#16
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âîò êëèíè÷åñêèå íàõîäêè ó äåòåé ñ ïîðàæåíèåì ðòà ãåðïåñîì -
185 cases were considered as PHGS and were included for analysis. Fever was present in 99.5%. The mean duration of fever was 5.11 days (±2.24) with the longest being 17 days. Common oral manifestations included oral ulcers (84.3%), which equally resided in the anterior and posterior part of the oral cavity (65.4% vs. 63.2%), gum swelling and/or bleeding (67.6%), and exudate coated tonsils (16.8%). Leukocytosis (WBC count > 15,000/uL3) was noted in 52 patients (28.1%) and a serum C-reactive protein level > 40 mg/L in 55 patients (29.7%). Fixty-five patients (35%) were diagnosed with PHGS on admission and were significantly more likely to have ulcers over the anterior oral cavity (76.1% vs. 26.7%) and gum swelling/bleeding (76.2% vs. 7.5%, p-value all < 0.001) on admission and were significantly less likely to receive antibiotic treatment (16.9 vs. 36.7%, p-value < 0.01) than others. --- BMC Infect Dis. 2020 Oct 20;20(1):782. Clinical features of gingivostomatitis due to primary infection of herpes simplex virus in children
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#17
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ëèõîðàäêà â 100% è äî 17 äíåé; ëåéêîöèòîç áîëåå 15 êàê ó âàøåãî ðåáåíêà ó êàæäîãî 3-4 ðåáåíêà; öðá áîëåå 40 ó êàæäîãî òðåòüåãî, åñëè ãåðïåñ áûë îáíàðóæåí ñðàçó, òî ðèñê ïîëó÷åíèÿ íåíóæíûõ ÀÁ ïàäàë äî êàæäîìó 7-ìó âìåñòî êàæäîìó òðåòüåìó
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#18
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Ñåãîäíÿ 15é äåíü áîëåçíè.
Äâà äíÿ íàçàä íî÷üþ ðåáåíîê ïîæàëîâàëñÿ íà øóì â óõå. ß ïîòðîãàëà, ïîñìîòðåëà, ñêàçàëà ÷òî ïðîøëî ê óòðó. Ïîçàâ÷åðà è â÷åðà íà ìîè âîïðîñû ïðî øóì è áîëü îòâå÷àëà, ÷òî âñå íîðìàëüíî. Ñåãîäíÿ íî÷üþ ñòàëà âûòåêàòü æèäêîñòü (æåëòîâàòàÿ ìîæåò áûòü ÷óòü ðîçîâàòàÿ, ò.ê. ìíå ïîêàçàëîñü íà ìàéêå áåëîé ÷òî ïÿòíî áóäòî êðàñíîâàòîå). Óæå ïîëäåíü, æèäêîñòü ïîäòåêàåò ÷àñà 3 óæå êàê ïðîñíóëàñü.  íî÷ü êîãäà ïåðâûé ðàç æàëîáû íà óõî ïîÿâèëèñü è ñåãîäíÿ íî÷üþ, çàêàïûâàëè Íàçèâèí. Îêàçûâàåòñÿ, áûëè îùóùåíèå êàêèå-òî â óõå ýòè äâà äíÿ, íî ðåáåíîê íå ãîâîðèë. Òåìïåðàòóðà, â ñâÿçè ñ áîëåçíüþ, ñåãîäíÿ 15é äåíü, ñåãîäíÿ óòðîì 37,5. Íî÷üþ ÷àñà íà 4 ïîäíèìàëàñü 38.5. Â÷åðà áûëî äî 38.9 äíåì, ñáèâàëà. Ðåáåíîê áûë ïîæèâåå ÷åì äî ýòîãî, è íà÷àë íåìíîãî åñòü. Ãîðëî, êàê ìíå êàæåòñÿ ñòàëî áëåäíåå. Ñòàðûå ÿçâû ïðîøëè. Íî ìíå â÷åðà ïîêàçàëîñü ÷òî ðÿäîì ïîÿâëÿþòñÿ 2 íîâûõ, íî ïîêà íå óâåðåíà. Ðåçóëüòàò ÍÀ ÃÅÐÏÅÑ ïðèøåë, ñäàííûé 2 äíÿ íàçàä, anti-HSV (1 è 2 òèïà) IgM - îòðèöàòåëüíî Ñèäèì ê Ëîðó. 1. Ðàçðûâ áàðàáàííîé ïåðåïîíêè ? Èëè ÷òî-òî äðóãîå? Îñëîæíåíèÿ îò ãåðïàíãèíû (íå ïîäòâåðæäåííîé)? 2. Êàê ëå÷èòü? Àíòèáèîòèê Àìîêñèöèëëèí? Êàêàÿ äîçèðîâêà (âåñ 21.5 êã , ðîñò 130 , âîçðàñò 8 ëåò), ñêîëüêî äíåé? 3. Êàêèå ìåðû è ëåêàðñòâà íåîáõîäèìû? 4. Äîïîëíèòåëüíûå îáñëåäîâàíèÿ? 5. Åñëè ðàçðûâ ïåðåïîíêè, êàïëè â óõî è ñîñóäîñóæèâàþùèå â íîñ íåëüçÿ æå? |
#19
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Ìîæåò ëè ýòî áûòü ìåíèíãèò?
Ñêîëüêî âðåìåíè ìîæåò âûòåêàòü èç óõà æèäêîñòü? Íà ÷òî îáðàùàòü âíèìàíèå? Åù¸, âäðóã ýòî èìååò çíà÷åíèå, ãëàíäû ñî ñòîðîíû áîëüíîãî óõà, ïàðó äíåé óæå áóäòî ðûõëàÿ ñòàëà, áóäòî â íåé ïîÿâèëèñü äûðî÷êè, îòâåðñòèÿ. |
#20
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ËÎÐ ñìîòðåë.Ïåðôîðàöèÿ áàðàáàíîé ïåðåïîíêè -íåðåäêîå ÿâëåíèå ïðè îòèòå(ñàìî÷óñòâèå óëó÷øàåòñÿ îáû÷íî).Àìîêñèöèëèíðåêîìåíäóþò ïðè îòèòå â äîçèðîâêå 75-80 ìã/êã â ñóòêå íå áîëåå 1500 â äåíü, ò.å ðåáåíêó âåñîì 21 êã â äîçå 750 ìã* 2/äåíü èëè 500*3 /äåíü.Êëèíèêó ìåíèíãèòà Âû íå îïèñûâàåòå.
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#21
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Âûøëè îò Ëîðà.
Ïî ãîðëó íè÷åãî íå ñêàçàëà è ïî ïåðâè÷íîìó äèàãíîçó. Ñêàçàëà âûñûïàíèé íå âèäèò, ãîðëî êðàñíîå åùå. Ïî óõó - ãíîéíûé îòèò. Âûïèñàëà: 1. Âèëüïðàôåí 1000ìã. ïî 1/2 òàáë. × 2 ð.  äåíü 7 äíåé 2. 3% ðàñòâîð ïåðåêèñè âîäîðîäà â áîëüíîå óõî êàïàòü îáèëüíî è âàòîé ñêðó÷åííîé ñîáèðàòü èç óõà ïîñëå ïîÿâëåíèÿ ïóçûðåé (èëè äèîêñèäèí , åñëè ÿ ïðàâèëüíî çàïîìíèëà, åñëè åñòü äîìà ñïðàøèâàëà ,ó íàñ íåò) 3. Îòîôà ïî 3 êàï. × 3 ðàçà â äåíü 7 äíåé ,  îáà óõà. Íà ìîé âîïðîñ ÷òî ïðè ðàçðûâå ïåðåïîíêè êàïàòü íåëüçÿ â óõî, îòâåòèëà ÷òî íàîáîðîò áåç êàïåëü ñëóõ ïîòåðÿòü ìîæåò. Íà âîïðîñ , ïî÷åìó íå Àìîêñèöèëèí (1ãî ðÿäà àíòèáèîòèê), ñêàçàëà ÷òî ïî å¸ ïðàêòèêå îí íå äåéñòâóåò. Óâàæàåìûå äîêòîðà , ÷òî æå ìíå äàâàòü ðåáåíêó è êàêèå äîçû? |
#22
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Öèòàòà:
Âûøå îïèñàëà íàçíà÷åíèÿ Ëîðà. Òîëüêî óâèäåëà âàø îòâåò. Ïðîêîììåíòèðóéòå ïîæàëóéñòà å¸ íàçíà÷åíèÿ. ×òî â èòîãå äàâàòü ðåáåíêó? È àíòèáèîòèê è êàïëè åñëè íàäî Îíà ñêàçàëà âî âòîðíèê ê íåé ïîêàçàòüñÿ. |
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#23
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Åù¸ óòî÷íþ, óõî ëîð íå ñìîòðåëà, ñðàçó âàòîé çàòêíóëî, ò.ê. òå÷åò ïîñòîÿííî èç íåãî.
Ñìîòðåëà òîëüêî íîñ è ãîðëî, ñïðàøèâàëà åñòü ëè íàñìîðê. Åñòü êàøåëü èíîãäà âëàæíûé, íîñ ñîâñåì ÷óòîê îòñìàðêèâàåòñÿ, ïî çàäíåé ñòåíêå ñòåêàåò. Ïðè÷èíà îòèòà - ðåáåíîê ïûòàëñÿ ñèëüíî âûñìîðêàòüñÿ? È ïîïàëî â óõî èíôåêöèÿ? Æèäêîñòü èç óõà - ýòî æå 100% ðàçðûâ ïåðåïîíêè? |
#24
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Íà÷àëè ïèòü Âèëüïðàôåí.
1. Ïî êàïëÿì Îòîôà è ïåðåêèñè âîäîðîäà âîïðîñ îòêðûò. 2. Ìîæåò íàäî ÷òî-òî äðóãîå âìåñòî ýòèõ êàïåëü? 3. Ðåáåíîê âûïëþíóë ðàñòâîð Âèëüïðîôåíà, äóìàþ ÷àñòè÷íî. ×òî äåëàòü â òàêèõ ñëó÷àÿõ? ß äàëà íîâóþ äîçó. Íå óâåðåííà, ÷òî òàê ïðàâèëüíî. 4. Ìîæíî ëè ïðèêðûâàòü óõî âàòîé, ò.ê. ïîñòîÿííî òå÷¸ò? Êàê ñïàòü? Íàäî ëè âûáèðàòü ïîëîæåíèå ãîëîâû? |
#25
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åñëè âíóòðü àíòèáèîòèê äàâàòü íå ñìîæåòå, òî ìåñòíûå êàïëè ñ îôëîêñàöèíîì - èíäèéñêèé äàíöèë â Ðîññèè - ëó÷øå ñèñòåìíûõ àíòèáèîòèêîâ
Eleven clinical trials (9 randomized and 2 nonrandomized) enrolling 1,484 adults and children were finally included in the analysis....0.3% ofloxacin otic solution is better than other otic antibiotic drops and other oral antibiotics in terms of overall cure rate and resolution of secondary outcome parameters. ORL J Otorhinolaryngol Relat Spec. 2003 Mar-Apr;65(2):106-16. A systematic review of the effectiveness of ofloxaxin otic solution for the treatment of suppurative otitis media.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#26
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×åðåç ÷àñ ïîñëå àíòèáèîòèêà ðåáåíêà ñèëüíî âûðâàëî.
×òî äåëàòü??? Äàâàòü ëè åù¸ äîçó? Ìîæåò ëè ýòî áûòü íåïåðåíîñèìîñòü? ×òî âöåëîì äåëàòü? |
#27
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Öèòàòà:
Ýòî çíà÷èò ÷òî àíòèáèîòèê íå ïîäõîäèò? |
#28
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ìíå åòî íåèçâåñòíî, èíîãäà ðåáåíêà ðâåò íà âêóñ èëè íàïîëíèòåëè ëåêàðñòâà, âñå ÷òî çíàë - íàïèñàë âûøå, êàê âû ïîñòóïèòå - âàøå ïðàâî;
íå çíàþ, ÷òî âû òàì äà¸òå èç ÀÁ, ìíå êîììåð÷. íàçâàíèÿ â ðô íåâåäîìû, íî âîò ëå÷åíèå îòèòà ó äåòåé àóãìåíòèíîì (àìîêñèêëàâîì) ïðîòèâ êàïåëü: èçëå÷åíèå áûëî â 76%, óäàëåíèå áàêòåðèé â 96 è ïîá. äåéñòâèå ó êàæäîãî 15-ãî; íà àìîêñîêëàâå èçëå÷èâàëîñü 70% è ó êàæäîãî òðåòüåãî - ïîá. äåéñòâèå Overall cure rate for clinically evaluable subjects was 76% with OFLX (n = 140) and 69% with AUG (n = 146; P = 0.169). OFLX had a greater overall pathogen eradication rate (96% vs. 67%; P<0.001). Treatment-related adverse event rates were 31% for AUG and 6% for OFLX (P<0.001).
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#29
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Öèòàòà:
Ìîæíî ïîïðîáûâàòü åù¸ ðàç åãî äàòü ñåé÷àñ? Ïåðåäîçèðîâêè íå áóäåò? ß îïàñàþñü ÷òî ïåðâè÷íàÿ áîëåçíü, åñëè âäðóã ýòî íå ãåðïàíãèíà, íåäîëå÷åííîé îñòàíåòñÿ, ðàç óæ ïðèøëîñü âñ¸-ðàâíî àíòèáèîòèê ïðèìåíÿòü. |
#30
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íåò ýòîãî ïðåïàðàòà ñðåäè ðåêîìåíäóåìûõ ìàêðîëèäîâ äëÿ äåòåé ñ îòèòîì - èëè àçèòðî- èëè êëàðèòðî-, êîãäà àëëåðãèÿ íà ïåíèöèëëèíû; ðâîòà íà ëåêàðñòâî - ãîâîðèò îá îòñóòñòâèè ýôôåêòà è âîçì. ïîá. äåéñòâèè; ïûòàòüñÿ äàâàòü åãî ïîâòîðíî - íàïîìèíàåò îòäàë¸ííî äàâàòü òóìàêè ðåáåíêó, ÷òîáû ó íåãî ïåðåñòàëà áîëåòü ãîëîâà; âû âèäèòå òàáëèöó ïî ññûëêå?
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |