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1.
J Pediatr ; 229: 33-40, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33075369

RESUMO

OBJECTIVE: To describe the similarities and differences in the evaluation and treatment of multisystem inflammatory syndrome in children (MIS-C) at hospitals in the US. STUDY DESIGN: We conducted a cross-sectional survey from June 16 to July 16, 2020, of US children's hospitals regarding protocols for management of patients with MIS-C. Elements included characteristics of the hospital, clinical definition of MIS-C, evaluation, treatment, and follow-up. We summarized key findings and compared results from centers in which >5 patients had been treated vs those in which ≤5 patients had been treated. RESULTS: In all, 40 centers of varying size and experience with MIS-C participated in this protocol survey. Overall, 21 of 40 centers required only 1 day of fever for MIS-C to be considered. In the evaluation of patients, there was often a tiered approach. Intravenous immunoglobulin was the most widely recommended medication to treat MIS-C (98% of centers). Corticosteroids were listed in 93% of protocols primarily for moderate or severe cases. Aspirin was commonly recommended for mild cases, whereas heparin or low molecular weight heparin were to be used primarily in severe cases. In severe cases, anakinra and vasopressors frequently were recommended; 39 of 40 centers recommended follow-up with cardiology. There were similar findings between centers in which >5 patients vs ≤5 patients had been managed. Supplemental materials containing hospital protocols are provided. CONCLUSIONS: There are many similarities yet key differences between hospital protocols for MIS-C. These findings can help healthcare providers learn from others regarding options for managing MIS-C.


Assuntos
COVID-19/terapia , Protocolos Clínicos , Padrões de Prática Médica/estatística & dados numéricos , Síndrome de Resposta Inflamatória Sistêmica/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticoagulantes/uso terapêutico , Antirreumáticos/uso terapêutico , Aspirina/uso terapêutico , COVID-19/diagnóstico , Criança , Estudos Transversais , Glucocorticoides/uso terapêutico , Heparina/uso terapêutico , Hospitais , Humanos , Imunoglobulinas Intravenosas , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Inquéritos e Questionários , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Estados Unidos/epidemiologia , Vasoconstritores/uso terapêutico
3.
Eur J Radiol ; 84(10): 1938-42, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26210092

RESUMO

INTRODUCTION: Right ventricular (RV) size and function in Duchenne muscular dystrophy (DMD) have not been well described. Using cardiac magnetic resonance (CMR) imaging we describe the relationship of RV and left ventricular (LV) size and function in a large DMD cohort. METHODS: Latest CMR scans of 272 patients consecutively seen at a single tertiary referral center (2011-2014) with skeletal muscle biopsy confirmed DMD were included. 1.5 and 3 Tesla CMR scanners were used. Biventricular ejection fraction (EF), end-diastolic volume index (EDVI), mass and mass index were compared across categories of LVEF. RESULTS: Mean age was 13.5 ± 4.9 years. 71% had normal (≥ 55%) LVEF while mild (EF 45-54%), moderate (EF 30-44%), and severe LV dysfunction (EF <30%) was present in 20%, 6% and 3% respectively. The correlation between RVEF and LVEF was weak. Even in patients with severe LV dysfunction, RVEF (49.7% ± 12.9%) was relatively preserved. There were no significant differences in RVEDVI and RV mass index across categories of LV function. CONCLUSION: In a large DMD cohort, RVEF was relatively preserved and RV size was preserved across categories of LV dysfunction.


Assuntos
Ventrículos do Coração/patologia , Distrofia Muscular de Duchenne/fisiopatologia , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia , Adolescente , Adulto , Volume Cardíaco/fisiologia , Criança , Estudos de Coortes , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Distrofia Muscular de Duchenne/patologia , Tamanho do Órgão , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/fisiopatologia , Adulto Jovem
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