febra in patologia pediatrica.ppt
TRANSCRIPT
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FEBRA IN PATOLOGIA PEDIATRICACONF DR MIHAI CRAIU
CLINICA II PEDIATRIEIOMC ALFRED RUSESCU
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FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
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FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
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DIMENSIUNEA PROBLEMEI
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DEFINITIE
Se defineste ca fiind febra o ascensiune a temperaturii la >38C [rectal]
Valori periculoase [hipertermie] sunt considerate cele >416 C
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Temperatura corporal - valori normaleNu exist consens n ceea ce privete grania dintre temperatura corporal normal i febr
Limita superioar a normalului variaz cu vrsta: - nou nscui 38.0 C - ntre o lun i 2 luni 38.1 C - ntre 2 luni i 3 luni 38.2 C - > 3 luni 37.6 37.8 C
Herzog L, Phillips S. Adressing concerns about fever. Clinical Pediatrics 2011; 50(5):383-390
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FRECVENTAFrecventa febrei este mai mare la copil decat la adult*
3.7 episoade / an la copil [frecventa aproape dubla la cei cu varsta
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Copiii fac deseori febra! [20-40% din parinti raporteaza cel putin un episod de febra pe an]
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FRECVENTAFebra este cea mai frecventa cauza de prezentare a copilului la medic si a doua cauza de spitalizare [dupa bolile respiratorii cu tuse / dispnee] *.
* Feverish illness in children: Assessment and initial management in children younger than 5 years. NICE clinical guidelines 2007.
- FRECVENTAFebra este cauza frecventa de apelare la MF *34% din telefoane MF au vizat intrebari despre copil
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FRECVENTAFebra este cauza frecventa de prezentare in UPU *32% din cele 120.000 prezentari la UPU [Spit Regional Nottingham] au fost la copil20% din prezentati aveau febra, 48% din copiii internati aveau febra
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Febra este un motiv frecvent de prezentare la CPU
Chart3
367
1386
PACIENTII CU FEBRA PREZENTATI LA CPU IOMC [367 PAC din 1753 Prezentati - esantion Ian - Nov 2012]
Sheet1
numevarstasexdomicdgtratGTteste cutanateIgER AdverseComplicatiiEozinofileAHCObs
Anastasiu M39MUTC+RA12.593
Anastasiu M41MUTC+RA12.593poz pt par caineidem 2
Ancu IEFRTC+RA17113
Andronie SG133MUAB+RAFlt/inh36141Pectus escav
Anghel DI36MRWR1394
Anghel IT83MUWR+RA25.5124.5spirofrate WR
Anghel M17MUWR+RAMonteluk9.2frate WRDermatita
Anghel V72MUWR+RA241233890/7103
Angheluta GM66FRWR17.5113
Apostol MA33FUWR1390Spasmul hohot plans
Apostol MA37FUWRMonteluk13.592Spasmul hohot plansidem 11
Ardelean A31FUWRfrate WR
Ardelean I66MUWR+RAsora WR
Asmarandei T14MUWR96
Asmarandei T15MUWR indV96idem 89
Badea A72FUWR18.5116mama astm trat cu ICS+LABAUrticarie
Badea AL60MUWR+RAMonteluk+Mometaz/nas19119spiro
Badea AL66MUWR+RAMonteluk+Mometaz/nas20121spiroCONTROLATOSA
Badea AL64MUAB+RAMonteluk+Flixo/inh+Mometaz/nas20121spiroCONTROLATOSA
Badita TN79MUWR21119687
Balanica T106MRAB27.5133
Banca V31MRTC+wheezing14.595.5
Banica AA59MRWR+RAMonteluk+Flt/nas16.8110spiro/poz acarieni3000EVOL FAVORRA severa
Barsan MI52FUWR+RAMonteluk+Flt/inh HD18104spiroRA severaidem 38Dermat4 exac in 10 luni
Barsan MI53FUWR+RAMonteluk+Flt/inh HD18104spiroidem 17Dermat
Barsan MI54FUWR+RAMonteluk+Flt/inh HD19106spiroRA severaidem 7 - 8dermat
Barsan MI55FUWR+RAMonteluk+Flt/inh19106spiroCONTROLAT - se scade doza Flt/inhRA severaidem 22. 23. 24Dermatita
Barsan MI56FUWR+RAMonteluk+Flt/inh18106spiroCONTROLATRA severaidem 23-26Dermatita
Bicher SM46MUWR+RA17.5
Botea S32MUWRnegNDermatita
Botez LA17MUWRBDP - ventilat mecanic 10 z
Brezeanu TG53MUTC+RA22115spiroNTRAHEOMALACIE1 exacerb in 5 luni
Brezeanu TG56MUTC+RA23116spiroTRAHEOMALACIEidem 28
Brezeanu TG59MUTC+RA22118CONTROLATTRAHEOMALACIEidem 31, 32
Buhnia T106MUABspiro
Buican R9MUWR+RA291%Dermat++
Buican R12MUWR+RAMonteluk291%idem 34Dermat++
Bulai L27MUWR14.593NN
Cadar R63MUWR+RA21.5116232.5O serM AB, T RA+urticarii
Calin MA71FUWR42127.5spirofrate cu RAObezitate
Calman MD63MUAB+RA26.5119.5spiro/poz acarieni+mucegaiRA severa
Cantoneru L50MUWR+RA16106
Caracuda C60FUTC+RA21.3116spiroRA severa
Ceausu IA61FUWR26118spiro10.75.6%[400]SUPRAPOND
Cernica TD56FURA18116
Chebarus AD23MUWR+RAMontelukpoz cazeinaIPLVDermat
Chebarus AD25MUWR+RAMontelukpoz cazeina42.2IPLVidem 43
Chirita S67FRAstm+RA20119.2spiro / pozNev Ota
Cioroianu EB56MUTC+RAMonteluk+Momet/nas20115spiroEVOL BUNA DE 6L
Cioroianu EB58MUWR+RAMonteluk+Mometaz/nas20115spiroNECONTROLAT - TC=WR>3/an[scor CR+]T AB M fumatidem 43
Citea M90MRTC+RAMonteluk23.5124spiro72M fumatoare
Ciucur R134MUAstm+RA
Codrea DM68MUTC+RARA severa
Cojocaru AL124MUWR+RAMonteluk47150spiro/poz acarieni>>RA severa
Coman AR66MRAB+RAMonteluk+Mometaz/nas32.5123spiro
Coman AR70MRAB+RAMonteluk+Xyzal36125spiroCONTROLATSUPRAPONDidem 48Dermat++
Constantin RCMUWR+RA26123
Constantin TA35MUWR+RAMonteluk+Mometaz/naspoz albus ou26.85%
Constantinescu S92FUAstm+RA22.512866511.4% [680]
Constantinescu S95FUAB+RAFlt/inh+Flt/nas23.5130spiroCONTROLATidem 48
Corcodel D40MUAB+RATC - N VienaNO serRA severa
Coricica AM23MUWRMonteluk10.882T SUDORII - 3413.70%repetate scaune cu sange
Cosma IA35FUWR+RAMontelukO ser
Costache MC47FUWr+TC
Costache T48MUWR+RA22122
Costan M36MURA18.5102O serDermat
Craiciu RM19MUWR indVMonteluk12.21 episod BO "dramatic"
Croitoru A27MUWR+RAMonteluk13101.7RA severa
Dane A68MUWR17.5110
Dasu M84MU4327.50%
Dinca BA158MUABICS+LABA [Seretide discus]59167spiroCONTROLAT
Dinu EA48MUWRMonteluk15105strabunica astm, matusa mat alergie polen
Dinu LC43FUTC+RA20.5107RGE
Dirla AO72MUAB+RAFlt/inhspirodepresie monteluk
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie majora Montelukidem 51
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie Majora Montelukidem 51 si 208
Dirla AO77MUAB+RAFlt/inh+Deslor+Mometaz/nasCONTROLATDepresie majora Montelukidem 68, 69, 70
Dobre CL55MUWR+RAMonteluk+Momet/nas14.7100.512115%RA severa
Dobrila V67MUAstm+RA24118RA severa
Dobrila V68MUAB+RAMonteluk+antihistTS 34; ECO C nRA severaidem 21
Dobrila V70MUWR+RAMonteluk+Mometaz/nas24118CONTROLATM RARA severaidem 53, 54
Dogaru CA52MUAB+RA22116poz polenuri
Donose MA51MUTC+RA17.2107.576.3VDC
Draghia AC148FRTC+RA56160spiroDermatita
Dragotoniu AE36FRWR+RAMonteluk1497.510.80%Tata & Mama RARA severaDermat
Dragotoniu AE42FRWR+RAMonteluk14.599CONTROLAT10.80%T si M RARA severaidem 78
Dumitrescu AMUWR+RA24.3120spirovar cu WRADHD?
