Η επίδραση του εμβολιασμού με τα συζευγμένα εμβόλια κατά του πνευμονιόκοκκου στην επιδημιολογία της πνευμονίας που επιπλέκεται με παραπνευμονική συλλογή (που απαιτεί παροχέτευση)

Εισαγωγή: Η παραπνευμονική συλλογή (ΠΣ) είναι συχνή επιπλοκή της πνευμονίας και δυνητικά σοβαρή σε περίπτωση εμπυήματος. Συχνότερο αίτιο της πνευμονίας είναι ο πνευμονιόκοκκος. Μετά την εισαγωγή του 7-δύναμου συζευγμένου πνευμονιοκοκκικού εμβολίου (PCV7), παρατηρήθηκε αύξηση των ΠΣ σε αρκετές χώρες. Η εισαγωγή του 13-δύναμου συζευγμένου πνευμονιοκοκκικού εμβολίου (PCV13) αναμένεται να παρέχει σημαντική προστασία έναντι των ΠΣ. Η παρούσα μελέτη έχει στόχο τη μελέτη της επίδρασης του εμβολιασμού με PCV7 και PCV13 στην επιδημιολογία των ΠΣ στην παιδική ηλικία. Μέθοδος: Πρόκειται για πολυκεντρική μελέτη καταγραφής παιδιών που νοσηλεύθηκαν σε δημόσια παιδιατρικά νοσοκομεία της Αττικής λόγω παραπνευμονικής συλλογής για την αντιμετώπιση της οποίας κρίθηκε απαραίτητη η τοποθέτηση θωρακικού σωλήνα παροχέτευσης (Bülau) την περίοδο από 01/01/2004 έως 30/06/2018. Τα δεδομένα ανάγονται στο σύνολο των εισαχθέντων ασθενών στα παιδιατρικά τμήματα ανά έτος. Αποτελέσματα: Καταγράφηκαν συνολικά 374 περιπτώσεις πνευμονίας με ΠΣ. Η ετήσια επίπτωση των ΠΣ αυξήθηκε κατά 0,14 ΠΣ/1000 εισαγωγές/έτος μετά την εισαγωγή του PCV7 στο Εθνικό Πρόγραμμα Εμβολιασμών. Μετά την εφαρμογή του PCV13, η αυξανόμενη διαχρονική μεταβολή της επίπτωσης αναστράφηκε και πλέον η ετήσια επίπτωση των ΠΣ μειώνεται κατά 0,02 ΠΣ/1000 εισαγωγές/έτος. Παράλληλα, παρατηρήθηκε μια ενδιαφέρουσα αύξηση του ορότυπου 3. Συμπέρασμα: Μετά την εφαρμογή του PCV13 στην περιοχή μας παρατηρείται μια μειωμένη τάση στο χρόνο για την επίπτωση των ΠΣ στην παιδική ηλικία. Ο ορότυπος 3 είναι στις μέρες μας ένα συχνό αίτιο ΠΣ. Η συνεχής παρακολούθηση είναι απαραίτητη, ώστε να επιβεβαιωθούν τα ευρήματα αυτά τα επόμενα έτη.Background: Parapneumonic effusion (PPE) is a common complication of community-acquired pneumonia. The most common cause of PPE is bacterial pneumonia due to Streptococcus pneumoniae. After the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7), an increase in the incidence of PPE was recorded. The 13-valent PCV (PCV13) is expected to provide a wide protection against PPE. We aim to examine the impact of PCV introduction on the number of complicated parapneumonic effusion (c-PPE) admissions among children in our area. Methods: We analyzed cases of pneumonia with PPE requiring chest tube insertion (complicated PPE, c-PPE) in the 3 public Children’s hospitals in Athens between 01/01/2004 and 30/06/2018. The annual incidence rate of c-PPE cases/1,000 general pediatric hospital admissions was recorded and time trend was examined. Results: A total of 374 cases of pneumonia with c-PPE were recorded. The annual incidence rate of PPE was increasing by 0.14 PPE/1000 admissions/year after the introduction of PCV7. After the introduction of PCV13, the increasing rate was reversed and nowadays the annual c-PPE admission rate is decreasing by 0.02 PPE/1000 admissions/year. An interesting increase in serotype 3 was reported. Conclusion: A decreasing time trend in c-PPE cases among children was shown after the introduction of PCV13 in our area. Serotype 3 is nowadays a common cause of PPE. Continuous surveillance is required to confirm these findings over time

