The prevalence and risk factors for visceral hemangiomas in children with infantile cutaneous hemangiomas

One of the most frequent benign tumor pathology in children is represented by infantile hemangiomas (IHs). Although they are mostly cutaneous, sometimes they can develop at visceral level, the liver being the most common localization. Objectives. Estimating visceral hemangiomas (VHs) prevalence, and identification of risk factors for VHs in patients with infantile cutaneous hemangiomas (ICHs). Materials and methods. 6 years cross-sectional study (2012-2017) including children diagnosed with ICHs, admitted in I.N.S.M.C “Alfred-Rusescu“. All patients underwent an ultrasound screening for the detection of VHs. In order to identify possible risk factors, we collected demographic and perinatal data. Outcomes. 138 patients diagnosed with infantile cutaneous hemangiomas (ICHs) were included, with a slight predominance of girls (58%). The prevalence of the VHs in our study was 7,24% (10 patients). The liver was the most common visceral localization (7 patients). Conclusions. Female gender, preterm birth, low birth weight, and multiple gestations were described as potential risk factors for IHs. In our study, only multiple gestations tend to be associated with visceral hemangiomas, but without a significant statistical correlation

First Case of COVID-19 Treated with Monoclonal Anti-Spike Antibodies in a Patient with Cystic Fibrosis in Romania

Patients with chronic lung conditions, including cystic fibrosis, may be prone to severe COVID-19. Therefore, therapeutic intervention should be prompt and tailored to all associated comorbidities. We report the case of a 17-year-old male adolescent with cystic fibrosis and multiple chronic conditions (bronchiectasis, exocrine pancreatic insufficiency, chronic multidrug resistant Pseudomonas aeruginosa colonization, nasal polyposis, chronic sinusitis, ventricular extrasystoles and multiple drug allergies), who presented with an acute episode of productive cough, and was confirmed with moderate COVID-19 based on positive RT-PCR for SARS-CoV-2 and lung imaging showing isolated foci of interstitial pneumonia. Intravenous treatment with the monoclonal antibody cocktail casirivimab and imdevimab was administered. The evolution was favorable, with rapid remission of the inflammatory syndrome and gradual decrease of cough, without progression to severe or critical COVID-19, but with complications such as repeated hemoptysis, which was due to the patient’s underlying conditions, and which required close monitoring for timely adjustment of the patient’s chronic treatment

INTRAOSSEOUS ACCESS – A CLASSICAL METHOD FOR VASCULAR ACCESS THAT REGAINS AN IMPORTANT ROLE AS RESUSCITATION TOOL

75-80% of life threatening situations, with unexpected arrest, are documented out of hospital (1). This situation generates frequently a diffi cult resuscitation. Main cause for failure is delay in gaining vascular access for fl uid and drug delivery (2). Intraosseous access (IO) is used for treatment in patients without a previously placed intravenous line that experience abrupt-onset life threatening situations (3). Authors revisit data from initial development of this method and document the role of IO access as a valuable tool during resuscitation according to European Resuscitation Council Guidelines 2010 (4). Particular aspects of technique, improvisations and real life trouble shooting issues are presented from a single pediatric Emergency Department experience

ABORDUL INTRAOSOS, METODA CLASICĂ DE ACCES VASCULAR REVENITĂ ÎN ACTUALITATE

75-80% dintre situaţiile ameninţătoare de viaţă, cu stop cardio-respirator neaşteptat, se petrec în afara spitalului (1). De aceea este întâlnită frecvent situaţia unei resuscitări difi cile. Principala cauză de eşec este obţinerea tardivă a unei căi de acces vascular pentru administrarea fl uidelor şi medicaţiei necesare în aceste situaţii (2). Abordul intraosos este folosit în tratamentul pacienţilor afl aţi în situaţii ameninţătoare de viaţă şi care nu au alt acces vascular instalat anterior (3). Lucrarea de faţă trece în revistă aspecte ale dezvoltării acestei tehnici de acces vascular rapid şi aplicaţiile ei actuale în medicina de urgenţă, prin prisma noilor ghiduri de resuscitare la copil, apărute sub egida European Resuscitation Council (4)

PARENTAL PERCEPTION ON NEBULIZED MEDICATION AND POTENTIAL REASONS FOR OFF-LABEL USAGE OF DEXAMETHASONE IN CHILDREN FROM ROMANIA