Dumitrescu A73MUWR+RAMonteluk+Mometaz/nasspiroCONTROLAT
Dumitrescu S37MUAB+RA14.5Dermatita
Dumitriu V50MUWR+RAspiroDermat
Dumitru FC111MUAstm41138.5spiro
Duta RN62MUWR+RAMonteluk+Mometaz/nas+Ketof20114spiro>>10.90%RA severaDermatita
Duta RN66MUWR+RAMonteluk?Mometaz/nas+Ketof20.5116spiro>>CONTROLAT10.90%RA severaidem 84Dermatita ++
Enache DC47MRAstm [Ex]Mometa+Deslor+Monteluk17spiro
Filipoiu AM13FUTC10.9sora WRMACROSOM
Florea C171FUTC58.5151Obezitate
Florea V75MUAstm [Ex]+RA29128
Furdui TA48MUWR/exacerb usoaraMontelukspiro
Geambazzi AA20MRWR [Ex]MontelukPectus escav
Geambazzi AA22MRWR/exacerb usoaraMontelukEVOL >3epis WR/ansora cu WRidem 25Pectus escav
Geambazzi SP47FRWR [Ex]Monteluk
Geambazzi SP51FRWRCONTROLATidem 83
Georgescu AI61FUWR+RAMonteluk20.5115.8spirofrate WR
Georgescu MA66MRWR+RA20.5121poz mucegai18.3Polipi corzi vocale
Georgescu RA72MUWR+RAMonteluk+Flt/nasO ser
Gherghelescu I14FUWRMonteluk
Ghidrigan SC104MUAstm [Ex]+RA29.5132.5374Depresie Majora5%
Ghidrigan SC107MUAstm+RALABA+ICS29.5133spiroDepresie Majora5%
Ghincea MA136FUABspiroVCD, OBEZ
Gorgan M31FUTC+RA22
Gramescu A60FUTC20.5113.5TRAHEOMALACIE
Grecu A42FUTC+RA16.51026.2%[510]
Grigoras C67FUWR IACRS23NEFRECTOMIE PARTIALA
Grigoras C69FUWR23idem 64
Grigorgore M26FUWRDermatita
Grozavu D76MRTC+RA20115
Guzu A29MUWR+RAMontelukRA severa
Guzu A30MUWR+RAMonteluk+Flt/nasEVOL FAVOR RARA severaIDEM 58
Guzu A32MUWR+RAMonteluk+Flt/nasCONTROLATRA severaidem 75,76
Himpa T103MUAB+RAMonteluk+Mometaz/nas40138.5spiroCONTROLATRA severa
Hornoiu B27MUWR+RAMonteluk11.593
Hornoiu B31MUWR+RAMonteluk1496CONTROLATidem 97
Iacob-Ritzi A18MUWR+RAFlt/inh11.2Pectus escav
Iancu MA98FUTC+RA34139spiroHipertrofie adenoamigdaliana - operatie
Iancu MA100FUTC+RA36141spiroPubertate precoceidem 69
Ichim EG78FRTC
Ilia RV102MUWRFlt/inh32136.5
Ilia RV103MUWRFlt/inh33136.5idem 35
Ilia RV104MUWRFlt/inhEVOL FAVOR
Ilia RV105MUWRFlt/inh HDspiro
Ilie CN125MUAstm+RAMonteluk+DeslorRA severa dupa oprirea medic)idem 70
Ilie CN126MUAstm+RAMonteluk+Deslor38142spiroidem 19
Incicas A52FUAstm+RA18.5111poz mucegai>>Dermat
Ion R72FUWR+RApoz polenuri+mucegai
Ion RE20FUWRM AB
Ionescu LA27MUTC13
Ionica M54FUWR
Iordache R7MUWR767Traheomalacie
Iordachi S27MUWR[Ex]
Iordan AA56MUWR+RAMonteluk15106spiro60.2Dermat
Jurubita AA31FUWR+RAMonteluk+Flt/inh13.598IPLVDermat
Jurubita AA32FUWR+RAMonteluk+Flt/inh+Mometaz/nas13.598IPLVidem 189Dermat
Jurubita AA34FUWR+RAMonteluk+Flt/inh+Mometaz/nas14100poz cazeinaIPLVidem 115, 116Dermat
Karali A32FUTC11.590Dermat
Lacraru RP53MUAB+RAMonteluk+ketotif18.5113spiroEVOL FAVORDermat
Lambrea DMUWR35141spirovar cu WR
Lazar AL26MUWR16MACROSOM
Leanca DC10MRWRRGE
Leonte DFUAstmspirobunic decedat astm
Licu MI50MUWR15108Pectus escavidem 53
Licu MI51MUWR [Ex]15.5108Pectus escavidem 31
Licu MI52MUWR15.5108idem 31
Luca AL108FUTC40.5130VCD, SUPRAPOND
Luca AL109FUTC40.5130VCD, SUPRAPONDidem 134
Maftei MP119MUAstm+RAFlt/inh+Mometaz/nas36143Dermatita
Maftei MP120MUAB+RAFlt/inh+Mometaz/nas36143idem 89Dermatita
Maftei MP125MUAB+RAMontelukspiroCONTROLAT - se scoate doza Flt/inh
Mainov IM66MUWR+RAMonteluk+Flt/nas35.6120spiroNfrate RA+unchi WRHipertrofie adenoamigdalianaDermat
Mainov IM68MUWR+RAMonteluk+Flt/nas+Flt/inh29121spiroCONTROL MEDIOCRU - adaugat ICSO serfrate WR+ unchi WRRA severaidem 105
Mainov MI71MUAB+RAMonteluk+Flt/inh29120spiroCONTROLATfrateWR/RA+unchi WROBEZ, OASidem 147
Mainov SG40MUWR+RAMonteluk16.5102frateRA+unchi WRPectus escavatum
Mainov SG42MUWR+RAMonteluk16.2103frate WR+ unchi WRPectus escavatumidem 106
Mainov SG44MUWR+RAMonteluk16.5104CONTROLATfrateAB/RA+unchi WRPectus escavatumidem 148-149
Marin DC69MRAB+RAMonteluk18.5109spiroCONTROLATPectus escavatum
Marin EF37FUWR+RAMonteluk1599128NECONTROLAT - ADAUGAT Flt/inh+Deslor+Mometaz/nasRA severa
Marin EF38FUAB+RA1599.5spiroRA severaidem 46
Marin EF40FUAB+RAMonteluk+Flt/inh+Deslor+Mometaz/nas15.6101RA severaidem 109
Marin MA10FRWRMonteluk8.57725M RA, matusa WR
Marinescu AM35FUWR+RAMontelukCONTROLAT PARTIAL - se introd Monetaz/nas
Marin-Gogan M51MURA
Matache M21MRWRMonteluk
Matei A51MUWR+RA625.6%[493]T WR+RABDP
McCollum M87MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroEVOL FAVOR DUPA EXACERB SEVERARA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroRA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26132RA severaidem 112 si 113Dematita
Meita D101MUABFlt/inh HD29134spiro/paneluri+>>T dermat M RA
Meita D101MUABFlt/inh HD29134spiro>>EVOL FAVORT dermat M RAidem 95
Meita D103MUAB[exacerb]+RA29134spiroidem 153, 154
Mereuta R168MUAB+RA50.4164spiro/ +polen
Mereuta R168MUAB+RA50164spiroidem 86
Mihai T72MUWR+RAMonteluk20116Hipertrofie adenoamigdaliana - coblatie
Mihai T73MUWR+RAidem 98
Mirea AM150MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operat
Mirea AM151MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 218
Mirea AM152MUTC+RA56154spiroCONTROLATTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 148, 149
Mirea RMUWR
Mocanita VM60MUTC+RA
Munteanu M204FUAB+RAspiro/poz par pisicaDermatita
Munteanu M206FUAB+RAspiro/poz par pisicaidem 162Dermat
Murata A81MUWR+RAspiro
Naftan DG54MUWR+RAMonteluk+Deslor6594%T RARA severa
Naghy N69FUAB+RAFlt/inh+Mometaz/nas19.5118spiroM RARA severa2 exacerb in 5 luni
Naghy N69FUAB[exacerb]+RAFlt/inh+Mometaz/nas19.5118spiroRA severaidem 175
Naghy N70FUAB+RAFlt/inh+Mometaz/nas+Deslor20118spiroM RARA severaidem 175. 178
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas+Deslor21119spiroCONTROLATM RARA severaidem 123,124, 125
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas20119spiroCONTROLATM RARA severaidem 165-168
Neacsu P17MUTCPneumonii recurente - deficit imuniv A+G select
Neagu AF63MUWR+RA1919Pectus escavatum
Nica TA25MUWR+RAMonteluk17.2EVOL FAVORDermatita ++
Niculae AM42MUWR+RA16.5101RA severa
Niculae AM43MUWR+RAMonteluk16r adv FLTinhEVOL FAVORO CRIZA SEVERAidem 103
Niculeasa MT54FUTC+RA17
Nita-Manu MA48MUWRFlt/inh EPISODICEVOL >3epis WR/an
Novac TMUAB19.5117.8Limfom Hodgkin
Obiziuc A44MUWR+RAFlt/nas21.5112idm 57
Obiziuc A45MUWR+RAFlt/nas21.5112idem 4
Ocheana DA62MRRA17.5113poz pt acarieni2864.20%
Oprea AM55FRTC+RA21.5116spiro
Oprea EA133FRAB+RAMonteluk58144spiroCONTROLATOBEZITATE
Palos VD24MUWR
Pandaru-Rugina D15MURC10.7frate WRStridor laring cong
Pandaru-Rugina MA38MUWR+RAMonteluk16102.5spiro
Pandaru-Rugina MA40MUWR+RAMonteluk16103spiro
Pantile TC83MRWR+RAMonteluk+Flt/inh+Mometaz/nas20119spiroO ser
Pantile TC89MRAB+RAMonteluk+Flt/inh+Monetaz/nas21.5121spiroCONTROLATidem 141
Parascu A48MRWR+RA26119.5spiro284RA severa
Pascu MV99MUWR+RA37140spiro3.5%[232]T WR M WR+Dermatita
Patrascanu FR42MUTC+RAMometa+Deslor151016.2N
Paun Z30FUWR/exacerb usoarasora cu atopieDermatitaINTERNATA
Paunescu T42MUWR+RAT RA severa, M RA+urticarieDermat
Pedrazzini34MRWR+RAFlt/inh+DeslorAgit MontelukO seridem 74
Pedrazzini35MRWR+RAFlt/inh+DeslorRA severaidem 14
Petrescu DA93MUWR+RA21.5125poz acarieni780/234015%
Petrescu J36FUAstm+RAMonteluk+Flt/inh
Picu AE60FUWR16.5104.5ADHD
Pirjolescu FS64FUTC+RAMonteluk+Mometaz/nas25118CONTROLAT
