کانال علمی و پاسخ به شایعات وشبهات پزشکی

اپیزود بررسی بیمار، شماره‌ی دوم: بررسی بیمار با شکایات متعدد، با هم‌راهی دکتر مهدیه جعفری @emipcast

تهیه شده توسط : کانال مطالعات تخصصی طب کودکان با نظارت دکتر منصور شیخ الاسلام https://t.me/pediatricarticles

Current Therapeutic Options for the Main Monogenic Autoinflammatory Diseases and PFAPA Syndrome: The most extensively studied and better pathogenically defined monogenic autoinflammatory conditions have been familial Mediterranean fever (FMF) , tumor necrosis factor (TNF) receptor–associated periodic fever syndrome (TRAPS), hyperimmunoglobulin D syndrome/mevalonate kinase deficiency (HIDS/MKD), and cryopyrin-associated periodic syndromes (CAPS), which comprise three disorders with the same genetic background, and different phenotypes and outcomes. The CAPS spectrum includes familial cold autoinflammatory syndrome (FCAS), the mildest form; Muckle-Wells syndrome (MWS), the intermediate presentation; and chronic infantile neurological, cutaneous, and articular syndrome (CINCA) or neonatal-onset multisystem inflammatory disorder (NOMID), the most severe disease . Until the late 1990s, traditional drugs, such as colchicine and glucocorticoids, had been used to treat autoinflammatory diseases. The pathogenic and therapeutic revolution started when NLRP3, one of the NOD-like receptors (NLRs) and part of the NLRP3 inflammasome, was discovered as the main actor in the activation of caspase 1 and the subsequent production of active interleukin 1β (IL-1β) . Mutations of genes involved in the inflammasome function or its related pathways were then identified as responsible for most of the monogenic autoinflammatory disorders recognized so far, also known as inflammasomopathies . The discovery of the aberrant production of IL-1β as the final cause of all inflammasomopathies led to the introduction of anti–IL-1 agents and other biologic drugs to the very limited therapeutic armamentarium available for such diseases until then . In addition, the more recent knowledge of other autoinflammatory mechanisms, such as the activation of nuclear factor κB (NF-κB) and type I interferon (IFN) pathways, also provided new therapeutic options, such as anti-TNF and Janu درs kinase (JAK) inhibitors agents, directed to the specific blockade of cytokines and molecules involved in these novel inflammatory mechanisms . Frontiers Front. Immunol., 03 June 2020 تهیه شده توسط : کانال مطالعات تخصصی طب کودکان با نظارت دکتر منصور شیخ الاسلام https://t.me/pediatricarticles

Emphysematous urinary tract infections: عفونت ادراری آمفیزماتو: Emphysematous urinary tract infections (UTIs) are infections of the lower or upper urinary tract associated with gas formation. They may involve the bladder (cystitis), renal pelvis (pyelitis), or kidney (pyelonephritis). Diabetes mellitus is a major risk factor for these infections .  — Emphysematous UTIs are usually due to Escherichia coli or Klebsiella pneumoniae. These two organisms account for 65 to 100 percent of the isolates described in various retrospective reports . Other reported causative organisms include Proteus, Enterococcus, Pseudomonas, Clostridium, and, rarely, Candida spp and Aspergillus . Some infections are polymicrobial. The pathogenesis of emphysematous UTIs is poorly understood. Among patients with diabetes mellitus, elevated tissue glucose levels may provide a more favorable microenvironment for gas-forming microbes. However, bacterial gas production does not fully explain the pathologic and clinical manifestations of emphysematous UTIs . Diabetes mellitus and urinary tract obstruction are the major risk factors for emphysematous UTIs. They occur more commonly in females. Emphysematous pyelonephritis has also been rarely reported in renal transplant recipients . The clinical features of emphysematous pyelonephritis and pyelitis are indistinguishable from those seen in severe, acute pyelonephritis. Most patients complain of fevers, chills, flank or abdominal pain, nausea, and vomiting. The onset of symptoms may be abrupt or evolve slowly over two to three weeks. CT is the preferred imaging modality as it is more sensitive than other modalities and can delineate the extent of gas formation and any obstructing lesions in the urinary tract . CT findings have also been used for prognostic classification of emphysematous pyelonephritis. Air associated with emphysematous UTI can also be detected on plain films of the abdomen, with a reported sensitivity ranging from 50 to 85 percent . #UTI #عفونت_ادراری تهیه شده توسط : کانال مطالعات تخصصی طب کودکان با نظارت دکتر منصور شیخ الاسلام https://t.me/pediatricarticles

The American Thyroid Association recommends that levothyroxine be consistently taken 60 minutes before breakfast or at bedtime, at least three hours after dinner. در زمان ثابتی استفاده شود.

