Jornal de pediatria
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To critically discuss the treatment of metabolic acidosis and the main mechanisms of disease associated with this disorder; and to describe controversial aspects related to the risks and benefits of using sodium bicarbonate and other therapies. ⋯ Despite the known effects of acidemia on the organism in critical situations, a protective role of acidemia in hypoxic cells and the risk of alkalemia secondary to drug interventions are being considered. There is consensus regarding the advantages of alkali and sodium bicarbonate therapy in cases with normal anion gap; however, in the presence of high anion gap acidosis, especially lactic acidosis, diabetic acidosis and cardiopulmonary resuscitation, the use of sodium bicarbonate is not beneficial and has potential adverse effects, limiting its indication. The only points of agreement in the literature refer to the early treatment of the underlying disease and the mechanisms generating metabolic acidemia. Other promising treatment alternatives have been proposed; however, the side effects and absence of controlled studies with pediatric populations translate into lack of evidence to support the routine use of such treatments.
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To review the literature relevant to diagnosis and management of meningococcal disease (MD). ⋯ MD is a life-threatening infection that requires early recognition and treatment. Time sensitive fluid resuscitation and antibiotic therapy are the most effective therapies for MD. Other therapies such as steroids may have a place in MD treatment but more definitive studies are necessary.
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Jornal de pediatria · May 2007
ReviewThe new guidelines for cardiopulmonary resuscitation: a critical analysis.
To describe the new American Heart Association (AHA) guidelines for pediatric life support, based on the scientific evidence evaluated by the International Liaison Committee on Resuscitation, and endorsed and disseminated by North American resuscitation councils. ⋯ The most recent AHA guidelines for pediatric resuscitation are focused primarily on basic life support care. They are based on the best available scientific evidence, although further research is required to validate these changes and provide new evidence for future guidelines.
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Jornal de pediatria · May 2007
ReviewNew guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients.
To provide a foundation for the diagnostic, prophylactic and therapeutic management of febrile neutropenia and sepsis in children with oncological diseases, with special attention to new protocols and guidelines. ⋯ Oncology patients are particularly vulnerable to infectious complications. Early identification and treatment are fundamental to improving survival rates.
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Jornal de pediatria · May 2007
ReviewDengue and dengue hemorrhagic fever: management issues in an intensive care unit.
To describe the epidemiology, clinical features and treatment of dengue fever and dengue shock syndrome. ⋯ There is no specific therapy for dengue infections. Good supportive care may be lifesaving, but ultimately initiatives aimed at vector control and prevention of mosquito bites may provide the greatest benefits.