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ABSTRACT: This case describes evidence for a Shiga toxin-producing Escherichia coli (STEC) O146:H28 infection leading to hemolytic uremic syndrome in a neonate. STEC O146:H28 was linked hitherto with asymptomatic carriage in humans. Based on strain characteristics and genotyping data, the mother is a healthy carrier who transmitted the STEC during delivery. STEC strains belonging to the low-pathogenic STEC group must also be considered in the workup of neonatal hemolytic uremic syndrome.
Clinical Infectious Diseases 10/2012; · 9.15 Impact Factor
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ABSTRACT: Dehydration is the most important complication of acute gastroenteritis and a major reason for hospital admission. The 'gold standard' for the assessment of the severity of dehydration is the percentage loss in body weight, which, unfortunately, is rarely available. Several clinical scores have been validated to assess the degree of dehydration accurately. © 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.
Acta Paediatrica 07/2012; 101(10):e479-81. · 2.07 Impact Factor
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ABSTRACT: The objective was to analyze the outcome following prenatal exposure to angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor antagonists (ARBs). For this purpose, a systematic review of published case reports and case series dealing with intrauterine exposure to ACE-Is or to ARBs using Medline as the source of data was performed. The publications retained for analysis included patients who were described individually, revealing, at minimum, the gestational age, substance used, period of medication intake, and the outcome. In total, 72 reports were included; 37 articles (118 well-documented cases) described the prenatal exposure to ACE-Is; and 35 articles (68 cases) described the prenatal exposure to ARBs. Overall, 52% of the newborns exposed to ACE-Is and 13% of the newborns exposed to ARBs did not exhibit any complications (P<0.0001). Neonatal complications were more frequent following exposure to ARBs and included renal failure, oligohydramnios, death, arterial hypotension, intrauterine growth retardation, respiratory distress syndrome, pulmonary hypoplasia, hypocalvaria, limb defects, persistent patent ductus arteriosus, or cerebral complications. The long-term outcome is described as positive in only 50% of the exposed children. Fetopathy caused by exposure to ACE-Is or ARBs has relevant neonatal and long-term complications. The outcome is poorer following exposure to ARBs. We propose the term "fetal renin-angiotensin system blockade syndrome" to describe the related clinical findings. Thirty years after the first description of ACE-I fetopathy, relevant complications are, at present, regularly described, indicating that the awareness of the deleterious effect of prenatal exposure to drugs inhibiting the renin-angiotensin system should be improved.
Hypertension 07/2012; 60(2):444-50. · 6.21 Impact Factor
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ABSTRACT: Symptomatic management is often all that is recommended in children with fever. To date, only 2 nationwide surveys of pediatricians regarding their attitudes toward fever have been published.
The aim of this study was to describe the management of children with fever by pediatricians in Switzerland.
For this survey, an initial close-ended questionnaire was tested and subsequently corrected. Between June 2010 and March 2011, an invitation was sent via electronic mail containing a link to the final version of the questionnaire. The survey was not commercially sponsored.
The questionnaire was sent to 900 pediatricians, of whom 322 (36%) responded. A total of 96% of respondents identified ≥38.5°C as the rectal temperature threshold for fever treatment, and 64% indicated that they prescribe antipyretics for the treatment of general discomfort. A total of 95% of respondents indicated that they prescribe paracetamol (acetaminophen) as the first choice of antipyretic drug, and 91% indicated that they often prescribe ibuprofen as well. An alternating regimen of 2 drugs and physical antipyresis were indicated as common practice by 77% and 65% of pediatricians, respectively. Homeopathic remedies are rarely prescribed (<10% of respondents). The most commonly prescribed routes of administration in children aged 18 months, 5 years, and 10 years were rectal (78%), oral (87%), and oral (99%), respectively. Ninety-two percent of respondents indicated that they believe that an exaggerated fear of fever is common among parents, but 81% stated that they do not lower the temperature threshold for initiating pharmacologic treatment exclusively to calm parents. Most respondents (95%) indicated a belief that it is possible to educate families about the fear of fever.