Platteeuw L163MUABFlt/inh63.5180spiroConvalescent Pneumonie cu r pleurala si HRB
Polifrone SM85MUWR+RA24123.7spiro>>
Pop AF74MUWRMonteluk36131OBEZ, hiperemotiv, sechele PC
Popa M54FRWR+RA16104
Popescu A122FRWR+RAMontelukspiro
Popescu AMG88FUAB+RAFlt/inh HD+Monteluk18118spiro/ poz mucegai1256/1788RA severaastm sever
Popescu AMG90FUAB+RAFlt/inh HD+Monteluk18118spiro/poz mucegai1256CONTROLATRA severaidem 189Astm sever
Popescu EM41FUWRMonteluk13.898
Popescu R53MUTC+RA18.5105
Popescu S97MUAB+RA25125spiro808
Popescu VA105MUTC+RAMonteluk+Mometaz/nas+D330130.5232HipoCa
Posea R34MUWR+RAMonteluk+Mometaz/nas14100478Dermat
Posea R35MUWR+RAMonteluk+Mometaz/nas14101478idem 221Dermatita
Puiu CLMUWR+RA23.5119
Radu AAMUAstm+RAspiro
Radu AV158MUTC50155spirofrate TC si EIB
Radu MS37MUWR indVSUPRAPOND
Radu SA121MUTC+RA40139spiro/poz polen238frate TC si EIB
Radulescu MIFUAB+RALoratadina30134spiro25.82.48%mama RA
Radulescu MIFUABMontelukspiroidem 111
Rangu AG41FWR+RA
Rizea DC82MRTC+RA27.7128
Roman E28MUTC13
Sandulescu T85MUWR+RAMonteluk22.2120spiro84CONTROLATDermatita
Sebes LV44MUWR+RA15.5101.5IPLVDermat
Secula TI75MUWR22.3119.5bunica astmDermatita
Setareh SFUTC+RA21.5116RA severaDermat
Simion M57MUAstm+RAMonteluk+Flt/inh+Deslor16375RA severa
Sisu VC48MUWR+RA711RGEDermat
Sisu VC49MUWR+RAMonteluk17105711RA severa
Sitaru ARMRWRpoz par hamster280
Sitaru EDFRWR+RAfrate WR, sensibilizat par hamsterDermat
Sofron D90FRTC+RAMometaz/nas27128spiro6.2VCD
Stan MG41MUWR+RA14.597alergie medic - beta-lactami
Stancescu DG79MRAB20119poz pt acarieni
Stanciu A43FRWR+RA15O ser
Stancu MT94FUAB[exacerb]+RAFlt/inh HD + SABA30138spiro/poz par pisica, calNECONTROLAT - dat ICS+LABA [Symbicort]Dermat++
Stancu MT95FUAB+RASymbicort [ICS+LABA}30138spiro/poz par pisica, calCONTROLAT - scos Symbicort - ICS HD+Montelukidem 243Dermat++
Stanga AM43MUWR+RAMonteluk161025.60%Bunica RARA severa
Stanga AM46MUWR+RAMonteluk+Mometaz/nas+Deslor16104EVOL FAVOR5.60%Bunica RARA severaidem 139
Stanga AM49MUWR+RaMonteluk+Mometaz/nas17107CONTROLAT5.60%Bunica RARA severaidem 244, 245
Stejar T74MRAstm+RAMonteluk21.5121spiro157.8
Stejar T78MUAB+RAMonteluk21.5121spiro/poz polen175.8CONTROLAT AB, pt RA - Mometaz/nasO seridem 226Dermat
Stoica R4MUWR7
Stoican ACMRWR+RA19110
Stoicescu T31MUWR+RAMonteluk17106>>CONTROLATDermatita
Suta DC8MUTC+RADeslor9M dermatita, surori cu WR,
Szilagy A14MUWR+RAMonteluk11.4RA severaDermat
Szilagy DO44MUWR+RA94O ser6%IgA si G usor39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]
PACIENTI NETERMOMETRIZATI[141 PAC din 1753 Prezentati - esantion Ian - Nov 2012]
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Febra inalta este frecventa?
Chart5
34
333
FEBRA >39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]
Sheet1
numevarstasexdomicdgtratGTteste cutanateIgER AdverseComplicatiiEozinofileAHCObs
Anastasiu M39MUTC+RA12.593
Anastasiu M41MUTC+RA12.593poz pt par caineidem 2
Ancu IEFRTC+RA17113
Andronie SG133MUAB+RAFlt/inh36141Pectus escav
Anghel DI36MRWR1394
Anghel IT83MUWR+RA25.5124.5spirofrate WR
Anghel M17MUWR+RAMonteluk9.2frate WRDermatita
Anghel V72MUWR+RA241233890/7103
Angheluta GM66FRWR17.5113
Apostol MA33FUWR1390Spasmul hohot plans
Apostol MA37FUWRMonteluk13.592Spasmul hohot plansidem 11
Ardelean A31FUWRfrate WR
Ardelean I66MUWR+RAsora WR
Asmarandei T14MUWR96
Asmarandei T15MUWR indV96idem 89
Badea A72FUWR18.5116mama astm trat cu ICS+LABAUrticarie
Badea AL60MUWR+RAMonteluk+Mometaz/nas19119spiro
Badea AL66MUWR+RAMonteluk+Mometaz/nas20121spiroCONTROLATOSA
Badea AL64MUAB+RAMonteluk+Flixo/inh+Mometaz/nas20121spiroCONTROLATOSA
Badita TN79MUWR21119687
Balanica T106MRAB27.5133
Banca V31MRTC+wheezing14.595.5
Banica AA59MRWR+RAMonteluk+Flt/nas16.8110spiro/poz acarieni3000EVOL FAVORRA severa
Barsan MI52FUWR+RAMonteluk+Flt/inh HD18104spiroRA severaidem 38Dermat4 exac in 10 luni
Barsan MI53FUWR+RAMonteluk+Flt/inh HD18104spiroidem 17Dermat
Barsan MI54FUWR+RAMonteluk+Flt/inh HD19106spiroRA severaidem 7 - 8dermat
Barsan MI55FUWR+RAMonteluk+Flt/inh19106spiroCONTROLAT - se scade doza Flt/inhRA severaidem 22. 23. 24Dermatita
Barsan MI56FUWR+RAMonteluk+Flt/inh18106spiroCONTROLATRA severaidem 23-26Dermatita
Bicher SM46MUWR+RA17.5
Botea S32MUWRnegNDermatita
Botez LA17MUWRBDP - ventilat mecanic 10 z
Brezeanu TG53MUTC+RA22115spiroNTRAHEOMALACIE1 exacerb in 5 luni
Brezeanu TG56MUTC+RA23116spiroTRAHEOMALACIEidem 28
Brezeanu TG59MUTC+RA22118CONTROLATTRAHEOMALACIEidem 31, 32
Buhnia T106MUABspiro
Buican R9MUWR+RA291%Dermat++
Buican R12MUWR+RAMonteluk291%idem 34Dermat++
Bulai L27MUWR14.593NN
Cadar R63MUWR+RA21.5116232.5O serM AB, T RA+urticarii
Calin MA71FUWR42127.5spirofrate cu RAObezitate
Calman MD63MUAB+RA26.5119.5spiro/poz acarieni+mucegaiRA severa
Cantoneru L50MUWR+RA16106
Caracuda C60FUTC+RA21.3116spiroRA severa
Ceausu IA61FUWR26118spiro10.75.6%[400]SUPRAPOND
Cernica TD56FURA18116
Chebarus AD23MUWR+RAMontelukpoz cazeinaIPLVDermat
Chebarus AD25MUWR+RAMontelukpoz cazeina42.2IPLVidem 43
Chirita S67FRAstm+RA20119.2spiro / pozNev Ota
Cioroianu EB56MUTC+RAMonteluk+Momet/nas20115spiroEVOL BUNA DE 6L
Cioroianu EB58MUWR+RAMonteluk+Mometaz/nas20115spiroNECONTROLAT - TC=WR>3/an[scor CR+]T AB M fumatidem 43
Citea M90MRTC+RAMonteluk23.5124spiro72M fumatoare
Ciucur R134MUAstm+RA
Codrea DM68MUTC+RARA severa
Cojocaru AL124MUWR+RAMonteluk47150spiro/poz acarieni>>RA severa
Coman AR66MRAB+RAMonteluk+Mometaz/nas32.5123spiro
Coman AR70MRAB+RAMonteluk+Xyzal36125spiroCONTROLATSUPRAPONDidem 48Dermat++
Constantin RCMUWR+RA26123
Constantin TA35MUWR+RAMonteluk+Mometaz/naspoz albus ou26.85%
Constantinescu S92FUAstm+RA22.512866511.4% [680]
Constantinescu S95FUAB+RAFlt/inh+Flt/nas23.5130spiroCONTROLATidem 48
Corcodel D40MUAB+RATC - N VienaNO serRA severa
Coricica AM23MUWRMonteluk10.882T SUDORII - 3413.70%repetate scaune cu sange
Cosma IA35FUWR+RAMontelukO ser
Costache MC47FUWr+TC
Costache T48MUWR+RA22122
Costan M36MURA18.5102O serDermat
Craiciu RM19MUWR indVMonteluk12.21 episod BO "dramatic"
Croitoru A27MUWR+RAMonteluk13101.7RA severa
Dane A68MUWR17.5110
Dasu M84MU4327.50%
Dinca BA158MUABICS+LABA [Seretide discus]59167spiroCONTROLAT
Dinu EA48MUWRMonteluk15105strabunica astm, matusa mat alergie polen
Dinu LC43FUTC+RA20.5107RGE
Dirla AO72MUAB+RAFlt/inhspirodepresie monteluk
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie majora Montelukidem 51
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie Majora Montelukidem 51 si 208
Dirla AO77MUAB+RAFlt/inh+Deslor+Mometaz/nasCONTROLATDepresie majora Montelukidem 68, 69, 70
Dobre CL55MUWR+RAMonteluk+Momet/nas14.7100.512115%RA severa
Dobrila V67MUAstm+RA24118RA severa
Dobrila V68MUAB+RAMonteluk+antihistTS 34; ECO C nRA severaidem 21
Dobrila V70MUWR+RAMonteluk+Mometaz/nas24118CONTROLATM RARA severaidem 53, 54
Dogaru CA52MUAB+RA22116poz polenuri
Donose MA51MUTC+RA17.2107.576.3VDC
Draghia AC148FRTC+RA56160spiroDermatita
Dragotoniu AE36FRWR+RAMonteluk1497.510.80%Tata & Mama RARA severaDermat
Dragotoniu AE42FRWR+RAMonteluk14.599CONTROLAT10.80%T si M RARA severaidem 78
Dumitrescu AMUWR+RA24.3120spirovar cu WRADHD?
Dumitrescu A73MUWR+RAMonteluk+Mometaz/nasspiroCONTROLAT
Dumitrescu S37MUAB+RA14.5Dermatita
Dumitriu V50MUWR+RAspiroDermat
Dumitru FC111MUAstm41138.5spiro
Duta RN62MUWR+RAMonteluk+Mometaz/nas+Ketof20114spiro>>10.90%RA severaDermatita
Duta RN66MUWR+RAMonteluk?Mometaz/nas+Ketof20.5116spiro>>CONTROLAT10.90%RA severaidem 84Dermatita ++
Enache DC47MRAstm [Ex]Mometa+Deslor+Monteluk17spiro
Filipoiu AM13FUTC10.9sora WRMACROSOM
Florea C171FUTC58.5151Obezitate
Florea V75MUAstm [Ex]+RA29128
Furdui TA48MUWR/exacerb usoaraMontelukspiro
Geambazzi AA20MRWR [Ex]MontelukPectus escav
Geambazzi AA22MRWR/exacerb usoaraMontelukEVOL >3epis WR/ansora cu WRidem 25Pectus escav
Geambazzi SP47FRWR [Ex]Monteluk
Geambazzi SP51FRWRCONTROLATidem 83
Georgescu AI61FUWR+RAMonteluk20.5115.8spirofrate WR
Georgescu MA66MRWR+RA20.5121poz mucegai18.3Polipi corzi vocale
Georgescu RA72MUWR+RAMonteluk+Flt/nasO ser
Gherghelescu I14FUWRMonteluk
Ghidrigan SC104MUAstm [Ex]+RA29.5132.5374Depresie Majora5%
Ghidrigan SC107MUAstm+RALABA+ICS29.5133spiroDepresie Majora5%
Ghincea MA136FUABspiroVCD, OBEZ
Gorgan M31FUTC+RA22
Gramescu A60FUTC20.5113.5TRAHEOMALACIE
Grecu A42FUTC+RA16.51026.2%[510]
Grigoras C67FUWR IACRS23NEFRECTOMIE PARTIALA
Grigoras C69FUWR23idem 64
Grigorgore M26FUWRDermatita
Grozavu D76MRTC+RA20115
Guzu A29MUWR+RAMontelukRA severa
Guzu A30MUWR+RAMonteluk+Flt/nasEVOL FAVOR RARA severaIDEM 58
Guzu A32MUWR+RAMonteluk+Flt/nasCONTROLATRA severaidem 75,76
Himpa T103MUAB+RAMonteluk+Mometaz/nas40138.5spiroCONTROLATRA severa
Hornoiu B27MUWR+RAMonteluk11.593
Hornoiu B31MUWR+RAMonteluk1496CONTROLATidem 97
Iacob-Ritzi A18MUWR+RAFlt/inh11.2Pectus escav
Iancu MA98FUTC+RA34139spiroHipertrofie adenoamigdaliana - operatie
Iancu MA100FUTC+RA36141spiroPubertate precoceidem 69
Ichim EG78FRTC
Ilia RV102MUWRFlt/inh32136.5
Ilia RV103MUWRFlt/inh33136.5idem 35
Ilia RV104MUWRFlt/inhEVOL FAVOR
Ilia RV105MUWRFlt/inh HDspiro
Ilie CN125MUAstm+RAMonteluk+DeslorRA severa dupa oprirea medic)idem 70
Ilie CN126MUAstm+RAMonteluk+Deslor38142spiroidem 19
Incicas A52FUAstm+RA18.5111poz mucegai>>Dermat
Ion R72FUWR+RApoz polenuri+mucegai
Ion RE20FUWRM AB
Ionescu LA27MUTC13
Ionica M54FUWR
Iordache R7MUWR767Traheomalacie
Iordachi S27MUWR[Ex]
Iordan AA56MUWR+RAMonteluk15106spiro60.2Dermat
Jurubita AA31FUWR+RAMonteluk+Flt/inh13.598IPLVDermat
Jurubita AA32FUWR+RAMonteluk+Flt/inh+Mometaz/nas13.598IPLVidem 189Dermat
Jurubita AA34FUWR+RAMonteluk+Flt/inh+Mometaz/nas14100poz cazeinaIPLVidem 115, 116Dermat
Karali A32FUTC11.590Dermat
Lacraru RP53MUAB+RAMonteluk+ketotif18.5113spiroEVOL FAVORDermat
Lambrea DMUWR35141spirovar cu WR
Lazar AL26MUWR16MACROSOM
Leanca DC10MRWRRGE
Leonte DFUAstmspirobunic decedat astm
Licu MI50MUWR15108Pectus escavidem 53
Licu MI51MUWR [Ex]15.5108Pectus escavidem 31
Licu MI52MUWR15.5108idem 31
Luca AL108FUTC40.5130VCD, SUPRAPOND
Luca AL109FUTC40.5130VCD, SUPRAPONDidem 134
Maftei MP119MUAstm+RAFlt/inh+Mometaz/nas36143Dermatita
Maftei MP120MUAB+RAFlt/inh+Mometaz/nas36143idem 89Dermatita
Maftei MP125MUAB+RAMontelukspiroCONTROLAT - se scoate doza Flt/inh
Mainov IM66MUWR+RAMonteluk+Flt/nas35.6120spiroNfrate RA+unchi WRHipertrofie adenoamigdalianaDermat
Mainov IM68MUWR+RAMonteluk+Flt/nas+Flt/inh29121spiroCONTROL MEDIOCRU - adaugat ICSO serfrate WR+ unchi WRRA severaidem 105
Mainov MI71MUAB+RAMonteluk+Flt/inh29120spiroCONTROLATfrateWR/RA+unchi WROBEZ, OASidem 147
Mainov SG40MUWR+RAMonteluk16.5102frateRA+unchi WRPectus escavatum
Mainov SG42MUWR+RAMonteluk16.2103frate WR+ unchi WRPectus escavatumidem 106
Mainov SG44MUWR+RAMonteluk16.5104CONTROLATfrateAB/RA+unchi WRPectus escavatumidem 148-149
Marin DC69MRAB+RAMonteluk18.5109spiroCONTROLATPectus escavatum
Marin EF37FUWR+RAMonteluk1599128NECONTROLAT - ADAUGAT Flt/inh+Deslor+Mometaz/nasRA severa
Marin EF38FUAB+RA1599.5spiroRA severaidem 46
Marin EF40FUAB+RAMonteluk+Flt/inh+Deslor+Mometaz/nas15.6101RA severaidem 109
Marin MA10FRWRMonteluk8.57725M RA, matusa WR
Marinescu AM35FUWR+RAMontelukCONTROLAT PARTIAL - se introd Monetaz/nas
Marin-Gogan M51MURA
Matache M21MRWRMonteluk
Matei A51MUWR+RA625.6%[493]T WR+RABDP
McCollum M87MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroEVOL FAVOR DUPA EXACERB SEVERARA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroRA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26132RA severaidem 112 si 113Dematita
Meita D101MUABFlt/inh HD29134spiro/paneluri+>>T dermat M RA
Meita D101MUABFlt/inh HD29134spiro>>EVOL FAVORT dermat M RAidem 95
Meita D103MUAB[exacerb]+RA29134spiroidem 153, 154
Mereuta R168MUAB+RA50.4164spiro/ +polen
Mereuta R168MUAB+RA50164spiroidem 86
Mihai T72MUWR+RAMonteluk20116Hipertrofie adenoamigdaliana - coblatie
Mihai T73MUWR+RAidem 98
Mirea AM150MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operat
Mirea AM151MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 218
Mirea AM152MUTC+RA56154spiroCONTROLATTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 148, 149
Mirea RMUWR
Mocanita VM60MUTC+RA
Munteanu M204FUAB+RAspiro/poz par pisicaDermatita
Munteanu M206FUAB+RAspiro/poz par pisicaidem 162Dermat
Murata A81MUWR+RAspiro
Naftan DG54MUWR+RAMonteluk+Deslor6594%T RARA severa
Naghy N69FUAB+RAFlt/inh+Mometaz/nas19.5118spiroM RARA severa2 exacerb in 5 luni
Naghy N69FUAB[exacerb]+RAFlt/inh+Mometaz/nas19.5118spiroRA severaidem 175
Naghy N70FUAB+RAFlt/inh+Mometaz/nas+Deslor20118spiroM RARA severaidem 175. 178
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas+Deslor21119spiroCONTROLATM RARA severaidem 123,124, 125
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas20119spiroCONTROLATM RARA severaidem 165-168
Neacsu P17MUTCPneumonii recurente - deficit imuniv A+G select
Neagu AF63MUWR+RA1919Pectus escavatum
Nica TA25MUWR+RAMonteluk17.2EVOL FAVORDermatita ++
Niculae AM42MUWR+RA16.5101RA severa
Niculae AM43MUWR+RAMonteluk16r adv FLTinhEVOL FAVORO CRIZA SEVERAidem 103
Niculeasa MT54FUTC+RA17
Nita-Manu MA48MUWRFlt/inh EPISODICEVOL >3epis WR/an
Novac TMUAB19.5117.8Limfom Hodgkin
Obiziuc A44MUWR+RAFlt/nas21.5112idm 57
Obiziuc A45MUWR+RAFlt/nas21.5112idem 4
Ocheana DA62MRRA17.5113poz pt acarieni2864.20%
Oprea AM55FRTC+RA21.5116spiro
Oprea EA133FRAB+RAMonteluk58144spiroCONTROLATOBEZITATE
Palos VD24MUWR
Pandaru-Rugina D15MURC10.7frate WRStridor laring cong
Pandaru-Rugina MA38MUWR+RAMonteluk16102.5spiro
Pandaru-Rugina MA40MUWR+RAMonteluk16103spiro
Pantile TC83MRWR+RAMonteluk+Flt/inh+Mometaz/nas20119spiroO ser
Pantile TC89MRAB+RAMonteluk+Flt/inh+Monetaz/nas21.5121spiroCONTROLATidem 141
Parascu A48MRWR+RA26119.5spiro284RA severa
Pascu MV99MUWR+RA37140spiro3.5%[232]T WR M WR+Dermatita
Patrascanu FR42MUTC+RAMometa+Deslor151016.2N
Paun Z30FUWR/exacerb usoarasora cu atopieDermatitaINTERNATA
Paunescu T42MUWR+RAT RA severa, M RA+urticarieDermat
Pedrazzini34MRWR+RAFlt/inh+DeslorAgit MontelukO seridem 74
Pedrazzini35MRWR+RAFlt/inh+DeslorRA severaidem 14
Petrescu DA93MUWR+RA21.5125poz acarieni780/234015%
Petrescu J36FUAstm+RAMonteluk+Flt/inh
Picu AE60FUWR16.5104.5ADHD
Pirjolescu FS64FUTC+RAMonteluk+Mometaz/nas25118CONTROLAT
Platteeuw L163MUABFlt/inh63.5180spiroConvalescent Pneumonie cu r pleurala si HRB
Polifrone SM85MUWR+RA24123.7spiro>>
Pop AF74MUWRMonteluk36131OBEZ, hiperemotiv, sechele PC
Popa M54FRWR+RA16104
Popescu A122FRWR+RAMontelukspiro
Popescu AMG88FUAB+RAFlt/inh HD+Monteluk18118spiro/ poz mucegai1256/1788RA severaastm sever
Popescu AMG90FUAB+RAFlt/inh HD+Monteluk18118spiro/poz mucegai1256CONTROLATRA severaidem 189Astm sever
Popescu EM41FUWRMonteluk13.898
Popescu R53MUTC+RA18.5105
Popescu S97MUAB+RA25125spiro808
Popescu VA105MUTC+RAMonteluk+Mometaz/nas+D330130.5232HipoCa
Posea R34MUWR+RAMonteluk+Mometaz/nas14100478Dermat
Posea R35MUWR+RAMonteluk+Mometaz/nas14101478idem 221Dermatita
Puiu CLMUWR+RA23.5119
Radu AAMUAstm+RAspiro
Radu AV158MUTC50155spirofrate TC si EIB
Radu MS37MUWR indVSUPRAPOND
Radu SA121MUTC+RA40139spiro/poz polen238frate TC si EIB
Radulescu MIFUAB+RALoratadina30134spiro25.82.48%mama RA
Radulescu MIFUABMontelukspiroidem 111
Rangu AG41FWR+RA
Rizea DC82MRTC+RA27.7128
Roman E28MUTC13
Sandulescu T85MUWR+RAMonteluk22.2120spiro84CONTROLATDermatita
Sebes LV44MUWR+RA15.5101.5IPLVDermat
Secula TI75MUWR22.3119.5bunica astmDermatita
Setareh SFUTC+RA21.5116RA severaDermat
Simion M57MUAstm+RAMonteluk+Flt/inh+Deslor16375RA severa
Sisu VC48MUWR+RA711RGEDermat
Sisu VC49MUWR+RAMonteluk17105711RA severa
Sitaru ARMRWRpoz par hamster280
Sitaru EDFRWR+RAfrate WR, sensibilizat par hamsterDermat
Sofron D90FRTC+RAMometaz/nas27128spiro6.2VCD
Stan MG41MUWR+RA14.597alergie medic - beta-lactami
Stancescu DG79MRAB20119poz pt acarieni
Stanciu A43FRWR+RA15O ser
Stancu MT94FUAB[exacerb]+RAFlt/inh HD + SABA30138spiro/poz par pisica, calNECONTROLAT - dat ICS+LABA [Symbicort]Dermat++
Stancu MT95FUAB+RASymbicort [ICS+LABA}30138spiro/poz par pisica, calCONTROLAT - scos Symbicort - ICS HD+Montelukidem 243Dermat++
Stanga AM43MUWR+RAMonteluk161025.60%Bunica RARA severa
Stanga AM46MUWR+RAMonteluk+Mometaz/nas+Deslor16104EVOL FAVOR5.60%Bunica RARA severaidem 139
Stanga AM49MUWR+RaMonteluk+Mometaz/nas17107CONTROLAT5.60%Bunica RARA severaidem 244, 245
Stejar T74MRAstm+RAMonteluk21.5121spiro157.8
Stejar T78MUAB+RAMonteluk21.5121spiro/poz polen175.8CONTROLAT AB, pt RA - Mometaz/nasO seridem 226Dermat
Stoica R4MUWR7
Stoican ACMRWR+RA19110
Stoicescu T31MUWR+RAMonteluk17106>>CONTROLATDermatita
Suta DC8MUTC+RADeslor9M dermatita, surori cu WR,
Szilagy A14MUWR+RAMonteluk11.4RA severaDermat
Szilagy DO44MUWR+RA94O ser6%IgA si G usor39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]
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Mecanismele FebreiFebra in sine nu este o boala!
Febra este un mecanism fiziologic pentru combaterea diverselor infectii.Incetineste replicarea virala sau bacterianaAccelereaza productia de PMN si limfocite TAccelereaza traficul de celule cu rol imun
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Modalitati de evaluare copilmasurare rectala & orala
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Modalitati de evaluare scolarmasurare axilara & orala
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Erori de masurare tehnice 1
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Erori de masurare tehnice 2
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FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
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BOLI CU FEBRA LA COPILNu numai infectiile pot genera febra!Inflamatii acuteBoli reumatismale [ACJ, RAA, LES, PAN, Sindrom Kawasaki, etc]Inflamatie alergicaIntoxicatii acute [accidentale, iatrogene]Anomalii termoreglare [tumori diencefalice]Febra factitiala / sindr Munchausen
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BOLI CU FEBRA LA COPILSemne de gravitate
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BOLI CU FEBRA LA COPIL
Boli febrile cu potential de severitate >>SepticemieMeningitaPielonefritaPneumonie acuta
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Care este ponderea cauzelor de febra?Cea mai frecventa cauza de febra fara focar la copilul prescolar sunt bolile virale
Bolile de colagen reprezinta 9%Malignitatile reprezinta 6%
* Chow A, Robinson JL.Fever of unknown origin in children: a systematic review. World J Pediatr. 2011 Feb;7(1):5-10.
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Dar la sugar ?Nici la sugarul cu varsta sub 3 luni, care are doar febra izolata nu exista un risc semnificativ de boala bacteriana.
2.1% din 1112 sugari cu varsta
- Infectiile febrile grave apar la
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Criteriile Rochester pentru severitate redusa in infectii cu febra la sugar
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FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
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TRATAMENT FEBRA
Este foarte diferita perspectiva asupra tratamenului febrei la :copil parinte medic
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Perspectiva pacientului COPILUL SCOLARFebra legitimeaza statutul de pacient / pacient
Febra produce empatie / ingrijorare / toleranta
Febra aduce BENEFICIISunt bolnav nu mai merg la scoala Nu mai fac lectii Pot sa stau acasa si sa ma joc
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Perspectiva parintelui - 1Febra produce ingrijorare *
CAUZA NR 1 de ingrijorare parentala
Motiv frecvent de medicatie fara prescriptie sau consult medical
*Kay J What worries parents when their preschool children are acutely ill and why? : a qualitative study. BMJ 1996;313:983-6.
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Perspectiva parintelui - 2
Parintii administreaza antitermice chiar si in conditii de temperatura putin crescuta, unori aproape normala*.
* Sullivan JE et al - Fever and antipyretic use in children. Pediatrics. 2011 ;127(3):580-7.
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Perspectiva parintelui - 3Febra produce PANICA, fiind expresia unei situatii GRAVE in acceptiunea parintilor*
Termenul fever phobia este introdus de Barton Schmitt in 1980
*Schmitt BD Fever phobia. Am J Dis Child 1980;134:176-81.
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Perspectiva parintelui - 4Parintii sunt convinsi ca febra in sine * poate produce:Leziuni neurologice (38,1%)Deshidratare (15,7%)Leziuni ale altor organe [rinichi, ficat] (14,2%)
* Zyoud SH et al - Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine. BMC Pediatr. 2013;13:66.
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Perspectiva parintelui - 5Parintii masoara febra cu ajutorul *:Termometrului (31,6%)Mainii, prin atingere (65,4%)Atingere apoi termometrizare (3%)
* Zyoud SH et al - Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine. BMC Pediatr. 2013;13:66.
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Fever phobia la halatele albe *230 medici de CPU intervievati in SUA. temperatura considerata a fi febra 37.8C Temperatura medie considerata ca fiind nociva 40.6C [limite 37.8 - 43.3C]. Temperatura medie la care s-au inceput antipireticele 37.8C Peste 1/3 din medici au recunoscut ca au administrat antipireticele inadecvat [exces de zel]. * Poirier MP, Collins EP, McGuire E Fever phobia: a survey of caregivers of children seen in a pediatric emergency department. Clin Pediatr (Phila). 2010;49:530-4.
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Perspectiva medicului 2
Alte date din practica
In UK medicii de familie folosesc rareori termomentrul *Deseori tehnica de termomentrizare este incorecta
* Clarke S The use of thermometers in general practice. Br Med J 1992;304:961-3.
