Inhaled Nitric Oxide Therapy for Acute Respiratory Distress Syndrome in Children.

The aim of this study was to evaluate the effects of inhaled nitric oxide (iNO) therapy on oxygenation and mortality in children with acute respiratory distress syndrome (ARDS). Thirty-three children with ARDS and an arterial SatO2 <88% despite mechanical ventilation were analyzed. Patients in the iNO group were prospectively enrolled and treated with conventional therapy plus iNO. The control group consisted of retrospectively analyzed patients treated only with conventional therapy. A significant increase in PaO2/FiO2 ratio (25.6%) and decrease in oxygenation index (19.5%) was observed after 4 h of iNO treatment, when compared to baseline values. A positive response to iNO was detected in 69% of patients, and there was no difference between pulmonary and extrapulmonary ARDS. There was no difference in mortality and duration of mechanical ventilation between iNO and control group.

Epidemiology of diseases caused by Streptococcus pyogenes in Serbia during a nine-year period (1991-1999).

BACKGROUND & OBJECTIVES: Streptococcus pyogenes (group A Streptococcus - GAS) is an important human pathogen which causes a variety of diseases, including tonsillopharyngitis, scarlet fever and rheumatic fever. It is important to understand the changes in epidemiology of the diseases caused by the pathogen for improved control of such infections. Hence, the aim of the present study was to carry out an epidemiological analysis of GAS infections in Serbia in a 9-yr period (1991-1999) and evaluation of susceptibility of GAS isolates obtained during the same period to penicillin and erythromycin. METHODS: Occurrence of tonsillopharyngitis, scarlatina and rheumatic fever was analyzed and GAS carrier status in healthy children was examined over a 9-yr period from 1991 to 1999. Susceptibility to penicillin and erythromycin was determined for 1657 GAS isolates obtained from patients diagnosed with pharyngitis or scarlet fever and 512 isolates from healthy carriers. M-type antigen was also determined in these isolates. RESULTS: The average incidences of tonsillopharyngitis and scarlet fever were 76.2 and 30.8 per cent respectively. A total of 166 cases of rheumatic fever were registered. Per cent of carriers varied from 5.5 to 11.4 per cent over the study period. Predominating M serotypes among GAS isolates tested were M1, M3, M4, M6, M11, M12 and M18, depending on the source of clinical material and period of isolation. Antimicrobial susceptibility testing showed susceptibility to penicillin in all isolates tested and resistance to erythromycin in 2.41 per cent of the isolates. INTERPRETATION & CONCLUSION: Although the fluctuations in incidence were noted during the nine-year period, the incidence of streptococcal tonsillopharyngitis is low but with a steady raise in Serbia. No significant changes in the incidence of scarlet fever and rheumatic fever were noted. Susceptibility to penicillin remained unchanged, but the number or erythromycin resistant strains have increased.