Based on the findings from the present survey, antipyretics are often prescribed to treat the general discomfort that accompanies fever. Nonetheless, a gap exists between available evidence and clinical practice. Guidelines should take this fact into account.
Clinical Therapeutics 01/2012; 34(1):250-6. · 2.32 Impact Factor
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ABSTRACT: Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy associated with defective regulation of the alternative complement pathway. The prognosis for patients with aHUS is poor, and plasma exchange represents the first-line therapy. Eculizumab is a humanized monoclonal anti-C5 antibody that prevents the activation of the terminal complement pathway. Here, we report the case of a 9-year-old girl with frequent relapsing aHUS due to heterozygous factor H mutation who was initially treated with plasma exchange three times per week with 150% plasma exchange volume. This treatment frequently caused allergic reactions and school absences. Because any reduction in the frequency of plasma exchange immediately induced relapses of the aHUS, treatment with eculizumab, 600 mg every 2 weeks, was started and plasma exchange completely stopped. On this drug regimen the patient showed no evidence of disease activity during a period of more than 24 months. Renal function improved, proteinuria disappeared, the number of antihypertensive medications could be decreased, and the quality of life increased substantially. The inhibition of the terminal complement pathway by eculizumab was also confirmed by renal biopsy, which showed the absence of thrombotic microangiopathy 2 months after the initiation of eculizumab therapy. This case illustrates the long-term favorable outcome of aHUS with eculizumab treatment.
Pediatric Nephrology 08/2011; 26(11):2085-8. · 2.52 Impact Factor
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Pediatric Nephrology 07/2011; 26(7):1177-8; author reply 1179. · 2.52 Impact Factor
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Kinderkrankenschwester: Organ der Sektion Kinderkrankenpflege / Deutsche Gesellschaft fur Sozialpadiatrie und Deutsche Gesellschaft fur Kinderheilkunde 06/2011; 30(6):242-6.
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Acta Paediatrica 05/2011; 100(5):775-7. · 2.07 Impact Factor
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ABSTRACT: Auger electron-emitting radionuclides have potential for the therapy of small-size cancers because of their high level of cytotoxicity, low-energy, high linear energy transfer, and short-range biologic effectiveness. Biologic effects are critically dependent on the subcellular (and even subnuclear) localization of these radionuclides. Our goals were the design, synthesis, and in vitro preclinical assessment of new trifunctional conjugates of somatostatin that should aim at the nucleus and, therefore, ensure a longer retention time in the cell, a close approximation to the DNA, and the success of Auger electron emitters in targeted radionuclide therapy as well as also improve other targeted therapy strategies.
Three trifunctional derivatives of [(1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid)0,Tyr3]octreotide (DOTA-TOC) bearing the nuclear localization signal (NLS) (of simian virus 40 large-T antigen) PKKKRKV in 3 different positions relative to the somatostatin analog sequence were synthesized using solid and solution phase peptide synthesis. These compounds together with DOTA-TOC and DOTA-NLS derivatives were labeled with 111In and tested for binding affinity, internalization, externalization, and nuclei localization on AR4-2J cells and on human embryonic cells stably transfected with sst2A.
The two N-terminal derivatives preserved the sstr2A binding affinity. Their rate of internalization in all tested sstr-expressing cell lines was always superior for the trifunctional derivatives in comparison with the parent compound. A 6-fold increase in cellular retention from the total internalized activity and a 45-fold higher accumulation in the cell nuclei were found for one of the N-terminally modified compounds compared with [111In]-DOTA-TOC. The C-terminal conjugate was inferior in all tests compared with the parent compound.
These encouraging results support our hypothesis that an additional NLS sequence to the DOTA-TOC could not only provide a better carrier for Auger electron-emitting radionuclides but also ensure a longer radioactivity retention time in the tumor cell.
Journal of Nuclear Medicine 01/2006; 46(12):2097-103. · 6.38 Impact Factor