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In Romania realitati despre termometrizare
Chart1
141
1612
PACIENTI NETERMOMETRIZATI[141 PAC din 1753 Prezentati - esantion Ian - Nov 2012]
Sheet1
numevarstasexdomicdgtratGTteste cutanateIgER AdverseComplicatiiEozinofileAHCObs
Anastasiu M39MUTC+RA12.593
Anastasiu M41MUTC+RA12.593poz pt par caineidem 2
Ancu IEFRTC+RA17113
Andronie SG133MUAB+RAFlt/inh36141Pectus escav
Anghel DI36MRWR1394
Anghel IT83MUWR+RA25.5124.5spirofrate WR
Anghel M17MUWR+RAMonteluk9.2frate WRDermatita
Anghel V72MUWR+RA241233890/7103
Angheluta GM66FRWR17.5113
Apostol MA33FUWR1390Spasmul hohot plans
Apostol MA37FUWRMonteluk13.592Spasmul hohot plansidem 11
Ardelean A31FUWRfrate WR
Ardelean I66MUWR+RAsora WR
Asmarandei T14MUWR96
Asmarandei T15MUWR indV96idem 89
Badea A72FUWR18.5116mama astm trat cu ICS+LABAUrticarie
Badea AL60MUWR+RAMonteluk+Mometaz/nas19119spiro
Badea AL66MUWR+RAMonteluk+Mometaz/nas20121spiroCONTROLATOSA
Badea AL64MUAB+RAMonteluk+Flixo/inh+Mometaz/nas20121spiroCONTROLATOSA
Badita TN79MUWR21119687
Balanica T106MRAB27.5133
Banca V31MRTC+wheezing14.595.5
Banica AA59MRWR+RAMonteluk+Flt/nas16.8110spiro/poz acarieni3000EVOL FAVORRA severa
Barsan MI52FUWR+RAMonteluk+Flt/inh HD18104spiroRA severaidem 38Dermat4 exac in 10 luni
Barsan MI53FUWR+RAMonteluk+Flt/inh HD18104spiroidem 17Dermat
Barsan MI54FUWR+RAMonteluk+Flt/inh HD19106spiroRA severaidem 7 - 8dermat
Barsan MI55FUWR+RAMonteluk+Flt/inh19106spiroCONTROLAT - se scade doza Flt/inhRA severaidem 22. 23. 24Dermatita
Barsan MI56FUWR+RAMonteluk+Flt/inh18106spiroCONTROLATRA severaidem 23-26Dermatita
Bicher SM46MUWR+RA17.5
Botea S32MUWRnegNDermatita
Botez LA17MUWRBDP - ventilat mecanic 10 z
Brezeanu TG53MUTC+RA22115spiroNTRAHEOMALACIE1 exacerb in 5 luni
Brezeanu TG56MUTC+RA23116spiroTRAHEOMALACIEidem 28
Brezeanu TG59MUTC+RA22118CONTROLATTRAHEOMALACIEidem 31, 32
Buhnia T106MUABspiro
Buican R9MUWR+RA291%Dermat++
Buican R12MUWR+RAMonteluk291%idem 34Dermat++
Bulai L27MUWR14.593NN
Cadar R63MUWR+RA21.5116232.5O serM AB, T RA+urticarii
Calin MA71FUWR42127.5spirofrate cu RAObezitate
Calman MD63MUAB+RA26.5119.5spiro/poz acarieni+mucegaiRA severa
Cantoneru L50MUWR+RA16106
Caracuda C60FUTC+RA21.3116spiroRA severa
Ceausu IA61FUWR26118spiro10.75.6%[400]SUPRAPOND
Cernica TD56FURA18116
Chebarus AD23MUWR+RAMontelukpoz cazeinaIPLVDermat
Chebarus AD25MUWR+RAMontelukpoz cazeina42.2IPLVidem 43
Chirita S67FRAstm+RA20119.2spiro / pozNev Ota
Cioroianu EB56MUTC+RAMonteluk+Momet/nas20115spiroEVOL BUNA DE 6L
Cioroianu EB58MUWR+RAMonteluk+Mometaz/nas20115spiroNECONTROLAT - TC=WR>3/an[scor CR+]T AB M fumatidem 43
Citea M90MRTC+RAMonteluk23.5124spiro72M fumatoare
Ciucur R134MUAstm+RA
Codrea DM68MUTC+RARA severa
Cojocaru AL124MUWR+RAMonteluk47150spiro/poz acarieni>>RA severa
Coman AR66MRAB+RAMonteluk+Mometaz/nas32.5123spiro
Coman AR70MRAB+RAMonteluk+Xyzal36125spiroCONTROLATSUPRAPONDidem 48Dermat++
Constantin RCMUWR+RA26123
Constantin TA35MUWR+RAMonteluk+Mometaz/naspoz albus ou26.85%
Constantinescu S92FUAstm+RA22.512866511.4% [680]
Constantinescu S95FUAB+RAFlt/inh+Flt/nas23.5130spiroCONTROLATidem 48
Corcodel D40MUAB+RATC - N VienaNO serRA severa
Coricica AM23MUWRMonteluk10.882T SUDORII - 3413.70%repetate scaune cu sange
Cosma IA35FUWR+RAMontelukO ser
Costache MC47FUWr+TC
Costache T48MUWR+RA22122
Costan M36MURA18.5102O serDermat
Craiciu RM19MUWR indVMonteluk12.21 episod BO "dramatic"
Croitoru A27MUWR+RAMonteluk13101.7RA severa
Dane A68MUWR17.5110
Dasu M84MU4327.50%
Dinca BA158MUABICS+LABA [Seretide discus]59167spiroCONTROLAT
Dinu EA48MUWRMonteluk15105strabunica astm, matusa mat alergie polen
Dinu LC43FUTC+RA20.5107RGE
Dirla AO72MUAB+RAFlt/inhspirodepresie monteluk
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie majora Montelukidem 51
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie Majora Montelukidem 51 si 208
Dirla AO77MUAB+RAFlt/inh+Deslor+Mometaz/nasCONTROLATDepresie majora Montelukidem 68, 69, 70
Dobre CL55MUWR+RAMonteluk+Momet/nas14.7100.512115%RA severa
Dobrila V67MUAstm+RA24118RA severa
Dobrila V68MUAB+RAMonteluk+antihistTS 34; ECO C nRA severaidem 21
Dobrila V70MUWR+RAMonteluk+Mometaz/nas24118CONTROLATM RARA severaidem 53, 54
Dogaru CA52MUAB+RA22116poz polenuri
Donose MA51MUTC+RA17.2107.576.3VDC
Draghia AC148FRTC+RA56160spiroDermatita
Dragotoniu AE36FRWR+RAMonteluk1497.510.80%Tata & Mama RARA severaDermat
Dragotoniu AE42FRWR+RAMonteluk14.599CONTROLAT10.80%T si M RARA severaidem 78
Dumitrescu AMUWR+RA24.3120spirovar cu WRADHD?
Dumitrescu A73MUWR+RAMonteluk+Mometaz/nasspiroCONTROLAT
Dumitrescu S37MUAB+RA14.5Dermatita
Dumitriu V50MUWR+RAspiroDermat
Dumitru FC111MUAstm41138.5spiro
Duta RN62MUWR+RAMonteluk+Mometaz/nas+Ketof20114spiro>>10.90%RA severaDermatita
Duta RN66MUWR+RAMonteluk?Mometaz/nas+Ketof20.5116spiro>>CONTROLAT10.90%RA severaidem 84Dermatita ++
Enache DC47MRAstm [Ex]Mometa+Deslor+Monteluk17spiro
Filipoiu AM13FUTC10.9sora WRMACROSOM
Florea C171FUTC58.5151Obezitate
Florea V75MUAstm [Ex]+RA29128
Furdui TA48MUWR/exacerb usoaraMontelukspiro
Geambazzi AA20MRWR [Ex]MontelukPectus escav
Geambazzi AA22MRWR/exacerb usoaraMontelukEVOL >3epis WR/ansora cu WRidem 25Pectus escav
Geambazzi SP47FRWR [Ex]Monteluk
Geambazzi SP51FRWRCONTROLATidem 83
Georgescu AI61FUWR+RAMonteluk20.5115.8spirofrate WR
Georgescu MA66MRWR+RA20.5121poz mucegai18.3Polipi corzi vocale
Georgescu RA72MUWR+RAMonteluk+Flt/nasO ser
Gherghelescu I14FUWRMonteluk
Ghidrigan SC104MUAstm [Ex]+RA29.5132.5374Depresie Majora5%
Ghidrigan SC107MUAstm+RALABA+ICS29.5133spiroDepresie Majora5%
Ghincea MA136FUABspiroVCD, OBEZ
Gorgan M31FUTC+RA22
Gramescu A60FUTC20.5113.5TRAHEOMALACIE
Grecu A42FUTC+RA16.51026.2%[510]
Grigoras C67FUWR IACRS23NEFRECTOMIE PARTIALA
Grigoras C69FUWR23idem 64
Grigorgore M26FUWRDermatita
Grozavu D76MRTC+RA20115
Guzu A29MUWR+RAMontelukRA severa
Guzu A30MUWR+RAMonteluk+Flt/nasEVOL FAVOR RARA severaIDEM 58
Guzu A32MUWR+RAMonteluk+Flt/nasCONTROLATRA severaidem 75,76
Himpa T103MUAB+RAMonteluk+Mometaz/nas40138.5spiroCONTROLATRA severa
Hornoiu B27MUWR+RAMonteluk11.593
Hornoiu B31MUWR+RAMonteluk1496CONTROLATidem 97
Iacob-Ritzi A18MUWR+RAFlt/inh11.2Pectus escav
Iancu MA98FUTC+RA34139spiroHipertrofie adenoamigdaliana - operatie
Iancu MA100FUTC+RA36141spiroPubertate precoceidem 69
Ichim EG78FRTC
Ilia RV102MUWRFlt/inh32136.5
Ilia RV103MUWRFlt/inh33136.5idem 35
Ilia RV104MUWRFlt/inhEVOL FAVOR
Ilia RV105MUWRFlt/inh HDspiro
Ilie CN125MUAstm+RAMonteluk+DeslorRA severa dupa oprirea medic)idem 70
Ilie CN126MUAstm+RAMonteluk+Deslor38142spiroidem 19
Incicas A52FUAstm+RA18.5111poz mucegai>>Dermat
Ion R72FUWR+RApoz polenuri+mucegai
Ion RE20FUWRM AB
Ionescu LA27MUTC13
Ionica M54FUWR
Iordache R7MUWR767Traheomalacie
Iordachi S27MUWR[Ex]
Iordan AA56MUWR+RAMonteluk15106spiro60.2Dermat
Jurubita AA31FUWR+RAMonteluk+Flt/inh13.598IPLVDermat
Jurubita AA32FUWR+RAMonteluk+Flt/inh+Mometaz/nas13.598IPLVidem 189Dermat
Jurubita AA34FUWR+RAMonteluk+Flt/inh+Mometaz/nas14100poz cazeinaIPLVidem 115, 116Dermat
Karali A32FUTC11.590Dermat
Lacraru RP53MUAB+RAMonteluk+ketotif18.5113spiroEVOL FAVORDermat
Lambrea DMUWR35141spirovar cu WR
Lazar AL26MUWR16MACROSOM
Leanca DC10MRWRRGE
Leonte DFUAstmspirobunic decedat astm
Licu MI50MUWR15108Pectus escavidem 53
Licu MI51MUWR [Ex]15.5108Pectus escavidem 31
Licu MI52MUWR15.5108idem 31
Luca AL108FUTC40.5130VCD, SUPRAPOND
Luca AL109FUTC40.5130VCD, SUPRAPONDidem 134
