega poisslapsel. Eesti Arst 2007; 86 (5): 348–35

Clinical parameters predicting failure of empirical antibacterial therapy in early onset neonatal sepsis, identified by classification and regression tree analysis

<p>Abstract</p> <p>Background</p> <p>About 10-20% of neonates with suspected or proven early onset sepsis (EOS) fail on the empiric antibiotic regimen of ampicillin or penicillin and gentamicin. We aimed to identify clinical and laboratory markers associated with empiric antibiotic treatment failure in neonates with suspected EOS.</p> <p>Methods</p> <p>Maternal and early neonatal characteristics predicting failure of empiric antibiotic treatment were identified by univariate logistic regression analysis from a prospective database of 283 neonates admitted to neonatal intensive care unit within 72 hours of life and requiring antibiotic therapy with penicillin or ampicillin and gentamicin. Variables, identified as significant by univariate analysis, were entered into stepwise multiple logistic regression (MLR) analysis and classification and regression tree (CRT) analysis to develop a decision algorithm for clinical application. In order to ensure the earliest possible timing separate analysis for 24 and 72 hours of age was performed.</p> <p>Results</p> <p>At 24 hours of age neonates with hypoglycaemia ≤ 2.55 mmol/L together with CRP values > 1.35 mg/L or those with BW ≤ 678 g had more than 30% likelihood of treatment failure. In normoglycaemic neonates with higher BW the best predictors of treatment failure at 24 hours were GA ≤ 27 weeks and among those, with higher GA, WBC ≤ 8.25 × 10⁹L^-1together with platelet count ≤ 143 × 10⁹L^-1. The algorithm allowed capture of 75% of treatment failure cases with a specificity of 89%. By 72 hours of age minimum platelet count ≤ 94.5 × 10⁹L^-1with need for vasoactive treatment or leukopaenia ≤ 3.5 × 10⁹L^-1or leukocytosis > 39.8 × 10⁹L^-1or blood glucose ≤ 1.65 mmol/L allowed capture of 81% of treatment failure cases with the specificity of 88%. The performance of MLR and CRT models was similar, except for higher specificity of the CRT at 72 h, compared to MLR analysis.</p> <p>Conclusion</p> <p>There is an identifiable group of neonates with high risk of EOS, likely to fail on conventional antibiotic therapy.</p

Ampitsilliini-gentamütsiini ja penitsilliini-gentamütsiini kombinatsioonide võrdlus vastsündinu varase sepsise ravis

Töö eesmärgiks oli võrrelda ampitsilliini-gentamütsiini vs penitsilliinigentamütsiini kombinatsioonide kliinilist efektiivsust vastsündinute varase sepsise (VVS) ravis. Kahekeskuseline prospektiivne klastriga juhuslikustatud uuring hõlmas kõik VVS-kahtlusega alla 72 tunni vanused vastsündinud. Esimesel uuringuperioodil kasutati ühes keskuses ampitsilliini ja teises penitsilliini kombinatsioonis gentamütsiiniga. Beetalaktaamantibiootikumid vahetati, kui pooled haiged olid uuringusse lülitatud. Primaarne tulem oli ravi ebaõnnestumine (vajadus antibakteriaalse ravi muutmiseks 72 tunni jooksul) ja/või surm 7 päeva jooksul. Soole kolonisatsiooni hinnati perineumi kaape alusel. Tõestatud VVSi sagedus oli 4,9%. Ampitsilliini ja penitsilliini skeemide vahel ei olnud erinevust 72 tunni jooksul antibakteriaalse ravi vahetuse, 7 päeva suremuse ega ravi ebaõnnestumise osas. Ampitsilliin ja penitsilliin kombinatsioonis gentamütsiiniga on võrdselt tõhusad vastsündinu varase sepsise empiirilises ravis. Eesti Arst 2009; 88(Lisa4):21−2

Climatology of Convective Storms in Estonia from Radar Data and Severe Convective Environments

Data from the C-band weather radar located in central Estonia in conjunction with the latest reanalysis of the European Centre for Medium-Range Weather Forecasts (ECMWF), ERA5, and Nordic Lightning Information System (NORDLIS) lightning location system data are used to investigate the climatology of convective storms for nine summer periods (2010–2019, 2017 excluded). First, an automated 35-dBZ reflectivity threshold-based storm area detection algorithm is used to derive initial individual convective cells from the base level radar reflectivity. Those detected cells are used as a basis combined with convective available potential energy (CAPE) values from ERA5 reanalysis to find thresholds for a severe convective storm in Estonia. A severe convective storm is defined as an area with radar reflectivity at least 51 dBZ and CAPE at least 80 J/kg. Verification of those severe convective storm areas with lightning data reveals a good correlation on various temporal scales from hourly to yearly distributions. The probability of a severe convective storm day in the study area during the summer period is 45%, and the probability of a thunderstorm day is 54%. Jenkinson Collison’ circulation types are calculated from ERA5 reanalysis to find the probability of a severe convective storm depending on the circulation direction and the representativeness of the investigated period by comparing it against 1979–2019. The prevailing airflow direction is from SW and W, whereas the probability of the convective storm to be severe is in the case of SE and S airflow. Finally, the spatial distribution of the severe convective storms shows that the yearly mean number of severe convective days for the 100 km2 grid cell is mostly between 3 and 8 in the distance up to 150 km from radar. Severe convective storms are most frequent in W and SW parts of continental Estonia