Πολυσυστηματικό φλεγμονώδες σύνδρομο των παιδιών με Covid-19

Εισαγωγή: To πολυσυστηματικό φλεγμονώδες σύνδρομο στα παιδιά (Multi- system inflammatory syndrome in children, MIS-C) εμφανίζεται σε παιδιά που έχουν νοσήσει από τον ιό SARS-CoV-2. To MIS-C αποτελεί ένα σοβαρό και απειλητικό για τη ζωή σύνδρομο που χαρακτηρίζεται από φλεγμονή διαφόρων οργάνων. Σκοπός: Η ανασκόπηση της διεθνούς βιβλιογραφίας για τη διερεύνηση της έκβασης των παιδιών με MIS-C, καθώς και της ανάγκης νοσηλείας σε μονάδα εντατικής θεραπείας Παίδων (ΠΜΕΘ) ή σε μονάδα εντατικής νοσηλείας νεογνών (ΜΕΝΝ). Μέθοδος: Πραγματοποιήθηκε συστηματική ανασκόπηση μελετών που δημοσιεύθηκαν μέχρι τον Αύγουστο του 2021 στην ελληνική και αγγλική γλώσσα στις βάσεις δεδομένων «Pubmed», «Scopus» και «Ιατροτεκ» με τις εξής λέξεις-κλειδιά: «multisystem inflammatory syndrome», «covid19», «chil- dren» και «outcome». Αποτελέσματα: Από τις 506 μελέτες που βρέθηκαν, οι 9 πληρούσαν τα κριτήρια ένταξης – αποκλεισμού και συμπεριελήφθησαν στην ανασκόπηση. Η πλειοψηφία των μελετών ήταν αναδρομικές μελέτες παρατήρησης, ενώ δύο ήταν προοπτικές μελέτες παρατήρησης. Από τα αποτελέσματα των μελετών προκύπτει ότι από το σύνολο των 242 ασθενών με MIS-C, μόλις 9 πέθαναν (3,7%), ενώ το 67,8% (164/242) των παιδιών νοσηλεύτηκε σε ΠΜΕΘ. Συμπεράσματα: Το MIS-C μπορεί να οδηγήσει σε πολυοργανική ανεπάρκεια που απαιτεί εντατική θεραπεία σε ΠΜΕΘ. Σχεδόν 7 στους 10 ασθενείς με MIS-C χρειάζονται νοσηλεία σε ΠΜΕΘ, με την πλειονότητα των ασθενών να απαιτεί στενή αιμοδυναμική παρακολούθηση και ινότροπη υποστήριξη. Η έγκαιρη διάγνωση και θεραπεία σχετίζεται με καλύτερη έκβαση των παιδιών με MIS-C.Introduction: Multisystem inflammatory syndrome in children (MIS-C) occurs in children who are sick with the SARS-CoV-2 virus. MIS-C is a serious and life-threatening syndrome characterized by inflammation of various organs. Aim: To review the international literature investigating the outcome of children with MIS-C, as well as the need for hospitalization in a pediatric intensive care unit (PICU) or neonatal intensive care unit (NICU). Method: We conducted a systematic review of studies published until the Au- gust 2021 in the Greek and English languages in the databases "Pubmed", "Scopus" and "Iatrotec" was carried out with the following keywords: "multi- system inflammatory syndrome", "covid19", "children" and "outcome". Results: Of the 506 studies found, 9 met the inclusion-exclusion criteria and were included in the review. The majority of studies were retrospective obser- vational studies, while two were prospective observational studies. The results of the studies show that out of the total of 242 patients with MIS-C, only 9 died (3.7%), while 67.8% (164/242) of the children were hospitalized in the ICU. Conclusion: MIS-C can lead to multiple organ failure requiring intensive care in the ICU. Nearly 7 in 10 patients with MIS-C require hospitalization in the ICU, with the majority of patients requiring hemodynamic monitoring and in- otropic support. Early diagnosis and treatment are associated with better out- comes for children with MIS-C

Antibacterial Activity of Ulva Lactuca Against Important Aquaculture Bacterial Strains

