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1.
Background
Brucella has been known to cause pyrexia of unknown origin.Case Characteristics
9-year-old boy with fever and abdominal pain; multiple abscesses within the liver on ultrasonography.Observations
IgM Antibodies against Brucella were raised in his serum sample, and Brucella serum agglutination test was positive. Immunological work-up suggested selective IgA deficiency. Reduction in size following treatment with trimethoprim-sulphamethoxazole, amikacin and doxycycline.Message
Brucellosis should be considered as an etiology of liver abscess in patients not responding to conventional antibiotics.2.
Hee Mang Yoon Jung Heon Kim Jong Seung Lee Jeong-Min Ryu Dae Yeon Kim Jeong-Yong Lee 《World journal of pediatrics : WJP》2018,14(2):184-190
Background
Appendicolith can cause appendiceal obstruction and acute appendicitis. Its high prevalence may be related to the high perforation rate in pediatric appendicitis. This study assessed the characteristics of appendicolith and its clinical significance in pediatric appendicitis.Methods
A retrospective study was performed among children and adolescents younger than 17 years who were preoperatively diagnosed with appendicitis in the pediatric emergency department (ED). A total of 269 patients with a mean age of 9.98 ± 3.37 years were enrolled. Clinical features and contrast-enhanced computed tomography findings were analyzed.Results
Among the 269 patients, 147 (54.6%) had appendicoliths, with a mean maximal diameter of 5.21 ± 2.34 mm. Compared to the no appendicolith group, the appendicolith group demonstrated more prolonged abdominal pain (≥ 48 hours) before the ED visit (23.1% vs. 11.5%; P = 0.013), clinical features of severe appendicitis (presence of fever, vomiting, positive urine ketone, and increased C-reactive protein), and higher rate of perforation (43.5% vs. 9.8%; P < 0.001). Multivariate risk factor analysis for perforated appendicitis in the appendicolith group revealed that maximal diameter of 5 mm or more in the appendicolith (adjusted odds ratio [aOR] 2.919; 95% CI 1.325–6.428, P = 0.008) and proximal collapse adjacent to the appendicolith (aOR 2.943; 95% CI 1.344–6.443, P = 0.007) were significant.Conclusions
Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and severe clinical conditions with a high risk of perforation.3.
Background
Oral polio vaccine can rarely lead to Vaccine-associated paralytic poliomyelitis (VAPP).Case characteristics
A 2-year-old child with asymmetric paralysis of lower limbs following first booster of oral polio vaccine; type 2 Vaccine-derived poliovirus (VDPV) isolated. Subsequently, the child was diagnosed to have common variable immunodeficiency.Outcome
Paralysis gradually improved on follow-up; monthly intravenous immunoglobulin therapy started for primary immunodeficiency.Message
We need to evaluate children with VAPP for underlying immunodeficiency.4.
Background
Atrial flutter not responding to medications could be secondary to structural malformations of heart.Case characteristics
A 5-year-old child with resistant arrhythmia, with onset in neonatal period.Outcome
Multiple right atrial diverticuli were detected on CT angiography and cardiac catheterization. Patient reverted to sinus rhythm following surgical excision of diverticuli.Message
In cases of intractable supraventricular tachycardia, structural anomalies of atrium should be suspected.5.
Background
The clinical management of intravenous immunoglobulin-resistant Kawasaki disease shock syndrome (KDSS) is obscure.Case characteristics
Three children presented with intravenous immunoglobulin-resistant KDSS complicated with myocarditis.Outcome
All cases were successfully managed with steroid pulse therapy.Message
Steroid pulse therapy is effective in immunoglobulin-resistant KDSS.6.
Background
Synovial arteriovenous malformation is rare.Case characteristics
We present three children with recurrent monoarthritis secondary to synovial arteriovenous malformation.Outcome
Two children underwent excision of arteriovenous malformation. Another child had diffuse arteriovenous malformation, which was inoperable.Message
Synovial arteriovenous malformations should be considered in the differential diagnosis of monoarthritis, especially of the knee.7.