anion gap: آنیون گپ: Using the results of the comprehensive metabolic panel (CMP), the anion gap is the difference between measured cations (positively charged ions like Na+ and K+) and measured anions (negatively charged ions like Cl- and HCO3-). There are three types: serum, plasma, and urine anion gaps. The most common application of the anion gap is classifying cases of metabolic acidosis, states of lower than normal blood pH. Specifically, classifying into either those that do and those that do not have unmeasured anions in the plasma. The human body is electrically neutral; therefore, in reality, does not have a true anion gap. The calculation then finds utility in exposing variations in that balance. However, changes in albumin and bicarbonate concentrations warrant specific attention.  anion gap formula: ([Na+] +[K+]) – ([Cl-] + [HCO3-]) = [UA] – [UC] Anion Gap = UA – UC From this manipulation, a health care practitioner or researcher can see that the 4 to 12 mmol/L range of the anion gap is precisely equal to the difference between the unmeasured anions and cations. نکات قابل توجه: Every 1 g/L decrease in albumin will decrease the anion gap by 0.25 mmol/L. A patient with hypoalbuminemia may present with a normal anion gap when in actuality, they have a high anion gap acidosis. Consider in ICU patients. Another ratio worth adding to your anion gap toolkit is every decrease in 10 g/L albumin = 2.3 mmol/L decrease in the anion gap. Interestingly, paraproteins such as IgG also cause a reduction in anion gap due to their positive charge. Thus, patients with monoclonal proliferation such as those suffering from IgG myeloma have significant increases in cation or positive ion concentration resulting in decreased and rarely increased anion gaps. Likewise, a polyclonal proliferation of IgG would have the same effect, which can present in a patient with HIV. Finally, patients prescribed lithium carbonate for bipolar disorder can have reduced anion gap. At therapeutic doses of 1.0 mmol/L, no change in the anion gap materializes. However, in lithium intoxication, a noticeable reduction is appreciated. Other causes of reduced ion gap include hypoalbuminemia, hypertriglyceridemia, decreased unmeasured anions such as phosphorus, and increased unmeasured cations such as magnesium. increased anion gap metabolic acidosis: Carbon monoxide/cyanide Aminoglycosides Theophylline Methanol Uremia Diabetic ketoacidosis Paracetamol/acetaminophen Iron/isoniazid Lactic acidosis Ethanol/ethylene glycol Salicylate/ASA normal anion gap metabolic acidosis: Ureterostomy Small bowel fistula Extra chloride Diarrhea Carbonic anhydrase inhibitor Adrenal insufficiency Rental tubular acidosis Pancreatic fistula. #anion_gap #acidosis #آنیون_گپ #اسیدوز تهیه شده توسط : کانال مطالعات تخصصی طب کودکان با نظارت دکتر منصور شیخ الاسلام https://t.me/pediatricarticles

#pneumococcal_vaccine #PCV #PPSV23 #واکسن_پنوموکک #واکسن تهیه شده توسط : کانال مطالعات تخصصی طب کودکان با نظارت دکتر منصور شیخ الاسلام https://t.me/pediatricarticles

Chronic hepatitis E: هپاتیت مزمن E:  — Chronic HEV infection is defined empirically as detection of HEV RNA in serum or stool for longer than six months. Chronic HEV almost exclusively occurs in immunosuppressed patients (eg, those with HIV infection, following solid organ or bone marrow transplantation) . Chronic infection is typically with HEV genotype 3 infection, although chronic infection with genotype 4 has been documented in a transplant recipient . Chronic HEV infection with genotypes 1 and 2 have not been reported. As with most chronic viral hepatitis patients, symptoms are minimal and include fatigue and nonspecific findings until progression to decompensated cirrhosis occurs. Patients with chronic HEV have persistently elevated aminotransferase levels, detectable serum HEV RNA, and histologic findings compatible with chronic viral hepatitis. #hepatitis #HEV #هپاتیت تهیه شده توسط : کانال مطالعات تخصصی طب کودکان با نظارت دکتر منصور شیخ الاسلام https://t.me/pediatricarticles

#UTI #عفونت_ادراری تهیه شده توسط : کانال مطالعات تخصصی طب کودکان با نظارت دکتر منصور شیخ الاسلام https://t.me/pediatricarticles

Roseola infantum: Laboratory features of roseola may include: ●Neutropenia and atypical lymphocytosis – Children with roseola may have relative neutropenia and mild atypical lymphocytosis . Early in the febrile period, the white blood cell count may be elevated but reaches its nadir (frequently in the range of 3000 cells/microL) by day 3 to 6 of illness, then gradually returns to normal over the following 7 to 10 days. ●Thrombocytopenia – Children with roseola also may have thrombocytopenia, which is thought to be caused by bone marrow suppression rather than immune-mediated peripheral consumption . ●Sterile pyuria – Children with roseola may have sterile pyuria. In a retrospective study from a single institution, 13 percent of 158 children with roseola had sterile pyuria . During the febrile phase, urinary tract infection (UTI) may be a diagnostic consideration in children with pyuria. UTI is a consideration among infants who present with fever before the onset of the characteristic roseola rash and are found to have pyuria during the evaluation of fever. Urine culture results will ultimately differentiate UTI from roseola in such children. A retrospective study of 158 young children (one month to three years) with roseola and 143 young children with UTI identified presenting clinical and laboratory findings more suggestive of UTI than roseola . Peripheral white blood cell (WBC) count >10,000 cells/microL was the most helpful single finding (occurring in 70 percent of children with UTI and only 4 percent of those with roseola). Additional findings that were more common among children with UTI than roseola included male sex, age <6 months, C-reactive protein >0.5 mg/dL (5 mg/L), and fever of <4 days duration at presentation. Although not examined in the study, a positive nitrite test by dipstick analysis is highly suggestive of UTI. Pending urine culture results, decisions regarding empiric antibiotics are best made on a case-by-case basis based upon the probability of UTI, which is determined by demographic and clinical factors (eg, age, circumcision status, urinary tract anomalies, etc) . To prevent unnecessary use of antibiotics in children in whom both UTI and roseola are being considered, it may be reasonable to withhold antibiotics pending urine culture results among those who are well-appearing, ≥6 months of age, have peripheral WBC count between 5000 and 10,000 cells/microL, and negative nitrites on dipstick analysis. اپتودیت #Roseola #رزئول تهیه شده توسط : کانال مطالعات تخصصی طب کودکان با نظارت دکتر منصور شیخ الاسلام https://t.me/pediatricarticles