Maftei MP119MUAstm+RAFlt/inh+Mometaz/nas36143Dermatita
Maftei MP120MUAB+RAFlt/inh+Mometaz/nas36143idem 89Dermatita
Maftei MP125MUAB+RAMontelukspiroCONTROLAT - se scoate doza Flt/inh
Mainov IM66MUWR+RAMonteluk+Flt/nas35.6120spiroNfrate RA+unchi WRHipertrofie adenoamigdalianaDermat
Mainov IM68MUWR+RAMonteluk+Flt/nas+Flt/inh29121spiroCONTROL MEDIOCRU - adaugat ICSO serfrate WR+ unchi WRRA severaidem 105
Mainov MI71MUAB+RAMonteluk+Flt/inh29120spiroCONTROLATfrateWR/RA+unchi WROBEZ, OASidem 147
Mainov SG40MUWR+RAMonteluk16.5102frateRA+unchi WRPectus escavatum
Mainov SG42MUWR+RAMonteluk16.2103frate WR+ unchi WRPectus escavatumidem 106
Mainov SG44MUWR+RAMonteluk16.5104CONTROLATfrateAB/RA+unchi WRPectus escavatumidem 148-149
Marin DC69MRAB+RAMonteluk18.5109spiroCONTROLATPectus escavatum
Marin EF37FUWR+RAMonteluk1599128NECONTROLAT - ADAUGAT Flt/inh+Deslor+Mometaz/nasRA severa
Marin EF38FUAB+RA1599.5spiroRA severaidem 46
Marin EF40FUAB+RAMonteluk+Flt/inh+Deslor+Mometaz/nas15.6101RA severaidem 109
Marin MA10FRWRMonteluk8.57725M RA, matusa WR
Marinescu AM35FUWR+RAMontelukCONTROLAT PARTIAL - se introd Monetaz/nas
Marin-Gogan M51MURA
Matache M21MRWRMonteluk
Matei A51MUWR+RA625.6%[493]T WR+RABDP
McCollum M87MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroEVOL FAVOR DUPA EXACERB SEVERARA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroRA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26132RA severaidem 112 si 113Dematita
Meita D101MUABFlt/inh HD29134spiro/paneluri+>>T dermat M RA
Meita D101MUABFlt/inh HD29134spiro>>EVOL FAVORT dermat M RAidem 95
Meita D103MUAB[exacerb]+RA29134spiroidem 153, 154
Mereuta R168MUAB+RA50.4164spiro/ +polen
Mereuta R168MUAB+RA50164spiroidem 86
Mihai T72MUWR+RAMonteluk20116Hipertrofie adenoamigdaliana - coblatie
Mihai T73MUWR+RAidem 98
Mirea AM150MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operat
Mirea AM151MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 218
Mirea AM152MUTC+RA56154spiroCONTROLATTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 148, 149
Mirea RMUWR
Mocanita VM60MUTC+RA
Munteanu M204FUAB+RAspiro/poz par pisicaDermatita
Munteanu M206FUAB+RAspiro/poz par pisicaidem 162Dermat
Murata A81MUWR+RAspiro
Naftan DG54MUWR+RAMonteluk+Deslor6594%T RARA severa
Naghy N69FUAB+RAFlt/inh+Mometaz/nas19.5118spiroM RARA severa2 exacerb in 5 luni
Naghy N69FUAB[exacerb]+RAFlt/inh+Mometaz/nas19.5118spiroRA severaidem 175
Naghy N70FUAB+RAFlt/inh+Mometaz/nas+Deslor20118spiroM RARA severaidem 175. 178
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas+Deslor21119spiroCONTROLATM RARA severaidem 123,124, 125
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas20119spiroCONTROLATM RARA severaidem 165-168
Neacsu P17MUTCPneumonii recurente - deficit imuniv A+G select
Neagu AF63MUWR+RA1919Pectus escavatum
Nica TA25MUWR+RAMonteluk17.2EVOL FAVORDermatita ++
Niculae AM42MUWR+RA16.5101RA severa
Niculae AM43MUWR+RAMonteluk16r adv FLTinhEVOL FAVORO CRIZA SEVERAidem 103
Niculeasa MT54FUTC+RA17
Nita-Manu MA48MUWRFlt/inh EPISODICEVOL >3epis WR/an
Novac TMUAB19.5117.8Limfom Hodgkin
Obiziuc A44MUWR+RAFlt/nas21.5112idm 57
Obiziuc A45MUWR+RAFlt/nas21.5112idem 4
Ocheana DA62MRRA17.5113poz pt acarieni2864.20%
Oprea AM55FRTC+RA21.5116spiro
Oprea EA133FRAB+RAMonteluk58144spiroCONTROLATOBEZITATE
Palos VD24MUWR
Pandaru-Rugina D15MURC10.7frate WRStridor laring cong
Pandaru-Rugina MA38MUWR+RAMonteluk16102.5spiro
Pandaru-Rugina MA40MUWR+RAMonteluk16103spiro
Pantile TC83MRWR+RAMonteluk+Flt/inh+Mometaz/nas20119spiroO ser
Pantile TC89MRAB+RAMonteluk+Flt/inh+Monetaz/nas21.5121spiroCONTROLATidem 141
Parascu A48MRWR+RA26119.5spiro284RA severa
Pascu MV99MUWR+RA37140spiro3.5%[232]T WR M WR+Dermatita
Patrascanu FR42MUTC+RAMometa+Deslor151016.2N
Paun Z30FUWR/exacerb usoarasora cu atopieDermatitaINTERNATA
Paunescu T42MUWR+RAT RA severa, M RA+urticarieDermat
Pedrazzini34MRWR+RAFlt/inh+DeslorAgit MontelukO seridem 74
Pedrazzini35MRWR+RAFlt/inh+DeslorRA severaidem 14
Petrescu DA93MUWR+RA21.5125poz acarieni780/234015%
Petrescu J36FUAstm+RAMonteluk+Flt/inh
Picu AE60FUWR16.5104.5ADHD
Pirjolescu FS64FUTC+RAMonteluk+Mometaz/nas25118CONTROLAT
Platteeuw L163MUABFlt/inh63.5180spiroConvalescent Pneumonie cu r pleurala si HRB
Polifrone SM85MUWR+RA24123.7spiro>>
Pop AF74MUWRMonteluk36131OBEZ, hiperemotiv, sechele PC
Popa M54FRWR+RA16104
Popescu A122FRWR+RAMontelukspiro
Popescu AMG88FUAB+RAFlt/inh HD+Monteluk18118spiro/ poz mucegai1256/1788RA severaastm sever
Popescu AMG90FUAB+RAFlt/inh HD+Monteluk18118spiro/poz mucegai1256CONTROLATRA severaidem 189Astm sever
Popescu EM41FUWRMonteluk13.898
Popescu R53MUTC+RA18.5105
Popescu S97MUAB+RA25125spiro808
Popescu VA105MUTC+RAMonteluk+Mometaz/nas+D330130.5232HipoCa
Posea R34MUWR+RAMonteluk+Mometaz/nas14100478Dermat
Posea R35MUWR+RAMonteluk+Mometaz/nas14101478idem 221Dermatita
Puiu CLMUWR+RA23.5119
Radu AAMUAstm+RAspiro
Radu AV158MUTC50155spirofrate TC si EIB
Radu MS37MUWR indVSUPRAPOND
Radu SA121MUTC+RA40139spiro/poz polen238frate TC si EIB
Radulescu MIFUAB+RALoratadina30134spiro25.82.48%mama RA
Radulescu MIFUABMontelukspiroidem 111
Rangu AG41FWR+RA
Rizea DC82MRTC+RA27.7128
Roman E28MUTC13
Sandulescu T85MUWR+RAMonteluk22.2120spiro84CONTROLATDermatita
Sebes LV44MUWR+RA15.5101.5IPLVDermat
Secula TI75MUWR22.3119.5bunica astmDermatita
Setareh SFUTC+RA21.5116RA severaDermat
Simion M57MUAstm+RAMonteluk+Flt/inh+Deslor16375RA severa
Sisu VC48MUWR+RA711RGEDermat
Sisu VC49MUWR+RAMonteluk17105711RA severa
Sitaru ARMRWRpoz par hamster280
Sitaru EDFRWR+RAfrate WR, sensibilizat par hamsterDermat
Sofron D90FRTC+RAMometaz/nas27128spiro6.2VCD
Stan MG41MUWR+RA14.597alergie medic - beta-lactami
Stancescu DG79MRAB20119poz pt acarieni
Stanciu A43FRWR+RA15O ser
Stancu MT94FUAB[exacerb]+RAFlt/inh HD + SABA30138spiro/poz par pisica, calNECONTROLAT - dat ICS+LABA [Symbicort]Dermat++
Stancu MT95FUAB+RASymbicort [ICS+LABA}30138spiro/poz par pisica, calCONTROLAT - scos Symbicort - ICS HD+Montelukidem 243Dermat++
Stanga AM43MUWR+RAMonteluk161025.60%Bunica RARA severa
Stanga AM46MUWR+RAMonteluk+Mometaz/nas+Deslor16104EVOL FAVOR5.60%Bunica RARA severaidem 139
Stanga AM49MUWR+RaMonteluk+Mometaz/nas17107CONTROLAT5.60%Bunica RARA severaidem 244, 245
Stejar T74MRAstm+RAMonteluk21.5121spiro157.8
Stejar T78MUAB+RAMonteluk21.5121spiro/poz polen175.8CONTROLAT AB, pt RA - Mometaz/nasO seridem 226Dermat
Stoica R4MUWR7
Stoican ACMRWR+RA19110
Stoicescu T31MUWR+RAMonteluk17106>>CONTROLATDermatita
Suta DC8MUTC+RADeslor9M dermatita, surori cu WR,
Szilagy A14MUWR+RAMonteluk11.4RA severaDermat
Szilagy DO44MUWR+RA94O ser6%IgA si G usor39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]
PACIENTI NETERMOMETRIZATI[141 PAC din 1753 Prezentati - esantion Ian - Nov 2012]
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Caz Mara A 4 ani 9 luni Mesajul mamei : Atasate sunt analizele recoltate miercuri 07 nov, in a 7-a zi de raceala (zilele 1 si 2 cu febra 38.8C, zilele 3 si 4 cu 37.5C si zilele 6 si 7 cu temperatura normala ziua si cu 35.5C! insotite de transpiratii reci noaptea -- urmate de inca 2 zile cu 35.5C si transpiratiidoar noaptea). []Am asteptat sa-i fac analize in stare de sanatate, dar numai in muci si raceli o tine
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Caz Mara A 4 ani 9 luni Asteptarile / ingrijorarile materne:
Febra este o cauza de ingrijorare [vezi precizia masuratorilor si notarea valorilor!]