Background
A recent randomized control trial in children with steroid-resistant nephrotic syndrome revealed that two doses of rituximab did not reduce proteinuria.Case characteristics
A 14-month-old boy developed refractory steroid-resistant nephrotic syndrome due to focal segmental glomerulosclerosis.Observation
The patient achieved complete remission 11 months after disease onset following eight doses of rituximab combined with steroids and cyclosporine.Message
Long-lasting B cell depletion with repeated rituximab administrations may be required to achieve complete remission in patients with steroid-resistant nephrotic syndrome and massive proteinuria.8.
Background
Foreign bodies in the airway can be a diagnostic and therapeutic challenge.Case characteristics
30-month-old girl with complaints of noisy and fast breathing following fall over a pile of sand. Sand was suctioned out by direct bronchoscopy. The child improved initially but condition worsened in next four days with marked stridor and wheeze.Observation
Imaging revealed elongated sharp radiodense opacity in the cervical region, suggestive of foreign body. At repeat bronchoscopy, paint material was removed from the airway, leading to recoveryMessage
Paint material mixed in the sand can adhere to the walls of the airway, and cause persistent symptoms of obstruction.9.
Vasanthan Tanigasalam B. Vishnu Bhat Sharmila Manivannan Malathi Munisamy Swapnil Parchand 《Indian pediatrics》2018,55(7):601-602
Background
Schimmelpenning syndrome is a multisystem disorder.Case characteristics
A term female neonate with sebaceous nevi of the face had choroid osteoma of the right eye.Observation
At one month of age, the infant was observed to have choroidal neovascularization that was successfully treated with laser photocoagulation and anti-VEGF.Message
Choroid osteoma and neovascularization are rare associations of Schimmelpenning syndrome, and should be screened for and managed early.10.
Sankalp Dudeja Pooja Sikka Kajal Jain Vanita Suri Praveen Kumar 《Indian pediatrics》2018,55(9):761-764
Objective
To improve the rates of first hour initiation of breastfeeding in neonates born through cesarean section from 0 to 80% over 3 months through a quality improvement (QI) process.Design
Quality improvement study.Setting
Labor Room-Operation Theatre of a tertiary care hospital.Participants
Stable newborns ≥35 weeks of gestation born by cesarean section under spinal anesthesia.Procedure
A team of nurses, pediatricians, obstetricians and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by Process flow mapping and Fish bone analysis. Various change ideas were tested through sequential Plan-Do- Study-Act (PDSA) cycles.Outcome measure
Proportion of eligible babies breast fed within 1 hour of delivery.Results
The rate of first-hour initiation of breastfeeding increased from 0% to 93% over the study period. The result was sustained even after the last PDSA cycle, without any additional resources.Conclusions
A QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in cesarean deliveries.11.
Background
Inflammatory myofibroblastic tumors of the trachea are rare childhood quasi-neoplastic lesions.Case characteristics
7-year-old boy with recurrent episodes of cough, breathing difficulty and wheeze, initially treated as asthma.Intervention
CT chest and flexible bronchoscopy revealed a mass lesion of the trachea, which was excised by diode laser through the ventilating bronchoscope. Histopathology confirmed it as the inflammatory myofibroblastic tumor.Message
Use of laser ensured complete endotracheal excision of the tumor.12.
Background
Blue rubber bleb nevus syndrome is a rare disease involving venous malformations.Case characteristics
We present a 6-year-old female with the syndrome, and consumptive coagulopathy.Intervention/Outcome
After management with sirolimus, symptoms resolved.Message
Sirolimus may be a valuable option for reducing bleeding complications and cosmetic sequelae for the patients with this syndrome.13.
Background
Neuromelioidosis is a rare conduction, which is difficult to diagnose and treat.Case characteristics
Preadolescent girl presenting with prolonged fever, acute ascending paralysis and encephalopathy.Outcome
Neuromelioidiosis was confirmed on brain biopsy culture. Patient improved with an intensive antibiotic regimen.Message
Neuromelioidosis can mimic acute demyelinating encephalomyelitis clinically and radiologically.14.