Efforts are made to produce functional aquaculture diets capable of promoting fish growth and health while being sustainable at social, economic and environmental levels. One of the emerging threats in aquaculture has become the antibiotic resistance phenomena due to antimicrobial drugs. Therefore, functional feed additives of marine origin have been introduced globally as an alternative to fish antibiotics. Towards the selection of natural and sustainable resources of bioactive compounds, seaweed has been proven to be a source of valuable substances showing antibacterial activity. Aim of this study is to evaluate the inhibition of bacterial growth caused by an ethanolic extract of the macroalgae Ulva lactuca against important aquaculture bacterial strains. Vibrio anguillarum O1, Photobacterium damselae sub. piscicida and Tenacibaculum maritimum, were incubated for 48 hours in sterile Brain Heart Infusion Broth and tested for resistance to the extract using broth cultures. The algal extract successfully inhibited the growth of all strains. The optimum inhibition was achieved for VAO1 and PHDP by the undiluted and 1:1 diluted extract, while for TMAR, by the 1:3 dilution as well. The antibacterial activity that the extract provided is considered to be the result of the containing bioactive compounds of the algal strain, such as polysaccharides, carotenoids and phenolic compounds

Role of the interval from completion of neoadjuvant therapy to surgery in postoperative morbidity in patients with locally advanced rectal cancer

Increasing the interval from completion of neoadjuvant therapy to surgery beyond 8 weeks is associated with increased response of rectal cancer to neoadjuvant therapy. However, reports are conflicting on whether extending the time to surgery is associated with increased perioperative morbidity. Patients who presented with a tumor within 15 cm of the anal verge in 2009-2015 were grouped according to the interval between completion of neoadjuvant therapy and surgery: < 8 weeks, 8-12 weeks, and 12-16 weeks. Among 607 patients, the surgery was performed at < 8 weeks in 317 patients, 8-12 weeks in 229 patients, and 12-16 weeks in 61 patients. Patients who underwent surgery at 8-12 weeks and patients who underwent surgery at < 8 weeks had comparable rates of complications (37% and 44%, respectively). Univariable analysis identified male sex, earlier date of diagnosis, tumor location within 5 cm of the anal verge, open operative approach, abdominoperineal resection, and use of neoadjuvant chemoradiotherapy alone to be associated with higher rates of complications. In multivariable analysis, male sex, tumor location within 5 cm of the anal verge, open operative approach, and neoadjuvant chemoradiotherapy administered alone were independently associated with the presence of a complication. The interval between neoadjuvant therapy and surgery was not an independent predictor of postoperative complications. Delaying surgery beyond 8 weeks from completion of neoadjuvant therapy does not appear to increase surgical morbidity in rectal cancer patients

Quality of life and function after rectal cancer surgery with and without sphincter preservation

Despite improvements in surgical techniques, functional outcomes and quality of life after therapy for rectal cancer remain suboptimal. We sought to prospectively evaluate the effect of bowel, bladder, and sexual functional outcomes on health-related quality of life (QOL) in patients with restorative versus non-restorative resections after rectal cancer surgery. A cohort of 211 patients with clinical stage I-III rectal cancer who underwent open surgery between 2006 and 2009 at Memorial Sloan Kettering were included. Subjects were asked to complete surveys preoperatively and at 6, 12, and 24 months after surgery. Validated instruments were used to measure QOL, bowel, bladder, and sexual function. Univariable and multivariable regression analyses evaluated predictors of 24- month QOL. In addition, longitudinal trends over the study period were evaluated using repeated measures models. In total, 180 patients (85%) completed at least 1 survey, and response rates at each time point were high (>70%). QOL was most impaired at 6 and 12 months and returned to baseline levels at 24 months. Among patients who underwent sphincter-preserving surgery (SPS; n=153 [85%]), overall bowel function at 24 months was significantly impaired and never returned to baseline. There were no differences in QOL at 24 months between patients who underwent SPS and those who did not (p=.29). Bowel function was correlated with QOL at 24 months (Pearson correlation,.41; p<.001). QOL among patients who have undergone SPS for rectal cancer is good despite poor function. Patients with ostomies are able to adjust to the functional changes and, overall, have good global QOL. Patients with low anastomoses had lower global QOL at 24 months than patients with permanent stomas. Our findings can help patients set expectations about function and quality of life after surgery for rectal cancer with and without a permanent stoma

Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: Results from the PelvEx Collaborative

Background: The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management. Methods: The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent agreement, whereas less than 80 per cent agreement indicated low consensus. Results: The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management. Consensus recommendations were developed, based on consensus agreement achieved on 34 statements. Conclusion: The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical research

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multi-disciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments