RESUMO
BACKGROUND: Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a standard procedure for patient with refractory shock in Pediatric Intensive Care Unit (PICU). There is a paucity of data on the time relationship between VA-ECMO support, nosocomial infection occurrence, and PICU length of stay (LOS). The aim of this study was to determine the characteristics and impact of ECMO-related infections. METHODS: This is a retrospective study from 01/2008 to 12/2014, enrolling children with a VA-ECMO support for > 6 h. We recorded the first PICU infection during the VA-ECMO run, defined as a positive microbiological sample with clinical signs of infection or clinical signs of severe infection without positive sample. RESULTS: During the study period, 41 patients (25/41 male) were included, with a median age of 41.2 months (IQR 12.9-89.9) and a 53% mortality rate. Median time on VA-ECMO was 4.2 d (IQR 2-7.1), median PICU LOS was 14.7 d (IQR 4,7-26,9). Overall, 34% patients developed an infection, with an incidence of 60/1000 VA-ECMO days. Median time to first infection was 4 d (IQR 3-5), with Pseudomonas spp. being the most commonly detected microorganism (42%). Infected sites were ventilator-associated pneumonia (9/14), sternotomy infection (2/14), bloodstream (2/14) and urinary tract infections (1/14). Longer VA-ECMO support (> 5 d) (OR 5.9 (CI 95% 1.4-24.6; p = 0.01) and longer PICU stay (> 14 d) (OR 12 (95% CI 2.2-65.5; p = 0.004) were associated with infection. CONCLUSION: In this single-center study, we underlined the high proportion and early occurrence of infections in patient on VA-ECMO, mostly in the first week. As infection was an early event, it may prolong the duration of VA-ECMO support and PICU LOS. Further research is needed to better understand the impact of infections on VA-ECMO and develop prevention strategies.
Assuntos
Infecção Hospitalar , Oxigenação por Membrana Extracorpórea , Humanos , Masculino , Criança , Lactente , Pré-Escolar , Resultado do Tratamento , Oxigenação por Membrana Extracorpórea/efeitos adversos , Infecção Hospitalar/etiologia , Estudos Retrospectivos , Mortalidade HospitalarRESUMO
BACKGROUND: Some conventional vaccines have been recognized as a cause of secondary immune thrombocytopenia (ITP). According to recent publications, mRNA vaccines are probably associated with an increased risk of ITP. CASE PRESENTATION: Our patient developed severe ITP one week after the second dose of COVID-19 mRNA vaccine. Medical management was not effective, requiring splenectomy to obtain sustained remission. CONCLUSION: Considering the temporality and immunological hypothesis, we consider the vaccine to be the trigger of this ITP. To our knowledge, our case is, to date, the most severe case of ITP reported following SARS-CoV-2 vaccination and could help for the therapeutic management of similar patients.
RESUMO
Glucids are ubiquitous and yet controversial components of our nutrition. This narrative review focuses on the potential harmful effects of sugars on health, particularly as a risk factor for overweight, obesity or diabetes mellitus. Current guidelines recommend a daily limit of intake, and notably a restriction on added sugars. « Keto ¼ diets and intermittent fasting are trending in this era of sugar mistrust. However, the metabolic benefits are not yet clearly established, and the underlying risks should restrain the prescription of these diets to a population of carefully selected patients.
Les glucides sont des composants ubiquitaires et pourtant controversés de notre alimentation. Cette revue narrative s'intéresse aux éventuels méfaits des sucres sur la santé, plus particulièrement sur le risque de développer un surpoids ou une obésité, ainsi qu'un diabète sucré. Les recommandations actuelles préconisent ainsi une limitation journalière des apports, et notamment une restriction des sucres ajoutés. Les régimes dits « Keto ¼ et de jeûne intermittent se sont récemment popularisés dans ce contexte de conjuration des sucres. Leurs bénéfices métaboliques ne sont cependant pas clairement démontrés à ce jour, et les risques encourus devraient limiter les praticiens à les recommander à une population de patients sélectionnés.
