ABSTRACT
New information on the intensive care applications of new generation 'high-density data clinical information systems' (HDDCIS) is increasingly being published in the academic literature. HDDCIS avoid data loss from bedside equipment and some provide vital signs statistical calculations to promote quick and easy evaluation of patient information. Our objective was to study whether manual records of continuously monitored vital signs in the Paediatric Intensive Care Unit could be replaced by these statistical calculations. Here we conducted a prospective observational clinical study in paediatric patients with severe diabetic ketoacidosis, using a Medlinecare® HDDCIS, which collects information from bedside equipment (1 data point per parameter, every 3-5 s) and automatically provides hourly statistical calculations of the central trend and sample dispersion. These calculations were compared with manual hourly nursing records for patient heart and respiratory rates and oxygen saturation. The central tendency calculations showed identical or remarkably similar values and strong correlations with manual nursing records. The sample dispersion calculations differed from the manual references and showed weaker correlations. We concluded that vital signs calculations of central tendency can replace manual records, thereby reducing the bureaucratic burden of staff. The significant sample dispersion calculations variability revealed that automatic random measurements must be supervised by healthcare personnel, making them inefficient.
Subject(s)
Clinical Relevance , Diabetic Ketoacidosis , Humans , Child , Respiratory Rate , Critical Care , Information SystemsABSTRACT
El tumor de los cordones sexuales con túbulos anulares es una neoplasia del estroma gonadal muy infrecuente. Representa el 0,05-0,6% de todos los tumores ováricos, según series. Se presenta un caso especialmente inusual, en una niña de 6 años, detectado a raíz de una pubertad precoz periférica isosexual. Su interés radica en que no se halló ninguna masa anexa al ovario, sino únicamente una asimetría gonadal, sin signos radiológicos de malignidad. Se realizó una salpingo-ooforectomía unilateral con linfadenectomía pélvica y paraaórtica ipsilateral, por vía laparoscópica, tras confirmarse la presencia de células tumorales en la biopsia intraoperatoria. La evolución posterior de la paciente fue favorable.
Sex cord tumor with annular tubules is an extremely uncommon gonadal stromal neoplasm. It represents 0.05-0.6% of all ovarian tumors, according to series. An unusual case is presented in a 6-year-old girl, detected as a result of an isosexual peripheral precocious puberty. The highlight of this case is that no mass attached to the ovary was found, but only a gonadal asymmetry without radiological signs of malignancy. After confirming the presence of tumoral cells by intraoperative biopsy, unilateral salpingo-oophorectomy with ipsilateral para-aortic and pelvic lymphadenectomy was performed. Afterwards, the evolution of the patient was favorable.
Subject(s)
Humans , Female , Child , Ovarian Neoplasms/complications , Puberty, Precocious/etiology , Sex Cord-Gonadal Stromal Tumors/complications , Ovarian Neoplasms/pathology , Sex Cord-Gonadal Stromal Tumors/pathologyABSTRACT
Sex cord tumor with annular tubules is an extremely uncommon gonadal stromal neoplasm. It represents 0.05-0.6% of all ovarian tumors, according to series. An unusual case is presented in a 6-year-old girl, detected as a result of an isosexual peripheral precocious puberty. The highlight of this case is that no mass attached to the ovary was found, but only a gonadal asymmetry without radiological signs of malignancy. After confirming the presence of tumoral cells by intraoperative biopsy, unilateral salpingo-oophorectomy with ipsilateral para-aortic and pelvic lymphadenectomy was performed. Afterwards, the evolution of the patient was favorable.
El tumor de los cordones sexuales con túbulos anulares es una neoplasia del estroma gonadal muy infrecuente. Representa el 0,05-0,6% de todos los tumores ováricos, según series. Se presenta un caso especialmente inusual, en una niña de 6 años, detectado a raíz de una pubertad precoz periférica isosexual. Su interés radica en que no se halló ninguna masa anexa al ovario, sino únicamente una asimetría gonadal, sin signos radiológicos de malignidad. Se realizó una salpingo-ooforectomía unilateral con linfadenectomía pélvica y paraaórtica ipsilateral, por vía laparoscópica, tras confirmarse la presencia de células tumorales en la biopsia intraoperatoria. La evolución posterior de la paciente fue favorable.