Parintele vrea certitudini analize
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Investigatii
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Raspunsul medicului
Investigatiile evoca natura virala a bolii. Mai ales prin numarul relativ scazut de leucocite.
Nu exista elemente de deficit imunologic (valorile diverselor imunoglobuline sunt normale si complementul seric este normal) [...]
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Raspunsul medicului [...]Pana aici nimic semnificativ! Un copil care nu are elemente de infectie acuta NU TREBUIE termometrizat.
Din pacate va mai face viroze. Suntem la inceputul iernii. Pastrati-va energia pentru afectiuni acute...
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Ce facem la un copil febril ?Antibiotice ??Investigatii ??Altceva ?!
Care sunt optiunile terapeutice imediate ?
- OPTIUNILE TERAPEUTICE IMEDIATELa copilul mic [
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Asteptarile parinteluiParintii abordeaza PERSONAL febra cu * :Antipiretice (34,8%)Manevre hipotermizante (49,8%)Medicatie homeopata (3,2%)53,2% cred ca antipireticele sunt nocive!
* Zyoud SH et al - Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine. BMC Pediatr. 2013;13:66.
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Reactia parinteluiParintii pot fi influentati sa administreze corect antitermicele de * :Sfatul medicului (61,7%)Febra foarte mare (14,9%)Recomandarile de prescriptie de pe flaconul de medicament (13,7%)
* Zyoud SH et al - Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine. BMC Pediatr. 2013;13:66.
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FEBRA LA COPILRolul antitermicelor in preventia recurentei convulsiilor febrile
NU scad semnificativ statistic riscul de recurenta *22.7% recurenta cu AT & 24.4% cu placebo
* Rosenbloom E et al - Do antipyretics prevent the recurrence of febrile seizures in children? A systematic review of randomized controlled trials and meta-analysis. Eur J Paediatr Neurol.2013 May 21. pii: S1090-3798(13)00065-2
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FEBRA LA COPILRolul antiinflamatoarelor nesteroidiene in IACRS
Mai degraba NU*Nu reduce evolutia boliiNu scade scorul de simptome
* Kim SY et al - Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev. 2013 Jun 4;6:CD006362.
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PROTOCOALE S R Ped
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FEBRA LA COPILCe putem administra la copil [SRPed]Paracetamolpo sau IR 10-15 mg/kg/doza la 4-6hiv 15 mg/kg/doza la 6hIbuprofenpo 5-10 mg/kg/doza la 6-8hKetoprofenpo 0.5 mg/kg/doza x 3 Schemele alternative la 3h cu Ib+Paracetamol
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Agentia Nationala a Medicamentului
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Agentia Nationala a Medicamentului
- Ibuprofen Suspensie n comparaie cu ParacetamolWalson PD, et al. Clin Pharmacol Ther 1989;46:9-17. Ibuprofen Suspensie 10 mg/kg reduce temparatura semnificativ mai mult dect paracetamol 10 mg/kg (p
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Asocierea alternativ a Ibuprofen si paracetamol este eficace 1,2Nabulsi MM, et al. BMC Med 2006;4:4., 2. Sullivan JE et al Pediatrics 2011 ;127(3):580-7 Metodologia folosit a putut demonstra o non-inferioritate n administrarea alternativ ibuprofen-paracetamol n comparaie cu ibuprofen n monoterapie
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Asocierea Ibuprofen i Paracetamol se dovedete a fi un regim antipiretic eficientHay AD, et al. BMJ 2008;337:a1302 2. Sullivan JE et al Pediatrics 2011 ;127(3):580-7
Terapia combinat se dovedete a fi superioar paracetamol n a scdea perioaadei de manifestare a febrei, efect manifestat n primele 4 ore de dup administrare
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Alte Optiuni
Paracetamol iv [Perfalgan]7mg/kgc/doza Dilutie 1:10 la copil micPev lenta cel putin 30 min [nu iv flush!]Diclofenac supozitoare [Voltaren 50mg]1.5 mg/kgc doza
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FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
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EFECTE ADVERSEEfectele adverse ale antitermicelor
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EFECTE ADVERSE
Acestea depind si de concordanta prescriptiei cu medicamentul cumparatAntitermicele PENTRU copil trebuie cumparrate de la farmacie!9% din recomandarile de AT in alte facilitati decat farmacia au fost eronate*
* Bardage C et al - Non-prescription medicines for pain and fever--a comparison of recommendations and counseling from staff in pharmacy and general sales stores. Health Policy.2013 Apr;110(1):76-83.
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Managementul febreiNu se recomand metode fizice de reducere a febrei [desi populare si frecvent uzitate] DECAT la non-responderi Majoritatea metodelor fizice de scdere a febrei se pot asocia cu reacii adverse severe: cretere paradoxal a febrei datorit vasoconstriciei; tremurturi i frisoane prelungite cu pierdere crescut de energie; hipoglicemie sever, com, deces (mpachetrile cu alcool).Management of Fever in Children: Summary of the Italian Pediatric Society Guidelines. Clinical Therapeutics Volume 31, Number 8, 2009
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Managementul febrei
mpachetrile cu ap cldu nu se asociaz cu aceste efecte adverse severe, dar pot determina disconfort.Management of Fever in Children: Summary of the Italian Pediatric Society Guidelines. Clinical Therapeutics Volume 31, Number 8, 2009
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FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
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CONCLUZIIFebra este foarte frecvent intalnita!Prima cauza de prezentare la MFA doua cauza de spitalizare la copil
Febra este temuta fever phobiaDe parintiDe medici
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CONCLUZIIFebra este deseori evaluata eronat!Parintii termometrizeaza copilul febril in mod corect doar in 1/3 cazuri
Combaterea febrei este temuta de parinti~ parinti considera antitermicele nocive
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CONCLUZII
Din fericire majoritatea parintilor (>60%) rezoneaza favorabil la indicatiile medicului privind medicatia hipotermizanta
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Ibuprofenul intruneste aceste expectative parentale dar si ale mediculuiSingur [in doza 10mg/kgc x 3/zi]Sau in asociere cu Paracetamol [de prima intentie in febra + durere]
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CONCLUZII
Brufenul are ca avantaje:SIGURANTASuspensie vascoasa care nu curge usor prin capac si nu poate fi bauta accidental de copilDozare precisa si individualizataEFICIENTAAtat singur cat si in combinatie cu paracetamol
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LECTURA SUPLIMENTARAPentru cei interesati de problematica febrei la copil Ghidul de Practica al Academiei Americane de Pediatrie 2011 Committee on Drugs, Section on Clinical Pharmacology and Therapeutics
http://pediatrics.aappublications.org/content/127/3/580.long
**Methods: Single-dose, placebo-controlled, double-blind, parallel-group studyCompared the efficacy, tolerability and dose-response of BRUFEN Syrup and paracetamol in 127 children (aged 2 to 11 years) with oral temperatures between 38.3C and 40.0CRandomised to BRUFEN Syrup 5 mg/kg (n=32), BRUFEN Syrup 10 mg/kg (n=28), paracetamol 10 mg/kg (n=33), or placebo (n=34)Children stratified into four groups depending on whether they were receiving concomitant oral antibiotics and whether they had low (38 to 39.1C) or high (39.2 to 40.0C) baseline oral temperatures1Results: 118 children included in the efficacy analysisAll active treatment agents were well-tolerated and significantly more effective than placebo (p