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#46
24.07.2006, 15:46
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Ïîïðîáóþ, íî î-î-î÷åíü íåóâåðåíà.
1).Íàøëà â ëèòåðàòóðå, ÷òî ãàíöèêëîâèð ïîêàçàí ïðè öèòîìåãàëîâèðóñíîé èíôåêöèè, èììóíîäåôèöèòàõ, ÿòðîãåííîé èììóíîñóïðåññèè ïîñëå òðàíñïëàíòàöèè îðãàíîâ è õèìèîòåðàïèè. Õîòÿ, êîíå÷íî, äëèòåëüíûé ïðèåì êîðòèêîñòåðîèäîâ òîæå èììóíîñóïðåññèÿ, íî âñå-òàêè ãàíöèêëîâèð îòïàäàåò. Ìîé âûáîð - àöèêëîâèð Ð.Î., ïîñêîëüêó - ïîêàçàíèÿ ê àöèêëîâèðó - âåòðÿíàÿ îñïà, ãåðïåñ; - íå ñêàçàíî, ÷òî ðåáåíîê â òÿæåëîì ñîñòîÿíèè , ÷òî ó íåãî ïîðàæåíèå ñëèçèñòûõ ðîòîâîé ïîëîñòè. À â/â ïóòü ââåäåíèÿ îñîáûõ ïðåèìóùåñòâ â äàííîé ñèòóàöèè íå èìååò. 2). Íàâåðíîå, èììóíîãëîáóëèí. Ïðèâèâêó äåëàòü óæå áåññìûñëåííî. Ïðåäïîëàãàþ, ÷òî ó íîâîðîæäåííîãî íåò èììóíîäåôèöèòà, êîòîðûé ñïðîâîöèðóåò òÿæåëîå ãåíåðàëèçîâàííîå ïîðàæåíèå. À èììóíîãëîáóëèí ìîæåò ïðåäîòâðàòèòü êàê ðàç-òàêè ãåíåðàëèçàöèþ ïðîöåññà. Íàäåþñü, íå î÷åíü ãëóïûå ðàññóæäåíèÿ. 
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#47
24.07.2006, 17:01
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Âåòðÿíêà ó íîâîðîæäåííîãî - æèçíåóãðîæàþøåå ñîñòîÿíèå. Íàâåðíîå, àöèêëîâèð IV.
Ðåáåíîê , ïîëó÷àþøèé ïðåäíèçîí - â ãðóïïå ðèñêà ïî ðàçâèòèþ îñëîæíåíèé. Àöèêëîâèð, ñêîðåå âñåãî, íóæåí. Íàâåðíîå, PO. Èììóíîãëîáóëèí, ïî-ìîåìó, äàåòñÿ íîâîðîæäåííûì è èèììóíîêîìïðîìåíòèðîâàííûì äåòÿì, åñëè îíè èìåëè êîíòàêò ñ âåòðÿíêîé, à íå áîëüíû åþ. Ìîãó îøèáàòüñÿ. P.S. Specific Measures Although acyclovir is more active against herpes simplex, it is the preferred drug for varicella and herpes zoster infections. Recommended parenteral acyclovir dosage for severe disease is 10 mg/kg (500 mg/m2) intravenously every 8 hours, each dose infused over 1 hour. Parenteral therapy should be started early in immunosuppressed patients or high-risk infected neonates. VZIG is of no value for established disease. The effect of oral acyclovir (80 mg/kg/d, divided in four doses) on varicella in immunocompetent children was modestly beneficial and nontoxic, but only when administered within 24 hours after the onset of varicella. Oral acyclovir should be used selectively in immunocompetent children (eg, when intercurrent illness is present; possibly when second attacks occur in the household or when the patient is an adolescent—both of which are associated with more severe disease) and in children with underlying chronic illnesses. Valacyclovir and famciclovir are superior antiviral agents because of better absorption; acyclovir is available as a pediatric suspension. Herpes zoster in an immunocompromised child should be treated with intravenous acyclovir when it is severe. Oral valacyclovir or famciclovir can be used in immunocompromised children when the nature of the illness and the immune status support this decision. Current Pediatric Diagnosis & Treatment 17th Edition Willam W. Hay, Jr., Myron J. Levin, Judith M. Sondheimer, and Robin R. Deterding
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#48
24.07.2006, 18:25
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Ðîæäåíèå ðåáåíêà ó ìàòåðè, ïåðåíåñøåé âåòðÿíêó çà íåäåëþ äî èëè ÷åðåç íåäåëþ ïîñëå ðîäîâ, ïðèâîäèò ê ðàçâèòèþ âåòðÿíêè ó ðåáåíêà, êîòîðàÿ ìîæåò ïðîòåêàòü î÷åíü òÿæåëî. èíèöèèðîâàííàÿ èíôåêöèÿ ïðîõîäèò â/ó, õîòÿ êëèíè÷åñêè ïðîÿâëÿåòñÿ ÷àùå ïîñëå ðîæäåíèÿ. Åñëè èíòåðâàë ìåæäó ðîäàìè è âåòðÿíêîé ó ðåáåíêà áîëüøå íåäåëè, ýòî îçíà÷àåò, ÷òî ó ðåáåíêà åñòü òðàíñïëàöåíòàðíûå ìàòåðèíñêèå à/ò. Åñëè ïðîøëî ìåíüøå íåäåëè, òî ýòèõ àíòèòåë íåò, è ðèñê ëåòàëüíîãî èñõîäà íàìíîãî âûøå.
