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Clinical Features in Children With Kawasaki Disease Shock Syndrome: A Systematic Review and Meta-Analysis
Zheng Z, Huang Y, Wang Z, Tang J, Chen X, Li Y, Li M, Zang C, Wang Y, Wang L, et al
Frontiers in cardiovascular medicine. 2021;8:736352
Abstract
Objective: This study aimed to identify the clinical features of Kawasaki disease shock syndrome (KDSS) in children. Methods: The case-control studies of KDSS and KD children up until April 30, 2021 were searched in multiple databases. The qualified research were retrieved by manually reviewing the references. Review Manager 5.3 software was used for statistical analysis. Results: The results showed that there was no significant difference in the incidence of male and female in children with KDSS. Children with KDSS compared with non-shocked KD, there were significant difference in age, duration of fever, white blood cell (WBC) count, percentage of neutrophils (NEUT%), platelet count (PLT), c-reactive protein level (CRP), alanine transaminase concentration (ALT), aspartate transaminase concentration (AST), albumin concentration (ALB), sodium concentration (Na), ejection fraction, and length of hospitalization as well as the incidence of coronary artery dilation, coronary artery aneurysm, left ventricular dysfunction, mitral regurgitation, pericardial effusion, initial diagnosis of KD, intravenous immunoglobulin (IVIG) resistance and receiving second dose of IVIG, vasoactive drugs, hormones, and albumin. In contrast, there was no difference in the hemoglobin concentration, erythrocyte sedimentation rate, and the incidence of conjunctival injection, oropharyngeal change, polymorphous rash, extremity change, and incomplete KD. Conclusion: Current evidence suggested that the children with KDSS had more severe indicators of inflammation and more cardiac abnormalities. These patients were resistant to immunoglobulin treatment and required extra anti-inflammatory treatment. Systematic Review Registration: PROSPERO registration number CRD42021241207.
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2.
Risk Factors of Coronary Artery Abnormality in Children With Kawasaki Disease: A Systematic Review and Meta-Analysis
Yan F, Pan B, Sun H, Tian J, Li M
Frontiers in pediatrics. 2019;7:374
Abstract
While coronary artery abnormality (CAA) has been established as the most serious complication of Kawasaki disease (KD), there have been no detailed systematic reviews of the risk factors associated with this condition. We searched six databases and performed a systematic review and meta-analysis. Study-specific odds ratios (ORs) for each factor were pooled using a random effects model. We identified four risk factors for CAA children with KD: gender (OR, 1.75; 95% confidence interval [CI], 1.59-1.92), intravenous immunoglobulin (IVIG) resistance (OR, 3.43; 95% CI, 2.07-5.67), IVIG treatment beyond 10 days of onset of symptoms (OR, 3.65; 95% CI, 2.23-5.97), and increased C-reactive protein levels (OR, 1.02; 95% CI, 1.01-1.02). More number of the five typical symptoms of KD was identified as a protective factor against CAA (OR, 0.47; 95% CI, 0.33-0.66). Pediatric patients with IVIG resistant were more likely to develop CAA within 1 month of the onset of KD than the general population, even in patients with other risk factors for CAA. Thus, there is a potential risk of CAA misdiagnosis if echocardiography is not carried out frequently. In summary, we report four risk factors for CAA and a protective factor against CAA in children with KD. We recommend that pediatricians consider these factors much more closely. With accurate prediction and early preventive treatment in high-risk patients, we can expect a reduction in CAA rates. Further research is now required to investigate the associations between CAA and other factors including the interval between KD onset and IVIG administration, platelet count, and the duration of fever. We also need to confirm whether the frequency of echocardiography within a month of KD onset should be increased in IVIG-resistant patients.
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3.
Therapeutic schemes for refractory ascites of advanced schistosomiasis: a clinical control study Chinese
He HR, Li M, Wei DP, Zhu JJ, Yang JB, Feng XH, Din W, Zhou RB, Lu GZ
Chinese Journal of Schistosomiasis Control. 2012;24((5):):570-2.
Abstract
OBJECTIVE To explore the therapeutic schemes for refractory ascites of advanced schistosomiasis. METHODS The advanced schistosomiasis patients with refractory ascites were randomly divided into 4 groups: a conventional group, high-dose albumin group, high-dose diuretic group, and comprehensive group, and the course of the treatment was 4 weeks. The abdominal circumference, urine volume, and weight changes were observed daily, and B-ultrasound, liver function, and renal function were performed weekly. RESULTS In the total effective rates, recurrence rates and A/G and renal function changes, the high-dose albumin group and comprehensive group were superior to the conventional group and high-dose diuretic group (P < 0.01). The death rate of the comprehensive group was the lowest among the 4 groups. CONCLUSION The therapeutic scheme of the comprehensive group is optimum.