Subject(s)
Ovarian Neoplasms/complications , Puberty, Precocious/etiology , Sex Cord-Gonadal Stromal Tumors/complications , Child , Female , Humans , Ovarian Neoplasms/pathology , Sex Cord-Gonadal Stromal Tumors/pathologyABSTRACT
OBJETIVO: Valorar la efectividad del tratamiento con hormona de crecimiento (GH) en niños pequeños para la edad gestacional (PEG) sin crecimiento recuperador (talla al iniciar la terapia<−2,5 DE), en la Comunidad Valenciana, entre el 01/01/2003 y el 31/12/2013, y comparar los resultados con los ya publicados. MATERIAL Y MÉTODOS: Los datos antropométricos de los PEG que constituyeron la muestra de estudio se recogieron retrospectivamente de los documentos de solicitud de tratamiento existentes en la Consejería de Sanidad de Valencia. RESULTADOS: Un total de 115 sujetos comenzaron a tratarse entre el 01/01/2003 y el 31/12/2013, con dosis de GH de 0,035 ± 0,004 mg/kg/día, a una edad de 8,10 ± 2,75 años y con una talla de -3,14 ± 0,59 DE. Talla alcanzada tras 2 años de terapia (n = 115, edad: 10,50 ± 2,72 años): -2,11 ± 0,66 DE; y tras 4 años (n = 96, edad: 12,6 5± 2,46 años): -1,76 ± 0,75 DE. Esta última mejoría de talla coincide con edades a las que suele producirse el estirón puberal. Solo 35 de los 115 niños finalizaron el crecimiento, en el periodo de estudio, a una edad de 16,22 ± 1,19 años. Este subgrupo no consiguió normalizar la talla adulta (-2,22 ± 0,86 DE), ni alcanzar su talla diana (-1,72 ± 0,75 DE); no obstante, hubo una buena aproximación a la talla del progenitor más bajo (-1,95 ± 1,28 DE). El 42,9% de estos 35 casos experimentaron un incremento de estatura superior a 1 DE. CONCLUSIONES: La muestra estudiada no obtiene una respuesta de crecimiento tan satisfactoria como las de otras series publicadas. Probablemente, estos resultados mejorarían iniciando el tratamiento más precozmente, e individualizando las dosis según las características del paciente
OBJECTIVE: To analyse the effectiveness of growth hormone (GH) therapy in short-stature children born small for gestational age (SGA) without catch-up growth (height at the beginning of treatment<-2.5 SDS), in Valencia (Spain), between 01/01/2003 and 12/31/2013; and to compare our findings with previously published data. MATERIALS AND METHODS: Anthropometric data from the SGA children were obtained from the database of the "Ministry of Health of Valencia". These data were retrospectively reviewed. RESULTS: A total of 115 SGA children, with a mean age of 8.10±2.75 years and height of 3.14±0.59 SDS started treatment (dose: 0.035±0.004mg/kg/day) between January 1st, 2003 and March 31st, 2013. After 2 years of therapy (n = 115, age: 10.50 ± 2.72 years) the height SDS was 2.11 ± 0.66; and after 4 years (n = 96, age: 12.65 ± 2.46 years) of 1.76 ± 0.75 SDS. This latest improvement in stature matches ages at which the growth spurt usually occurs. Only 35 out of 115 children reached adult height, although impaired (− 2.22 ± 0.86 SDS), and failed to achieve their target height (− 1.72 ± 0.75 SDS). However, this sub-group grew to near the height of the shorter parent (−1.95 ±1.28 SDS), and 42,9% of these 35 cases increased their stature by more than 1 SDS. CONCLUSIONS: The studied sample did not achieve satisfactory growth results, as in other published series. Our findings might be improved by starting treatment earlier, and with doses individualised according to patient characteristics
Subject(s)
Humans , Male , Female , Human Growth Hormone/administration & dosage , Human Growth Hormone/pharmacology , Human Growth Hormone/therapeutic use , Gestational Age , Anthropometry/methods , Growth and Development , Growth and Development/physiology , Retrospective Studies , Evaluation of the Efficacy-Effectiveness of Interventions , Prenatal Diagnosis/trendsABSTRACT
OBJECTIVE: To analyse the effectiveness of growth hormone (GH) therapy in short-stature children born small for gestational age (SGA) without catch-up growth (height at the beginning of treatment<-2.5 SDS), in Valencia (Spain), between 01/01/2003 and 12/31/2013; and to compare our findings with previously published data. MATERIALS AND METHODS: Anthropometric data from the SGA children were obtained from the database of the «Ministry of Health of Valencia¼. These data were retrospectively reviewed. RESULTS: A total of 115 SGA children, with a mean age of 8.10±2.75 years and height of -3.14±0.59 SDS started treatment (dose: 0.035±0.004mg/kg/day) between January 1st, 2003 and March 31st, 2013. After 2 years of therapy (n=115, age: 10.50±2.72 years) the height SDS was -2.11±0.66; and after 4 years (n = 96, age: 12.65±2.46 years) of -1.76±0.75 SDS. This latest improvement in stature matches ages at which the growth spurt usually occurs. Only 35 out of 115 children reached adult height, although impaired (-2.22±0.86 SDS), and failed to achieve their target height (-1.72 ±0.75 SDS). However, this sub-group grew to near the height of the shorter parent (-1.95 ±1.28 SDS), and 42,9% of these 35 cases increased their stature by more than 1 SDS. CONCLUSIONS: The studied sample did not achieve satisfactory growth results, as in other published series. Our findings might be improved by starting treatment earlier, and with doses individualised according to patient characteristics.
