Pediatric Emergency Cases Managed with Intraosseous Access: Indications, Complication and Outcomes

Intraosseous (IO) access is an alternative way of administering fluid and drug and also taking biopsies needed for clinical and laboratory tests in cases when peripheral venous access couldn’t be established. The IO route was successfully secured in all cases with a significant shorter time of vascular access insertion, shorter length of stay and reduction in mortality in IO group vs. IV group.  IO access was first used in 1922. This technique was widely used during 1940’s when emergency medical care was routinely needed for seriously injured patients in World War II. Since 1950’s after the introduction of peripheral venous access technique IO access lost its actuality. In management of Pediatric emergencies intravascular (venous) access is prior but sometimes establishing peripheral venous access is impossible or it may take too much time because of anatomical or physiological characteristics, such as an excessive subcutaneous fatty tissue and veins with a small diameter. Vasoconstriction, reduction of circulating blood volume and peripheral venous collapse takes place during cardiopulmonary arrest, septic or hypovolemic shock and prolonged status epilepticus. This features alone or in combination can make venous catheterization impossible.For pediatric resuscitation, vascular access must be established quickly, often in difficult circumstances. Alternative methods of peripheral access, such as umbilical catheter, central venous lines, venous cut-down, and ultrasound guided access, may be poor options because of the patient’s age or condition, the urgency of resuscitation, and/or the skill of available clinicians. Anatomically, the described site is suggested to offer a safe alternative access point for emergency infusion in severely hypovolemic newborns and infants, without the risk of damage to any anatomical structures. IO access complications are infection - cellulites, abscess, osteomyelitis and fracture. The most widespread complication is extravasation, which, if left unidentified, can cause compartment syndrome. The EZ-IO® device is easy to use and requires minimal training. These studies suggest that the EZ-IO® is an easy to use, easy to learn tool that can be used successfully in resuscitation scenarios with minimal training.  It is evident that blood samples drawn immediately after intraosseous cannulation can provide accurate laboratory and blood bank data to aid in resuscitation. More recently, the pharmacokinetics of intraosseous drug delivery has been compared with central venous drug delivery

მედიკამენტებზე რეფერენტული ფასწარმოქმნა მოლდოვეთში: გამოცდილება, გამოწვევები

The main goal of creating a reference price system is to reduce the cost of medicines. Although the principles of reference pricing in European countries are a matter of debate, its use is becoming more widespread. The debate concerns such issues as the definition of market segments to which the reference system should be applied, the calculation of reimbursement levels, as well as the impact of the reference system on the pricing and marketing policies of pharmaceutical companies. Based on the experience of the Republic of Moldova, a deep analysis of the above-mentioned problems is appropriate in countries facing similar challenges.რეფერენტული ფასების სისტემის შექმნის მთავარი მიზანია მედიკამენტების ღირებულების შემცირება. მიუხედავად იმისა, რომ ევროპის ქვეყნებში რეფერენტული ფასების პრინციპები დებატების საგანია, მისი გამოყენება სულ უფრო ფართოვდება. დებატები ეხება ისეთ საკითხებს, როგორებიცაა ბაზრის სეგმენტების განსაზღვრა, რომლებზეც უნდა იყოს გამოყენებული რეფერენტული სისტემა, ანაზღაურების დონის გამოთვლა, ასევე, რეფერენტული სისტემის გავლენა ფარმაცევტული კომპანიების ფასწარმოქმნაზე და მარკეტინგულ პოლიტიკაზე. მოლდოვას რესპუბლიკის გამოცდილებიდან გამომდინარე,  მსგავსი გამოწვევების წინაშე მდგარ ქვეყნებში მიზანშეწონილია ზემოთაღნიშნული პრობლემების ღრმა ანალიზი