Åñëè ìàòü çàáîëåëà âåòðÿíêîé çà ïÿòü äíåé äî èëè ÷åðåç äâà äíÿ ïîñëå ðîäîâ, òî ðåáåíêó ââîäèòñÿ VZIG â/ì. Íåäîíîøåííûì ââîäèòñÿ, äàæå åñëè ìàòü çàáîëåëà ÷åðåç íåäåëþ ïîñëå ðîäîâ. Bâåäåíèå VZIG íå âñåãäà ïðåäîòâðàùàåò ðàçâèòèå çàáîëåâàíèÿ, íî ïðåäîòâðàùàåò ðàçâèòèå ëåòàëüíûõ è òÿæåëûõ ôîðì. Ïîñêîëüêó âåòðÿíêà ìîæåò áûòü æèçíåóãðîæàþùåé, ìëàäåíöàì ââîäèòñÿ è àöèêëîâèð â/â. Âåòðÿíêà ëå÷èòñÿ òîëüêî àöèêëîâèðîì. Àöèêëîâèð Ð.Î. 20 ìã íà êã õ 4 ðàçà íà 5 äíåé ðåêîìåíäóåòñÿ íåáåðåìåííûì ñòàðøå 13 ëåò, à òàêæå äåòÿì äî ãîäà, äåòÿì ñòàðøå ãîäà, ñòðàäàþùèì õð. êîæíûìè èëè ëåãî÷íûìè çàáîëåâàíèÿìè, ïîëó÷àþùèìè ãîðìîíàëüíóþ (short term, interrmitent, aerosolized) òåðàïèþ èëè ñàëèöèëàòû. Â/ íàçíà÷àåòñÿ â ñëó÷àå òÿæåëîãî çàáîëåâàíèÿ èëè ó èìóíîêîìïðîìåòèðîâàííûõ ïàöèåíòîâ. Èíôîðìàöèÿ âçÿòà èç Íåëüñîíà è Pediatrics 2006.
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#49
24.07.2006, 18:33
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Öèòàòà:
Öèòàòà:
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#51
24.07.2006, 18:43
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Varicella-Zoster Immune Globulin, VZIG
Indications: The following information represents a summary of the CDC guidelines for individuals in whom the use of VZIG is indicated (patients should meet all 4 criteria).[909] •Susceptible to varicella-zoster infection (i.e., not immune). •Significant exposure occurred 96 hours or less prior to VZIG administration; significant exposure to patients with varicella or herpes zoster defined as one of the following: a) Household contact; b) Playmate contact (face-to-face indoor play for >= 1 hour); c) Hospital contact (in same 2—4 bed room, adjacent beds in a large ward, face-to-face contact with an infectious staff member or patient, visit by an individual deemed infectious); d) Transplacental contact (neonates born to women who develop varicella infection within 5 days before or 48 hours after delivery, regardless of whether the mother previously received VZIG). •Younger than 13 years of age (administration to immunocompromised adults and adolescents greater than 13 years of age, older patients, or pregnant women on an individual basis). •The presence of one of the following underlying illnesses or conditions: leukemia, lymphoma, or bone marrow transplantation; congenital or acquired immunodeficiency, including HIV; drug or radiation induced immunosuppression; neonates as defined under significant exposure; premature neonates of < 28 weeks gestation or with a birthweight of <= 1 kg regardless of maternal history of prior varicella infection For varicella prophylaxis of individuals with no history of chickenpox or shingles who meet the criteria for prophylaxis after significant exposure to varicella: NOTE: Dosages below are for single-exposures to varicella-zoster. Postexposure prophylaxis with VZIG should be repeated in individuals who do not develop varicella infection and who are exposed again to varicella virus more than 3 weeks after the administration of the initial dose. Unless evidence of adequate immunity or varicella infection exists, VZIG doses should continue to be repeated at 3-week intervals in patients who continue to have repeated varicella exposure until the risk of exposure is no longer present. NOTE: The VariZIG™ dosing recommendation for infants who weigh less than 5 kg by the Advisory Committee on Immunization Practices (ACIP) is different from the recommendation approved by the FDA. The FDA currently recommends the use of a full 125-unit vial in infants weighing 5—10 kg and use of a half vial (62.5 units, 0.6 ml) for those weighing less than 5 kg. In contrast, an ACIP-recommended amendment to the FDA protocol that was submitted for approval recommends the use of a 125 unit dose for all patients weighing less than 10 kg. Of note, the volume of 1 vial of VariZIG™ is the same as VZIG, and the excipients of 1 full vial are within the amounts accepted for this weight.[8850] Intramuscular dosage: Adults and adolescents: 125 units/10 kg (up to a maximum of 625 units) IM. Administer as soon as possible within 96 hours after exposure, ideally within 48 hours. Do not give fractional dosages (i.e., less than or a portion of 125 units) of VZIG vials; round up dosage to the closest full vial amount and administer that vials full contents. Children and infants: The CDC recommends 125 units/10 kg of body weight IM, rounded to the nearest 125 units according to the following schedule based on body weight. Maximum dosage should not exceed 625 units. Administer the VZIG dose as soon as possible within 96 hours after exposure, ideally within 48 hours.[909] Do not give fractional dosages (i.e., less than or a portion of 125 units) of VZIG vials; round up dosage to the closest full vial amount and administer that vials full contents. Neonates <= 10 kg: The CDC recommends 125 units IM as soon as possible within 96 hours after exposure, ideally within 48 hours.[909] Premature Neonates of < 28 weeks gestation or who weigh <= 1 kg: The CDC recommends 125 units IM preferably within 96 hours of delivery, regardless of maternal history.[909] Maximum Dosage Limits: •Adults: 625 units/dose IM. •Elderly: 625 units/dose IM. •Adolescents: 625 units/dose IM. •Children: 125 units/10 kg/dose IM, not to exceed 625 units/dose IM. •Infants: 125 units/10 kg/dose IM, not to exceed 625 units/dose IM. •Neonates <= 10 kg: 125 units/dose IM. Patients with hepatic impairment: No dosage adjustments are needed. Patients with renal impairment: No dosage adjustments are needed.
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#52
24.07.2006, 18:45
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Êîãäà ïîòîâàÿ ïðîáà áóäåò îòðèöàòåëüíîé?
1.Ýêòîäåðìàëüíàÿ äèñïëàçèÿ. 2.Íàêîïëåíèå ãëèêîãåíà (Glycogen storage disease) 1 òèïà. 3.Ãèïîòèðåîèäèçì. 4.Ìëàäåíåö ñ CF ïîíèæåííîãî ïèòàíèÿ è ñ îòåêàìè.
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#53
24.07.2006, 18:54
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Öèòàòà:
Öèòàòà:
È åùå èíôîðìàöèÿ. Åñòü òàêîå "ïðàâèëî" 5 è 2. Âåòðÿíêà ó ìàòåðè çà 5 äíåé äî ðîäîâ è ÷åðåç 2 äíÿ ïîñëå ðîäîâ - ìëàäåíöó ââîäèòñÿ VZIG.
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#55
24.07.2006, 19:04
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Öèòàòà:
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#56
24.07.2006, 19:08
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Öèòàòà:
Åãî ìàìà ìîæåò è íå áîëåëà âîâñå. 
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#57
24.07.2006, 19:13
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Ïðè ýêòîäåðìàëüíîé äèñïëàçèè, ãèïîòèðåîçå, ïîòîâàÿ ïðîáà ÷àùå ïîëîæèòåëüíàÿ.
Ïðè ãëèêîãåíîçå II òèïà - òîæå. Âîò ÷òî êàñàåòñÿ I òèïà, äàííûõ ïî ïîòîâîé ïðîáå íå íàøëà.  À ÷òî òàêîå Öèòàòà:
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#58
24.07.2006, 19:14
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Ýýýý, ïîêà îêíî â òðåå âèñåëî, çàäà÷à êóäà-òî ïðîïàëà...
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#59
24.07.2006, 19:16
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#60
24.07.2006, 19:18
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Öèòàòà:
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Ëèíåéíûé âèä