Antioxidant and Anti-Inflammatory Phytochemicals for the Treatment of Inflammatory Bowel Disease: A Systematic Review

Inflammatory bowel disease (IBD) remains a burden for patients with increasing prevalence in industrialized countries. Phytochemicals are non-nutrient plant derived bioactive substances with antioxidant and anti-inflammatory effects that may prove beneficial to IBD patients. This review aims to overview current evidence on the application and impact of isolated phytochemicals or phytochemicals contained in plant extracts and essential oils on patients suffering from IBD. A systematic literature search was conducted for studies relating to the use of phytochemicals for the treatment of IBD. Ultimately, 37 human clinical trials and 3 systematic reviews providing human IBD patient data relevant to phytochemicals as therapeutic agents were included. Phytochemicals in the form of curcumin, Plantago ovata seeds, polyphenon E, silymarin, resveratrol supplements or an herbal preparation of myrrh, chamomile and coffee charcoal have evidence from human clinical trials supporting their safety and beneficial effects. Cannabinoids improve quality of life but not IBD outcomes. The addition of probiotics like B. longum to fructo-oligosaccharides promote healthy composition of the gut microbiome. Phytochemicals like mastiha, anthocyanins, berberine, tormentil, T2, ecabet sodium and Pycnogenol need more well-designed trials. Systematic research on phytochemicals can lead to the discovery of useful therapeutics. These secondary metabolites can be incorporated in current IBD treatment strategies to limit side effects, promote mucosal healing and provide higher quality of life to patients

Acinar cell carcinoma in childhood: A case report of a very rare tumor

Pancreatic tumors are reported rarely in childhood and represent an extremely rare entity in Pediatric Oncology. One of the least common types of pediatric pancreatic tumor is acinar cell carcinoma (ACC). We aim to present a rare case of ACC and the difficulties we faced during diagnosis and treatment

Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer

Background: Identifying potential predictive factors for the type of bacteremia (Gram-negative vs. Gram-positive) in children with cancer would be crucial for the timely selection of the appropriate empiric antibiotic treatment. Materials and Methods: Demographic, clinical, and laboratory characteristics of children with cancer and a bacterial bloodstream infection (BSI) (February 1, 2011 to February 28, 2018) in a tertiary pediatric oncology department were retrospectively examined and were correlated with the type of isolated bacteria. Results: Among 224 monomicrobial bacterial BSI episodes, Gram-negative and Gram-positive bacteria were isolated in 110 and 114 episodes, respectively. Gram-negative bacteria were isolated significantly more frequently in girls (Gram-negative/Gram-positive ratio 1.7:1) versus boys (Gram-negative/Gram-positive ratio 0.72:1), P=0.002, in patients with previous BSI episodes (1.4:1) versus those without (0.8:1), P=0.042, and in children with hematologic malignancy (1.3:1) versus those who suffered from solid tumors (0.52:1), P=0.003. Gram-negative BSI episodes were more frequently correlated with a lower count of leukocytes, P=0.009, neutrophils, P=0.009 and platelets, P=0.002, but with significantly higher C-reactive protein (CRP) levels, P=0.049. Female sex, hematologic malignancy, and higher CRP levels remained independent risk factors for Gram-negative BSI in the multivariate analysis. Among neutropenic patients, boys with solid tumors and a recent central venous catheter placement appear to be at increased risk for Gram-positive BSI in the multivariate analysis. Conclusions: Although Gram-negative and Gram-positive BSIs are close to balance in children with cancer, Gram-negative bacteria are more likely to be isolated in girls, children with hematologic malignancies and those with higher CRP level at admission. In contrast, neutropenic boys with solid tumors and a recently placed central venous catheter may be at increased risk for Gram-positive BSI indicating probably the need for initially adding antibiotics targeting Gram-positive bacteria