Neonataalne hemokromatoos ei osutunud fataalseks haiguseks

Neonataalne hemokromotoos on harva esinev halva prognoosiga raualadestushaigus. Raua ladestumine loote organismi algab umbes 24. rasedusnädalal. Rasedus võib sel puhul lõppeda loote surma, enneaegsuse või arengupeetusega. Edasine haiguse kulg on progresseeruv ja lõpeb sageli surmaga. Nüüdisaegse meditsiini kasutuses ei ole võimalusi haiguse avastamiseks looteeas. Vastsündinul avaldub haigus hemor- raagilise ja raske maksa puudulikkuse sündroomina. Haiguse etioloogia ei ole lõplikult selge. Haiguse mõõduka väljendusastme korral võib ravi, mis on suunatud liigse raua eemaldamisele organismist, ja antioksüdantravi osutuda tulemuslikuks. Samuti võib maksa siirdamine olla tõhus ravimeetod. Eesti Arst 2007; 86 (5): 354–35

Pharmacokinetics of penicillin G in preterm and term neonates.

Group B streptococci are common causative agents of early-onset neonatal sepsis (EOS). Pharmacokinetic (PK) data for penicillin G have been described for extremely preterm neonates but poorly for late-preterm and term neonates. Thus, evidence-based dosing recommendations are lacking. We described PK of penicillin G in neonates with gestational age (GA) ≥32 weeks and postnatal age 90% for MICs ≤2 mg/L with doses of 25,000 IU/kg/q12h. In neonates, regardless of GA, PK parameters of penicillin G are similar. The dose of 25,000 IU/kg/q12h is suggested for treatment of group B streptococcal EOS diagnosed within the first 72 hours of life

Valguse levik ühemoodilistes optilistes nanofiibrites

http://tartu.ester.ee/record=b2693091~S1*es

Rahvusvaheline rakendusteatri loomeplatvorm ja konverents "Draama ühendab inimesi: teater elukestvas õppes"

http://www.ester.ee/record=b4483303*es

Climate Benefit of Different Tree Species on Former Agricultural Land in Northern Europe

The new European Union Forest Strategy for 2030 aims to plant an additional 3 billion trees on non-forest land to mitigate climate change. However, the choice of tree species for afforestation to achieve the maximum climate benefit is unclear. We compared the climate benefit of six different species in terms of carbon (C) sequestration in biomass and the harvested wood substitution in products to avoid carbon dioxide (CO2) emissions from fossil-based materials over the 100-year period by afforesting about 1/4 of the available area in northern Europe. The highest climate benefit was observed for larch, both at a stand scale (1626 Mg CO2 eqv. ha(-1)) and at the landscape level for the studied scenario (579 million Mg CO2 eqv.). Larch was followed by Norway spruce, poplar, hybrid aspen and birch, showing a climate benefit about 40-50% lower than that for larch. The climate benefit of willow was about 70% lower than larch. Willow showed 6-14-fold lower C stocks at the landscape level after 100 years than other tree species. The major climate benefit over the 100-year period comes from wood substitution and avoided emissions, but C stock buildup at the landscape level also removes significant amounts of CO2 already present in the atmosphere. The choice of tree species is important to maximize climate change mitigation

C-reaktiivse valgu dünaamika ennustamine meropeneemravi ajal vastsündinutel ja imikutel

Eesti Arst 2024; 103(10):52

Pharmacokinetic-Pharmacodynamic Modeling in Pediatric Drug Development, and the Importance of Standardized Scaling of Clearance.

Pharmacokinetic/pharmacodynamic (PKPD) modeling is important in the design and conduct of clinical pharmacology research in children. During drug development, PKPD modeling and simulation should underpin rational trial design and facilitate extrapolation to investigate efficacy and safety. The application of PKPD modeling to optimize dosing recommendations and therapeutic drug monitoring is also increasing, and PKPD model-based dose individualization will become a core feature of personalized medicine. Following extensive progress on pediatric PK modeling, a greater emphasis now needs to be placed on PD modeling to understand age-related changes in drug effects. This paper discusses the principles of PKPD modeling in the context of pediatric drug development, summarizing how important PK parameters, such as clearance (CL), are scaled with size and age, and highlights a standardized method for CL scaling in children. One standard scaling method would facilitate comparison of PK parameters across multiple studies, thus increasing the utility of existing PK models and facilitating optimal design of new studies

Ampitsilliini farmakokineetika enneaegsetel ja ajalistel vastsündinutel esimesel elunädalal

Eesti Arst 2022; 101(2):12

Plasma and CSF pharmacokinetics of meropenem in neonates and young infants: results from the NeoMero studies.

Background: Sepsis and bacterial meningitis are major causes of mortality and morbidity in neonates and infants. Meropenem, a broad-spectrum antibiotic, is not licensed for use in neonates and infants below 3 months of age and sufficient information on its plasma and CSF disposition and dosing in neonates and infants is lacking. Objectives: To determine plasma and CSF pharmacokinetics of meropenem in neonates and young infants and the link between pharmacokinetics and clinical outcomes in babies with late-onset sepsis (LOS). Methods: Data were collected in two recently conducted studies, i.e. NeoMero-1 (neonatal LOS) and NeoMero-2 (neonatal meningitis). Optimally timed plasma samples (n = 401) from 167 patients and opportunistic CSF samples (n = 78) from 56 patients were analysed. Results: A one-compartment model with allometric scaling and fixed maturation gave adequate fit to both plasma and CSF data; the CL and volume (standardized to 70 kg) were 16.7 (95% CI 14.7, 18.9) L/h and 38.6 (95% CI 34.9, 43.4) L, respectively. CSF penetration was low (8%), but rose with increasing CSF protein, with 40% penetration predicted at a protein concentration of 6 g/L. Increased infusion time improved plasma target attainment, but lowered CSF concentrations. For 24 patients with culture-proven Gram-negative LOS, pharmacodynamic target attainment was similar regardless of the test-of-cure visit outcome. Conclusions: Simulations showed that longer infusions increase plasma PTA but decrease CSF PTA. CSF penetration is worsened with long infusions so increasing dose frequency to achieve therapeutic targets should be considered

Coagulase negative staphylococcal sepsis in neonates: do we need to adapt vancomycin dose or target?

BACKGROUND: Despite differences in types of infection and causative organisms, pharmacokinetic-pharmacodynamic (PKPD) targets of vancomycin therapy derived from adult studies are suggested for neonates. We aimed to identify doses needed for the attainment of AUC/MIC > 400 and AUC/MIC > 300 in neonates with sepsis and correlate these targets with recommended doses and treatment outcome. METHODS: Neonates who had Vancomycin therapeutic drug monitoring (TDM) performed between January 1, 2010 and December 31, 2012 were studied. Clinical characteristics, episodes of Gram-positive sepsis with outcomes and all neonatal blood culture isolates in hospital were collected from medical records. To estimate probability of target attainment of AUC/MIC >400 and AUC/MIC >300 a 1000-subject Monte Carlo simulation was performed by calculating AUC using Anderson’s (Anderson et al. 2006) and TDM trough concentrations (C(trough)) based population PK models. RESULTS: Final dataset included 76 patients; 57 with confirmed Gram-positive sepsis. TDM was taken after the 1(st) to 44(th) dose. 84.1% of C(trough) were within the range 5–15 mg/L. Currently recommended doses achieved probability of the targets (PTA) of AUC/MIC >400 and AUC/MIC >300 in less than 25% and 40% of cases, respectively. Doses required for 80% PTA of AUC/MIC > 400 for MIC ≥2 mg/L resulted in C(trough) values ≥14 mg/L. Mean AUC/MIC values were similar in treatment failure and success groups. CONCLUSION: With currently recommended vancomycin dosing the therapeutic target of AUC/MIC > 400 is achieved only by 25% of neonates. Appropriate PKPD targets and respective dosing regimens need to be defined in prospective clinical studies in this population