Nevitha Athikari Manamal Tanu Singhal Abhaya Kumar Darshana Sanghvi Jayanti Mani 《Indian pediatrics》2018,55(11):993-994
Background
Neuroschistosomiasis is an uncommonly reported disease.Case characteristics
An adolescent Indian boy residing in Kenya presented with headache, visual symptoms and seizures, with MRI showing space-occupying lesions in the occipital lobe and cerebellum.Observation
Brain biopsy was diagnostic of neuro-schistosomiasis; complete recovery was seen with praziquantel and corticosteroid therapy.Message
This case highlights the importance of considering epidemiology in differential diagnosis and establishing definitive diagnosis even if it is by invasive methods.15.
Background
Congenital tracheobiliary fistula is a rare developmental anomaly with a persistent communication between the biliary system and the trachea.Characteristics
A 7-day-old baby with severe respiratory distress and aspiration pneumonia.Outcome
Tracheobilliary fistula identified on bronchoscopy. Open surgical excision of fistula was followed by improvement.Message
This condition should be considered in the differential diagnosis of intractable aspiration pneumonia.16.
M. Joseph John Chepsy C. Philip Amrith Mathew Abhilasha Williams Naveen Kakkar 《Indian pediatrics》2017,54(4):327-328
Background
Allogeneic stem cell transplant is the only curative treatment for Wiskott-Aldrich syndrome.Case characteristics
18-months-old boy with no sibling, cord blood or matched unrelated donor transplant options.Outcome
Doing well 7 years after haploidentical stem cell transplantation using unmanipulated bone marrow as the stem cell source.Message
Father as a haplo-identical donor is a feasible option.17.
Background
Immunodeficient children are more prone for invasive cryptococcal infections.Case characteristics
A 2-year-old boy with disseminated cryptococcosis was evaluated for underlying immunodeficiency without success.Intervention/outcome
Child was managed successfully.Message
Immunocompetent children with disseminated cryptococcosis can present diagnostic or therapeutic challenge in resource-limited settings.18.
Background
Tyrosine Hydroxylase deficiency is a rare neurotransmitter disorder.Case Characteristics
An Indian family with the disorder.Observation
Phenotypic variation, elevated serum prolactin, genetic confirmation, and partial treatment-responsiveness.Messages
Tyrosine Hydroxylase deficiency is a treatable inborn error of metabolism and serum prolactin assists in diagnosis.19.
Objective
To develop nomogram of Transcutaneous Bilirubin among healthy term and late-preterm neonates during first 96 hours of age.Design
Longitudinal observational study.Setting
Neonatal unit of a tertiary care Hospital of Central Gujarat, India.Participants
1075 healthy term and late preterm neonates (≥35weeks).Intervention
Six-hourly transcutaneous bilirubin was obtained from birth to 96 hour of life using Drager JM 103 Transcutaneous Bilirubinometer.Main outcome measures
Nomogram of Transcutaneous Bilirubin with percentile values was obtained, rate of rise of bilirubin was calculated and predictive ability of normative data was analyzed for subsequent need of phototherapy.Results
The age-specific percentile curves and nomogram were developed from the transcutaneous bilirubin readings of 1,010 neonates. Rate of rise in first 12 hour was 0.2 mg/dL and was 0.17 mg/dL in 12 to 24 hour of life which decreased on second day of life. Neonates who required phototherapy had consistently higher readings of transcutaneous bilirubin and also higher rate of rise in first 48 hrs.Conclusion
Neonates whose transcutaneous bilirubin is above the 50th percentile should be monitored for the development of significant hyperbilirubinemia.20.
Kln Rao Prema Menon R Samujh Jk Mahajan M Bawa Ma Malik Br Mittal 《Indian pediatrics》2018,55(12):1046-1049