Aim: To measure midregional pro-adrenomedullin (MR-pro-ADM) in critically ill septic patients to determine its prognostic usefulness as compared with other used biomarkers in pediatric intensive care units, C-reactive protein (CRP) and procalcitonin (PCT). Materials & methods: Prospective observational study conducted on 95 patients. Results: Mean levels of MR-pro-ADM were significantly higher when patients needed mechanical ventilation (3.2 ± 4.3 vs 1.6 ± 2.4) and inotropes (4.4 ± 5.2 vs 1.3 ± 1.2). Receiver operating characteristic curves of mortality were higher for MR-pro-ADM (cut-off value of 2.2). This marker showed higher positive predictive prognostic value than PCT and CRP (31 vs 21.6% and 15.8%, respectively). Conclusion: MR-pro-ADM levels are good indicators of disease severity and show better reliability than PCT and CRP for predicting in-hospital mortality.

Procalcitonin

Adrenomedullin

10.2217/bmm.14.77

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The impact of childhood RSV infection on children's and parents' quality of life: a prospective multicenter study in Spain

BMC Infectious Diseases (2021)

Eva Díez-Gandía Carla Gómez-Álvarez Mónica López‐Lacort Cintia Muñoz-Quiles Isabel Úbeda-Sansano

Abstract Background Several immunisation candidates against RSV are in late-stage clinical trials. To evaluate the benefits of a potential vaccination programme, both economic and health benefits will be needed. Health benefits are usually measured in Health-related Quality of Life (HRQoL) loss using standardised questionnaires. However, there are no RSV-specific questionnaires validated for children under 2 years, in whom most RSV episodes occur. Therefore, HRQoL estimates are taken from literature or inadequate tools. We determined HRQoL loss and direct costs due to an RSV episode in children younger than 2 years and their caregivers during a month of follow up, using a new questionnaire administered online. Methods An observational prospective multicentre surveillance study was conducted in children aged younger than two years. Children were recruited from 8 primary care centres and 1 hospital in the Valencia region and Catalonia (Spain). RSV-positive cases were obtained by immunochromatographic test. HRQoL was assessed using a new ad-hoc 38 item-questionnaire developed. Parents of infected children completed 4 questionnaires at four timepoints (day 0, 7, 14 and 30) after diagnosis. Results 117 children were enrolled in the study and 86 (73.5%) were RSV + . Median (interquartile range; IQR) scores were 0.52 (0.42–0.68), 0.65 (0.49–0.79), 0.82 (0.68–0.97) and 0.94 (0.81–1), for days 0, 7, 14 and 30, respectively. Compared to total recovery (Q30), HRQoL loss was 37.5%, 31.5% and 8.9% on days 0, 7 and 14 since diagnosis of the disease. The total median cost per patient (including treatments) was €598.8 (IQR: 359.63–2425.85). Conclusions RSV had almost 40% impact on HRQoL during the first week since onset of symptoms and the median cost per episode and patient was about €600. These results represent a substantial input for health-economic evaluations of future RSV-related interventions such as vaccination.

Interquartile range

Medical microbiology

Tropical Medicine

10.1186/s12879-021-06629-z

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Meningitis pneumocòccica: quins factors pronòstics ens poden ajudar a manejar-la?

Pediatria catalana: butlletí de la Societat Catalana de Pediatria (2012)

Iolanda Jordán Laura Monfort Jessica Ortiz Mònica Balaguer

Fonament. La meningitis pneumococcica (MP) continua representant una fita terapeutica per a la pediatria, ja que sovint comporta sequeles neurologiques (SN) greus, i pot arribar a generar una mortalitat elevada, d'entorn el 4-8%. El coneixement dels factors pronostics de mala evolucio pot ajudar a fer un tractament mes precoc i orientat. Objectiu. Coneixer els factors pronostics de SN mes importants en un infant amb sospita de MP, per poder orientar el tractament inicial i pronostic. Metode. Revisio de la literatura cientifica dels darrers trenta anys mitjancant Pubmed. Resultats. La incidencia de SN pot arribar al 25-30%. Les mes frequents son l'epilepsia, les paresies-paralisis, la sordesa i les alteracions tardanes del desenvolupament. Els factors de mal pronostic mes importants son: la simptomatologia al debut (convulsions persistents, focalitat neurologica, disminucio del sensori), la hipoglucoraquia i l'alteracio de les proves d'imatge. El tractament amb dexametasona es un factor protector. Conclusions. La presencia d'aquests factors de mal pronostic ha d'implicar un tractament precoc i dirigit, i un monitoratge intensiu.

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