Paediatric respiratory reviews
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Paediatr Respir Rev · Mar 2010
ReviewCardiac manifestations of neuromuscular disorders in children.
Cardiac abnormalities occur in association with many of the neuromuscular disorders that present in childhood. Genetic defects involving the cytoskeleton, nuclear membrane, and mitochondrial function have all been described in patients with skeletal myopathy and cardiac involvement. The most common classes of neuromuscular disorders with cardiac manifestations are the muscular dystrophies- Duchenne, Becker, limb-girdle and Emery Dreifuss. ⋯ The most common cardiac findings include dilated or hypertrophic cardiomyopathy, atrioventricular conduction defects, atrial fibrillation and ventricular arrhythmias. Screening for cardiac involvement should be performed in all children with neuromuscular disorders that have the potential for cardiac involvement. This review discusses the cardiac findings associated with specific neuromuscular disorders and outlines the indications for evaluation and treatment.
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Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidoides brasiliensis. The infection is endemic in subtropical areas of Latin America and has a high prevalence in Brazil. The disease is acquired by airborne inhalation of conidia and is frequently observed in adult male rural workers. ⋯ Sulfonamides, ketoconazole, itraconazole, fluconazole and amphotericin B have been successfully used in the treatment of paracoccidioidomycosis. Itraconazole is the treatment of choice, being effective in more than 95% of cases. Co-trimoxazole is still frequently used especially in chronic progressive disease and as maintenance after a course of amphotericin B in severe cases of this mycosis.
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Paediatr Respir Rev · Jun 2009
ReviewRole of ventilation in RSV disease: CPAP, ventilation, HFO, ECMO.
Respiratory syncytial virus (RSV) lower respiratory tract disease may present as bronchiolitis, an obstructive lung disease with hyperinflation, or pneumonitis, a restrictive parenchymal disease with diffuse consolidation, a large intrapulmonary shunt and acute respiratory distress syndrome (ARDS). Although a significant proportion of those admitted to hospital will require some form of respiratory support, there have been few randomised studies to determine which is the most beneficial. ⋯ Current practice regarding ventilator support is largely based on clinical judgment and case reports. Multicentre randomised trials with long-term follow-ups are urgently required.
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Paediatr Respir Rev · Dec 2008
ReviewVentilatory strategies in the neonatal and paediatric intensive care units.
Mechanical ventilation is a common form of support in the modern day intensive care unit (ICU). In order for the clinician better to understand and apply mechanical ventilation, it is important that they understand the physiological principles of ventilation. This review describes these basic concepts; parameters of mechanical ventilation, high frequency ventilation and non-invasive ventilation. An overview of ventilatory strategies for four common diseases seen in paediatric and neonatal ICUs will be discussed.
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Paediatr Respir Rev · Sep 2008
ReviewEarly detection of lung disease in children with cystic fibrosis using lung function.
Measurement of lung function is routine in older children and adults with cystic fibrosis (CF) but not in infants and preschool children. Pulmonary infection, neutrophil-dominated inflammation and clinical exacerbations in young children similar to those seen in older subjects have been identified and highlight the urgent need to evaluate lung function in early life. ⋯ In addition, the majority of studies in young children with CF have not reported longitudinal data and therefore the prognostic potential of existing lung function methods to track disease progression is poorly understood. This review aims to describe recent research findings in infants and preschool children and to outline currently available lung function techniques, issues around their standardization and their relative advantages and disadvantages in young children with CF.