The advancement of technology and the increasing digitisation of healthcare systems have opened new opportunities to transform the delivery of child health services. The importance of interoperable electronic health data in enhancing healthcare systems and improving child health care is evident. Interoperability ensures seamless data exchange and communication among healthcare entities, providers, institutions, household and systems. Using standardised data formats, coding systems, and terminologies is crucial in achieving interoperability and overcoming the barriers of different systems, formats, and locations. Paediatricians and other child health stakeholders can effectively address data structure, coding, and terminology inconsistencies by promoting interoperability and improving data quality and accuracy of children and youth, according to guidelines of the World Health Organisation. Thus, ensure comprehensive health assessments and screenings for children, including timely follow-up and communication of results. And implement effective vaccination schedules and strategies, ensuring timely administration of vaccines and prompt response to any concerns or adverse events. Developmental milestones can be continuously monitored. This can improve care coordination, enhance decision-making, and optimise health outcomes for children. In conclusion, using interoperable electronic child health data holds great promise in advancing international child healthcare systems and enhancing the child's care and well-being. By promoting standardised data exchange, interoperability enables timely health assessments, accurate vaccination schedules, continuous monitoring of developmental milestones, coordination of care, and collaboration among child healthcare professionals and the individual or their caregiver. Embracing interoperability is essential for creating a person-centric and data-driven healthcare ecosystem where the potential of digitalisation and innovation can be fully realized.
Viral infections induce exosomes containing viral material and inflammatory factors. During respiratory tract infection, exosomes can easily cross the blood-brain barrier and transmit the inflammatory signal to the brain; however, such a hypothesis has no experimental evidence. The study investigated whether exosomes from virus mimetic poly (I:C)-primed airway cells enter the brain and interact with brain immune cells microglia. Airway cells were isolated from Wistar rats and BALB/c mice; microglial cell cultures - from Wistar rats. Exosomes from poly (I:C)-stimulated airway cell culture medium were isolated by precipitation, visualised by transmission electron microscopy, and evaluated by nanoparticle analyser; exosomal markers CD81 and CD9 were determined by ELISA. For in vitro and in vivo tracking, exosomes were loaded with Alexa Fluor 555-labelled RNA. Intracellular reactive oxygen species (ROS) were evaluated by DCFDA fluo-rescence and mitochondrial superoxide - by MitoSOX. The exosomes from poly (I:C)-primed airway cells entered the brain within an hour after intranasal introduction, were internalised by microglia, and induced intracellular and intramitochondrial ROS production. There was no ROS increase in microglial cells was after treatment with exosomes from airway cells untreated with poly (I:C). The data indicate that virus-primed airway cell exosomes might enter the brain and induce the activation of microglial cells.
Left atrium (LA) is an important biomarker of adverse cardiovascular outcomes and cerebrovascular events. This study aimed to evaluate LA myocardial deformation using cardiac magnetic resonance feature tracking (CMR-FT) in patients with acute ST-segment elevation myocardial infarction (STEMI) and secondary mitral regurgitation (MR). Additionally, to assess interobserver and intraobserver variability of the technique.Twenty patients with STEMI underwent CMR with a 1.5Tesla MRI scanner. According to the presence of MR patients were divided into two groups: MR(+) and MR(-). Total LA strain (ɛs), passive LA strain (ɛe), and active LA strain (ɛa) were obtained. Additionally, total, passive and active strain rates (SRs, SRe, and SRa) were calculated. To assess interobserver agreement data analysis was performed by second independent observer.LA volumetric and functional parameters were similar in both groups. All LA strain values were significantly higher in patients with MR: ɛs (27.67±10.25 for MR(-) vs. 32.80±6.95 for MR(+); P=0.01), ɛe (15.29±7.30 for MR(-) vs. 19.22±6.04 for MR(+); P=0.01) and ɛa (12.38±4.23 for MR(-) vs. 14.44±5.19 for MR(+); P=0.03). Only SRe significantly increased in patients with MR (-0.57±0.24 for MR(-) vs. -0.70±0.20 for MR(+); P=0.01). All LA deformation parameters demonstrated high interobserver and intraobserver agreement.Conventional volumetric and functional LA parameters do not detect early changes in LA performance in patients with STEMI and secondary MR. In contrast, LA reservoir, passive and active strain are significantly higher in patients with MR. Only peak early negative strain rate substantially increases during secondary MR. LA deformation parameters derived from conventional cine images using CMR-FT technique are highly reproducible.
Pain affects every fifth adult worldwide and is a significant health problem. From a physiological perspective, pain is a protective reaction that restricts physical functions and causes responses in physiological systems. These responses are accessible for evaluation via recorded biosignals and can be favorably used as feedback in active pain therapy via auricular vagus nerve stimulation (aVNS). The aim of this study is to assess the significance of diverse parameters of biosignals with respect to their deflection from cold stressor to deep breathing and their suitability for use as biofeedback in aVNS stimulator. Seventy-eight volunteers participated in two cold pressors and one deep breathing test. Three targeted physiological parameters ( RR interval of electrocardiogram, cardiac deflection magnitude Z AC of ear impedance signal, and cardiac deflection magnitude PPG AC of finger photoplethysmogram) and two reference parameters (systolic and diastolic blood pressures BP S and BP D ) were derived and monitored. The results show that the cold water decreases the medians of targeted parameters (by 5.6, 9.3%, and 8.0% of RR , Z AC , and PPG AC , respectively) and increases the medians of reference parameters (by 7.1% and 6.1% of BP S and BP D , respectively), with opposite changes in deep breathing. Increasing pain level from relatively mild to moderate/strong with cold stressor varies the medians of targeted and reference parameters in the range from 0.5% to 6.0% (e.g., 2.9% for RR , Z AC and 6.0% for BP D ). The physiological footprints of painful cold stressor and relaxing deep breathing were shown for auricular and non-auricular biosignals. The investigated targeted parameters can be used as biofeedback to close the loop in aVNS to personalize the pain therapy and increase its compliance.
Vaikų žaizdos – viena dažniausių pacientų kreipimosi į skubiosios pagalbos skyrių priežasčių. Šio tyrimo tikslas – įvertinti pediatrinių pacientų ir jų tėvų emocinę būklę (baimę, nerimą), taikant skirtingus žaizdos tvarkymo būdus bei vaikų patiriamą skausmą skirtingų procedūrų metu. Iš viso išanalizuota 101 anketa. Vidutinis vaikų amžius 6,81 [3,67- 9,58] metai. Ištirta, jog vyresniems vaikams dažniau taikytas siuvimas, jaunesniems – klijavimas klijais ir Steri-strip procedūros. Vaikų baimė ir nerimas prieš siuvimo procedūrą buvo didesnis, lyginant su klijavimo ir Steri-strip procedūromis. Po visų procedūrų emocinė būklė pagerėjo, tačiau po siuvimo ji išliko blogesnė, palyginus su klijavimu. Tėvų emocinė būklė pagerėjo tik po klijavimo klijais ir Steri-strip procedūrų. Mažiausias vaiko patiriamas skausmas Steri-strip procedūros metu. Gautos išvados, kad neinvaziniai žaizdos tvarkymo metodai, t.y. klijavimas Steri-strip ir klijais, sukelia mažiau nerimo ir baimės vaikų tėvams bei patiems vaikams. Klijavimas Steri-strip pleistrais yra mažiausiai skausminga procedūra vaikams, todėl reikėtų apgalvoti šių metodų taikymą, kai žaizdos dydis, vieta ar kitos susijusios ypatybės leidžia tai atlikti.
Off-label treatment is often seen in pediatrics, especially in pediatric intensive care and neonatal departments. It is linked to a broad range of factors, including restriction of pharmacological studies for ethical reasons, different pharmacokinetic and pharmacodynamic properties of medicines due to age and physiological differences in children, and the difficulty of manufacturing and dosage determination. These gaps increase the likelihood of adverse reactions. Various measures are being taken to avoid unnecessary risks to children without depriving them of potentially effective pharmacotherapy. This study aimed to analyse the studies reported in literature on the relationship between off-label prescribing, the latest recommendations, and the impact of this treatment on the pediatric population. The literature shows that off-label are often prescribed due to children’s younger age, respiratory or rare diseases. Relevant groups of commonly misused medicines are as follows anti-infectives, respiratory medicines or treatment for neurological conditions. It has been observed that the most common off-label prescriptions are related to inappropriate dosage, patient age or indications for use. To deal with the problem, researchers are encouraging the research community to find new, scientifically supported and effective treatments by increasing the sharing of high-quality research and data. This is to achieve trustworthy, evidence-based medical care and to protect children from ineffective or even harmful treatments. For off-label treatment, the European Academy of Paediatrics and the European Society of Perinatal and Paediatric Pharmacology have issued new guidelines to ensure the safest possible care for children.
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