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4.
Significance of changes of T lymphocytes subsets in children with infectious mononucleosis and the effects of different interventions
Chen ZG, Li M, Ji JZ, Chen H, Chen YF, Chen FH
Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi [Chinese Journal of Experimental and Clinical Virology]. 2009;23((2):):118-20.
Abstract
OBJECTIVE To investigate changes of T lymphocytes subsets in children with infectious mononucleosis (IM) and the effects of different interventions. METHODS Forty-eight children with IM were enrolled, 28 cases were assigned to the group treated with intravenous immunoglobulin (IVIG) 400 mg/(kg x d) for 5 continuous days or IVIG 1 g/(kg x d) for 2 continuous days, the remaining 20 cases were treated with ganciclovir (GCV) 5-10 mg/(kg x d) for 5 consecutive days. All these children were given general supportive therapies. Twenty healthy children from healthcare clinic serviced as control group. RESULTS CD4 (%), CD8 (%) and the CD4/CD8 ratio in healthy control group were (34. 12 +/- 3. 53)%, (26. 22 +/- 4. 43)% and (1. 41 +/- 0. 3), in IVIG group were (24. 2 +/- 4. 3)%, (36. 4 +/- 6. 8)% and (0. 72 +/- 0. 12), and in GCV group were (23. 7 +/- 5. 1)%, (37. 3 +/- 7. 8)% and (0. 67 +/- 0. 13), respectively. CD4 (%), CD8 (%) and the ratio CD4/CD8 in the control group were significantly different from those in both groups with IM (P < 0. 05). Compared with pre-treatment levels, the 28 cases treated with IVIG had significant improvement, the CD4 (%) increased, CD8 (%) decreased and the ratio of CD4/CD8 increased after treatment (P < 0. 05). However, 20 cases in GCV treatment group made less changes (P > 0. 05) . Meanwhile, the clinical symptoms and signs in the IVIG group were improved faster than that in the GCV group (P < 0. 05). The rate of remission in IVIG group was 88. 7% vs. 59. 2% of GCV group (P < 0. 05); the hospital days in IVIG group were (9. 2 +/- 4. 3) days vs. (13. 8 +/- 5. 1) days in the GCV (P < 0. 05). CONCLUSION It is indicated that the subsets of T lymphocytes in peripheral blood are obviously abnormal in children with IM caused by EBV infection in acute phase. IVIG can regulate the immunological derangements of T lymphocytes subsets, on which anti-viral therapy alone may have little impact.
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5.
High-dose intravenous immune globulin for stiff-person syndrome
Dalakas MC, Fujii M, Li M, Lutfi B, Kyhos J, McElroy B
New England Journal of Medicine. 2001;345((26):):1870-6.
Abstract
BACKGROUND Stiff-person syndrome is a disabling central nervous system disorder with no satisfactory treatment that is characterized by muscle rigidity, episodic muscle spasms, high titers of antibodies against glutamic acid decarboxylase (GAD65), and a frequent association with autoimmune disorders. Because stiff-person syndrome is most likely immune-mediated, we evaluated the efficacy of intravenous immune globulin. METHODS We assigned 16 patients who had stiff-person syndrome and anti-GAD65 antibodies, in random order, to receive intravenous immune globulin or placebo for three months, followed by a one-month washout period and then by three months of therapy with the alternative agent. Efficacy was judged by improvements in scores on the distribution-of-stiffness index and heightened-sensitivity scale from base line (month 1) to the second and third month of each treatment phase. Direct and carryover effects of treatment were compared in the two groups. RESULTS Among patients who received immune globulin first, stiffness scores decreased significantly (P=0.02) and heightened-sensitivity scores decreased substantially during immune globulin therapy but rebounded during placebo administration. In contrast, the scores in the group that received placebo first remained constant during placebo administration but dropped significantly during immune globulin therapy (P=0.01). When the data were analyzed for a direct and a first-order carryover effect, there was a significant difference in stiffness scores (P=0.01 and P<0.001, respectively) between the immune globulin and placebo groups, and immune globulin therapy had a significant direct treatment effect on sensitivity scores (P=0.03). Eleven patients who received immune globulin became able to walk more easily or without assistance, their frequency of falls decreased, and they were able to perform work-related or household tasks. The duration of the beneficial effects of immune globulin varied from six weeks to one year. Anti-GAD65 antibody titers declined after immune globulin therapy but not after placebo administration. CONCLUSIONS Intravenous immune globulin is a well-tolerated and effective, albeit costly, therapy for patients with stiff-person syndrome and anti-GAD65 antibodies.