Background and aim. In the last decade a significant increase of nebulized medication usage has been documented in Romania. Authors are aiming to describe parental and physician’s change of perspective regarding nebulized medication in the new era of online communication and education. Material and methods. Two different questionnaires were posted in a large and representative group (more than 60,000 followers) of Romanian parents and physicians, Virtual Children’s Hospital („Spitalul Virtual de Copii”). Results. More than 4,000 answers were submitted. 94.4% responders confirmed using at least once wetnebulized medication in children. A particular aspect documented was dexamethasone off-label usage via nebulizer in 67.8% children. Additional 7% of responders confirmed that they received an indication to nebulize a normal saline suspension with dexamethasone phosphate for parenteral usage, but they didn’t follow the indication and used an approved treatment. Conclusions. Upon our knowledge this is the first large study on nebulized dexamethasone in Romanian literature. 95% of Romanian children receive nebulized medication. Nebulizer is regarded by parents as a simple and friendly tool that can solve virtually all issues related to airway diseases in our country. 75% of children that received nebulized medication had a prescription for off-label use of dexamethasone

First Case of COVID-19 Treated with Monoclonal Anti-Spike Antibodies in a Patient with Cystic Fibrosis in Romania

Patients with chronic lung conditions, including cystic fibrosis, may be prone to severe COVID-19. Therefore, therapeutic intervention should be prompt and tailored to all associated comorbidities. We report the case of a 17-year-old male adolescent with cystic fibrosis and multiple chronic conditions (bronchiectasis, exocrine pancreatic insufficiency, chronic multidrug resistant Pseudomonas aeruginosa colonization, nasal polyposis, chronic sinusitis, ventricular extrasystoles and multiple drug allergies), who presented with an acute episode of productive cough, and was confirmed with moderate COVID-19 based on positive RT-PCR for SARS-CoV-2 and lung imaging showing isolated foci of interstitial pneumonia. Intravenous treatment with the monoclonal antibody cocktail casirivimab and imdevimab was administered. The evolution was favorable, with rapid remission of the inflammatory syndrome and gradual decrease of cough, without progression to severe or critical COVID-19, but with complications such as repeated hemoptysis, which was due to the patient’s underlying conditions, and which required close monitoring for timely adjustment of the patient’s chronic treatment

Current and Future Therapeutic Approaches of Exocrine Pancreatic Insufficiency in Children with Cystic Fibrosis in the Era of Personalized Medicine

This review presents current updates of pancreatic enzyme replacement therapy in children with cystic fibrosis based on literature published in the last decade and some special considerations regarding pancreatic enzyme replacement therapy in the era of new therapies, such as cystic fibrosis transmembrane conductance regulator modulator therapies. Few articles evaluate the efficacy of pancreatic enzyme replacement therapy in the pediatric population, and most studies also included children and adults with cystic fibrosis. Approximately 85% of cystic fibrosis patients have exocrine pancreatic insufficiency and need pancreatic enzyme replacement therapy. Fecal elastase is the most commonly used diagnostic test for exocrine pancreatic insufficiency, although this value can fluctuate over time. While it is used as a diagnostic test, it cannot be used for monitoring the effectiveness of pancreatic enzyme replacement therapy and for adjusting doses. Pancreatic enzyme replacement therapy, the actual treatment for exocrine pancreatic insufficiency, is essential in children with cystic fibrosis to prevent malabsorption and malnutrition and needs to be urgently initiated. This therapy presents many considerations for physicians, patients, and their families, including types and timing of administration, dose monitoring, and therapy failures. Based on clinical trials, pancreatic enzyme replacement therapy is considered effective and well-tolerated in children with cystic fibrosis. An important key point in cystic fibrosis treatment is the recent hypothesis that cystic fibrosis transmembrane conductance regulator modulators could improve pancreatic function, further studies being essential. Pancreatic enzyme replacement therapy is addressed a complication of the disease (exocrine pancreatic insufficiency), while modulators target the defective cystic fibrosis transmembrane conductance regulator protein. Exocrine pancreatic insufficiency in cystic fibrosis remains an active area of research in this era of cystic fibrosis transmembrane conductance regulator modulator therapies. This new therapy could represent an example of personalized medicine in cystic fibrosis patients, with each class of modulators being addressed to patients with specific genetic mutations

INFANTIL CUTANED HEMANGIOMATOSIS ASSOCIATED WITH MULTIFOCAL HEPATIC HEMANGIOMATOSIS – CASE PRESENTATION

Infantile hemangiomas are the most frequent tumors of infancy, with an incidence reaching almost 10% (1). In children with more than 5 skin hemangiomas it has been noticed a highly association with visceral hemangiomas, the liver being the main site for their localization (2). Regarding therapeutic approach, if for skin hemangiomas the treatment is well established, for hepatic infantile hemangiomas clear guidelines are still necessary

Abstracts From The 3Rd International Severe Asthma Forum (Isaf)

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