თამბაქოს მოხმარების დაწყების მიზეზები ახალგაზრდებში

oai:openjournals.ge:article/6080Influence on tobacco consumption makes social environment. Especially such factors as the friend\u27s and parent\u27s attitude towards behavior, also level of the information about tobacco real damages. This research aims to identify the characteristics and factors that contribute to tobacco use in the launch of the teenager. Methodology: Qualitative research method was carried out in direct interviews, among young people selected by the non-random selection principle. Results: All respondents have consumed tobacco consumption at a juvenile age. In all cases, the community played a decisive role in tobacco consumption. Respondents started smoking in the circle of friends and classmates. Interviews show, that the youth\u27s organism responded negatively to tobacco consumption, but despite this, they continued to do this behavior. The surveyor showed that consumption of tobacco, in the teenagers, is perceived as good reputable social behavior. Those who didn\u27t consumption nowadays tobacco, says, that they didn\u27t have communication with those community, in which relationship times was started smoking. Conclusion: It is advisable to encourage tobacco use restrictions. In this regard, it is welcome to introduce the Law on Tobacco Control in Georgia that prohibits tobacco consumption and advertising in public places, particularly in educational and other institutions, as well as selling tobacco products near schools.თამბაქოს მოხმარებაზე გავლენას ახდენს სოციალური გარემო, განსაკუთრებით ისეთი ფაქტორები, როგორებიცაა განათლების და ინფორმირებულობის დონე, ახლო სოციალური წრე, მშობლების ქცევა, ოჯახის წევრთა მხარდაჭერა. კვლევის მიზანია იმ თვისებათა და ფაქტორთა გამოვლენა, რაც ხელს უწყობს თამბაქოს მოხმარების დაწყებას თინეიჯერობის ასაკში. მეთოდოლოგია. ჩატარდა თვისებრივი კვლევა, პირდაპირი გამოკითხვისა და ფოკუს-ჯგუფის სახით, არაშემთხვევითი შერჩევის პრინციპით შერჩეულ ახალგაზრდებში. შედეგები. რესპონდენტების უმრავლესობა თამბაქოს მოხმარებას იწყებს არასრულწლოვან ასაკში. ამ მხრივ ასევე მნიშვნელოვანია სამეგობრო წრის და ოჯახის გავლენა. თამბაქოს მოხმარების დაწყებისადმი გადამწყვეტი როლი ახლო სოციუმმა ითამაშა. ახალგაზრდებში უფრო დადებითად აღიქმება თამბაქოს მოხმარება ვიდრე უარყოფითად. რესპოდენტებმა თამბაქოს მოხმარება პირველად მეგობრებისა და კლასელების წრეში დაიწყო. იმისმიუხედავდ, რომ ახალგაზრდების ორგანიზმი უარყოფითად რეაგირებდა თამბაქოს მოხმარებაზე, ისინი ამ ქცევას მაინც აგრძელებდნენ. დისკუსია. ახალგაზრდები საკუთარი პიროვნული მომწიფების სადემონსტრაციოდ მოიხმარენ თამბაქოს, ამგვარი ქცევა სხვაზე ორიენტირებულია, მათთვის ახდენს იმის აფიშირებას, რომ ისინი საზოგადოების სრულფასოვანი და ზრდასრული წევრები არიან, ემსახურება სხვათა მიმართ მათი ქცევითი, ნებითი თუ ვიზუალური მხარის დადებითი რეპუტაციის შექმნის მიზანს. დასკვნა. მიზანშეწონილია თამბაქოს მოხმარების შეზღუდვის ღონისძიებების ხელშემწყობა. ამ მხრივ, მისასალმებელია საქართველოში „თამბაქოს კონტროლის შესახებ” კანონის ამოქმედება, რომელიც კრძალავს საზოგადოებრივი თავშეყრის ადგილებში, კერძოდ, სასწავლო და სხვა სახის დაწესებულებებში თამბაქოს მოხმარებას და რეკლამირებას, ასევე სკოლებთან ახლოს თამბაქოს ნაწარმის გაიყიდვას

The Importance of Prenatal Stress on the Development of ADHD in Children Literature Review 2019

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects children and often persists into adulthood. Research suggests that there is a link between maternal stress levels and the development of this condition.  According to the Centers for Disease Control and Prevention (CDC), 6.1 million children living in the United States in 2016 had received a diagnosis of ADHD. The symptoms of ADHD can vary from person to person, but they typically include difficulties with concentrating, paying attention, and controlling impulses.It is not clear what causes ADHD, but scientists believe that genetics, certain environmental factors, and brain changes may play a role in its development. Researchers have also investigated the role of nutrients, such as vitamin D and hormone, such as prenatal testosterone.  In this article, wewill reviewed the latest  literature assessing the relationship between prenatal exposure to psychosocial stress during pregnancy and to the risk of developing behavioral problems related to attention deficit hyperactivity disorder (ADHD) in Childhood

АНАЛІЗ ПОТОЧНОГО СТАНУ РИНКУ КОРПОРАТИВНИХ ЦІННИХ ПАПЕРІВ УКРАЇНИ

The article indicates the importance of special attention that is required to study the development of a segment of the financial market as the corporate securities market. Obviously, one of the key problems of the national securities market is "deficit" of financing instruments for investment measures. The analysis of the main tendencies and regularities of the stock market development, as well as the dynamics of the volume of movement of the main instruments on it show that the largest volumes of trades on the stock market were in the month of the greatest political instability in the country.Particular attention is paid to the current state of the corporate securities market in Ukraine, in particular, the assessment of domestic market indices in the period from 2004-2016 is carried out in detail. Issue shares, which significantly influenced the overall structure of registered shares and their share in Ukraine’s GDP, are shown. The dynamics of volume and number of issues of corporate bonds issue are analyzed.It is revealed that the domestic stock market today is significantly lagging behind in the development of the stock markets of industrialized countries. Creating favourable conditions for the functioning of securities is an integral part of the economic policy of most countries of the world. The securities market of Ukraine needs a clear system of investor protection, support for the stability of the market infrastructure development in all areas and effective regulation. The conducted market analysis allows to predict its further development and helps to highlight the main aspects of determining the features of construction of other components of the financial market.Проанализировано текущее состояние рынка корпоративных ценных бумаг в Украине, в частности подробно проведена оценка показателей отечественного рынка в период с 2004—2016 гг. Обнаружено ряд проблем, которые негативно влияют на прозрачность операций и неразвитость инфраструктуры. Спрогнозировано его дальнейшее развитие и определены особенности построения других финансовых рынков.Особливої уваги потребує вивчення розвитку такого сегмента фінансового ринку, як ринок корпоративних цінних паперів. Наголошено, що однією з ключових проблем національного фондового ринку є «дефіцит» інструментів фінансування інвестиційних заходів. Проведено аналіз основних тенденцій і закономірностей розвитку фондового ринку, а також динаміки обсягів руху основних інструментів на ньому. Визначено, що найбільші обсяги торгів на фондовому ринку були в місяці найбільшої політичної нестабільності у країні.Особливу увагу зосереджено на сучасному стані ринку корпоративних цінних паперів в Україні, зокрема детально проведено оцінку показників вітчизняного ринку в період 2004—2016 років. Показано випуски акції, які суттєво вплинули на загальну структуру зареєстрованих випусків акцій та їхню частку у ВВП України. Проаналізовано динаміку обсягу і кількості випусків корпоративних облігацій.З’ясовано, що вітчизняний фондовий ринок сьогодні значно відстає у своєму розвитку від фондових ринків промислово розвинутих країн. Створення сприятливих умов для функціонування цінних паперів є невід’ємною складовою економічної політики більшості країн світу. Ринкові цінних паперів України потрібна чітка система захисту прав інвесторів, підтримка стабільності розвитку інфраструктури ринку в усіх напрямах та ефективне регулювання. Проведений аналіз ринку дає змогу прогнозувати його подальший розвиток і допомагає виділити головні аспекти щодо визначення особливостей побудови інших складових фінансового ринку

Factors that influence tobacco use in Georgian youth

Objective: Social environment, especially education, levels of awareness, friends and parental behavior greatly affects the use of tobacco among teenagers. The research aims to identify various factors that promote tobacco use in youth. --- Method: Qualitative and analytic cross-sectional descriptive research method was carried in among students from Tbilisi State University. --- Results: Most respondents have started tobacco consumption at juvenile age. The community played a decisive role in starting tobacco use. Respondents started using tobacco with their classmates and close friends. The survey has shown that tobacco consumption was perceived as a positive social behavior among teenagers. Introducing the tobacco control laws that prohibit tobacco consumption and advertising in public places, particularly near schools are of paramount importance. --- Conclusion: Interventions that focus particularly on multiple risk factors may have an impact on the use of tobacco by adolescents. Where possible, such programs should be personalized to ensure that they address the specific set of risk factors that has a bearing on each individual's tobacco use.peer-reviewe

Fetal Stress, Inflammatory Marker and Childhood Asthma

Background: Asthma research has focused on postnatal exposures, but there is recent evidence to indicate immune responses might be initiated in fetal period. Systemic Inflammatory processes during pregnancy might affect fetal lung development that could increase propensity in the child to develop lung diseases.Objective: To identify the association of C-reactive protein (CRP) levels in Pregnant (with stress in second trimester), newborn blood samples (cord blood) with childhood wheezing.Methods: Serum CRP concentrations (Turbidimetric method) were measured in maternal blood on the 13-17 weeks of gestation in 32 pregnant women and in the newborn  cord blood after delivery. During1 year the frequency of wheezing diseases evaluated by the International Study on Asthma and Allergy in Childhood (ISAAC). Results: Maternal C-reactive protein was associated with the wheezing and lower respiratory tract infections r=.413*; - p=0.019. Compared to children with cord blood C-reactive protein high level had increased risks of wheezing, r=572;  p=0.001Conclusion: Our results suggest that elevated maternal and Cord blood CRP levels are associated with wheezing and lower respiratory tract infections in the first  years and predictive  asthma young in life

Effect of a Proposed Trastuzumab Biosimilar Compared With Trastuzumab on Overall Response Rate in Patients With ERBB2 (HER2)–Positive Metastatic Breast Cancer. A Randomized Clinical Trial

IMPORTANCE Treatment with the anti-ERBB2 humanized monoclonal antibody trastuzumab and chemotherapy significantly improves outcome in patients with ERBB2 (HER2)–positive metastatic breast cancer; a clinically effective biosimilar may help increase access to this therapy. OBJECTIVE To compare the overall response rate and assess the safety of a proposed trastuzumab biosimilar plus a taxane or trastuzumab plus a taxane in patients without prior treatment for ERBB2-positive metastatic breast cancer. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, randomized, parallel-group, phase 3 equivalence study in patients with metastatic breast cancer. From December 2012 to August 2015, 500 patients were randomized 1:1 to receive a proposed biosimilar or trastuzumab plus a taxane. Chemotherapy was administered for at least 24 weeks followed by antibody alone until unacceptable toxic effects or disease progression occurred. INTERVENTIONS Proposed biosimilar (n = 230) or trastuzumab (n = 228) with a taxane. MAIN OUTCOMES AND MEASURES The primary outcome was week 24 overall response rate (ORR) defined as complete or partial response. Equivalence boundaries were 0.81 to 1.24 with a 90% CI for ORR ratio (proposed biosimilar/trastuzumab) and −15% to 15% with a 95% CI for ORR difference. Secondary outcome measures included time to tumor progression, progression-free and overall survival at week 48, and adverse events. RESULTS Among 500 women randomized, the intention-to-treat population included 458 women (mean [SD] age, 53.6 [11.11] years) and the safety population included 493 women. The ORR was 69.6% (95% CI, 63.62%-75.51%) for the proposed biosimilar vs 64.0% (95% CI, 57.81%-70.26%) for trastuzumab. The ORR ratio (1.09; 90% CI, 0.974-1.211) and ORR difference (5.53; 95% CI, −3.08 to 14.04) were within the equivalence boundaries. At week 48, there was no statistically significant difference with the proposed biosimilar vs trastuzumab for time to tumor progression (41.3% vs 43.0%; −1.7%; 95% CI, −11.1% to 6.9%), progression-free survival (44.3% vs 44.7%; −0.4%; 95% CI, −9.4% to 8.7%), or overall survival (89.1% vs 85.1%; 4.0%; 95% CI, −2.1% to 10.3%). In the proposed biosimilar and trastuzumab groups, 239 (98.6%) and 233 (94.7%) had at least 1 adverse event, the most common including neutropenia (57.5% vs 53.3%), peripheral neuropathy (23.1% vs 24.8%), and diarrhea (20.6% vs 20.7%). CONCLUSIONS AND RELEVANCE Among women with ERBB2-positive metastatic breast cancer receiving taxanes, the use of a proposed trastuzumab biosimilar compared with trastuzumab resulted in an equivalent overall response rate at 24 weeks. Further study is needed to assess safety and long-term clinical outcome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02472964; EudraCT Identifier: 2011-001965-4