Subject(s)
Growth Disorders/drug therapy , Human Growth Hormone/therapeutic use , Adolescent , Child , Female , Humans , Infant, Small for Gestational Age , Male , Retrospective Studies , Spain , Time FactorsABSTRACT
INTRODUCTION AND OBJECTIVES: The availability of a noninvasive marker of vascular lesions that enables their detection in the preclinical phase would be of great benefit for cardiovascular disease prevention. The aim of this study was to investigate the usefulness of a range of indices of arterial wall stiffness in the common carotid artery, as derived using high-resolution Doppler ultrasonography, for identifying vascular damage in children with risk factors. METHODS: The study involved 99 children (age, 8-16 years) divided into two groups: 65 had cardiovascular risk factors (45 obesity, 20 dyslipidemia) and 34 were controls. Family histories of cardiovascular risk factors and anthropometric and biochemical measurements were recorded. Functional parameters of arterial stiffness (i.e., arterial compliance, elastic modulus, beta stiffness index, pulse wave velocity, and augmentation index) and the intima-media thickness were also measured. RESULTS: Some functional vascular parameters were higher in obese children than controls: there were significant differences in beta stiffness index (P< .02), elastic modulus (P< .001) and pulse wave velocity (P< .01). There was a significant difference in arterial compliance between dyslipidemics and controls (P< .05). No significant difference in intima-media thickness was found between the groups. In obese children, there were positive correlations between body mass index, systolic pressure and triglyceride levels and vascular parameters (i.e., elastic modulus and pulse wave velocity); in dyslipidemic children, triglyceride levels and the same parameters were correlated. CONCLUSIONS: Ultrasonographic measurement of arterial stiffness is a sensitive technique that can detect vascular damage in children with cardiovascular risk factors earlier than intima-media thickness measurement.
Subject(s)
Carotid Arteries/diagnostic imaging , Dyslipidemias/diagnostic imaging , Obesity/diagnostic imaging , Ultrasonography, Doppler , Adolescent , Cardiovascular Diseases/epidemiology , Carotid Arteries/pathology , Carotid Arteries/physiopathology , Case-Control Studies , Child , Female , Humans , Male , Risk FactorsABSTRACT
Introducción y objetivos. Para la prevención de la enfermedad cardiovascular resulta de gran interés disponer de un marcador incruento de lesión vascular que permita su detección en fase preclínica. Nuestro objetivo fue analizar diversos índices de rigidez arterial de la carótida común mediante ultrasonografía Doppler de alta resolución para definir su utilidad como detector de daño vascular en niños con factores de riesgo. Métodos. Se estudió a 99 niños (edades, 8-16 años) divididos en dos grupos: 65 niños con factores de riesgo cardiovascular (45 obesos, 20 dislipémicos) y 34 controles. Se recogieron antecedentes familiares de riesgo cardiovascular y variables antropométricas y bioquímicas. Se midieron parámetros funcionales de rigidez arterial (compliance arterial, módulo elástico, índice beta de rigidez, velocidad de la onda de pulso e índice de aumento) y el grosor íntima-media. Resultados. Los niños obesos presentaron parámetros vasculares funcionales elevados respecto a los controles, que fueron significativos para el índice beta (p < 0,02), el módulo elástico (p < 0,001) y la velocidad de onda del pulso (p < 0,01). En los dislipémicos constatamos diferencias significativas en la compliance arterial respecto a los controles (p < 0,05). No hubo diferencias significativas en el grosor íntima-media entre grupos. Encontramos correlación positiva entre el índice de masa corporal, la presión sistólica y los triglicéridos con los parámetros vasculares (módulo elástico y velocidad de onda del pulso) en los obesos y, entre triglicéridos y los mismos parámetros en los dislipémicos. Conclusiones. La medida ultrasonográfica de la rigidez arterial es un procedimiento sensible que puede resultar más precoz que el grosor íntima-media para detectar daño vascular en niños con factores de riesgo cardiovascular (AU)
Introduction and objectives. The availability of a noninvasive marker of vascular lesions that enables their detection in the preclinical phase would be of great benefit for cardiovascular disease prevention. The aim of this study was to investigate the usefulness of a range of indices of arterial wall stiffness in the common carotid artery, as derived using high-resolution Doppler ultrasonography, for identifying vascular damage in children with risk factors. Methods. The study involved 99 children (age, 8-16 years) divided into two groups: 65 had cardiovascular risk factors (45 obesity, 20 dyslipidemia) and 34 were controls. Family histories of cardiovascular risk factors and anthropometric and biochemical measurements were recorded. Functional parameters of arterial stiffness (i.e., arterial compliance, elastic modulus, beta stiffness index, pulse wave velocity, and augmentation index) and the intima-media thickness were also measured. Results. Some functional vascular parameters were higher in obese children than controls: there were significant differences in beta stiffness index (P<.02), elastic modulus (P<.001) and pulse wave velocity (P<.01). There was a significant difference in arterial compliance between dyslipidemics and controls (P<.05). No significant difference in intima-media thickness was found between the groups. In obese children, there were positive correlations between body mass index, systolic pressure and triglyceride levels and vascular parameters (i.e., elastic modulus and pulse wave velocity); in dyslipidemic children, triglyceride levels and the same parameters were correlated. Conclusions. Ultrasonographic measurement of arterial stiffness is a sensitive technique that can detect vascular damage in children with cardiovascular risk factors earlier than intimamedia thickness measurement (AU)
