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91.
Suresh Kumar Alka Khadwal Sanjay Verma Sunit C. Singhi 《Indian journal of pediatrics》2013,80(5):421-422
An 11-year-old boy presented with epistaxis, petechial hemorrhages, easy bruising, and purpuric rash. He was diagnosed to have immune thrombocytopenic purpura and evidence of concomitant parvovirus B19 and dengue viral infection. 相似文献
92.
Sore throat is one of the common reasons for outpatient and emergency visits among children. It could be because of several
etiologies; of these bacterial pharyngitis is the most important. Major challenge for the clinician is to diagnose group A
beta hemolytic streptococcus (GABHS) pharyngitis and diphtheria, which are associated with serious complications. Throat swab
smear with culture and rapid antigen tests are useful for making the diagnosis but the later may not be available in resource
poor settings. Many clinical scores have been devised to diagnose GABHS with variable success but usually clinical features,
epidemiological criteria and expert clinical judgment with or without supportive investigations indicate need for antibiotics.
A child with sore throat and toxic look may have diphtheria or parapharyngeal/retropharyngeal abscess, and therefore should
be hospitalized. 相似文献
93.
Chest pain is a worrisome symptom that often causes parents to bring their child to emergency department(ED) for evaluation.
In the majority of cases, the etiology of the chest pain is benign, but in one-fourth of the cases symptoms are distressing
enough to cause children to miss school. The clinician’s primary goal in ED evaluation of chest pain is to identify serious
causes and rule out organic pathology. The diagnostic evaluation includes a thorough history and physical examination. Younger
children are more likely to have a cardiorespiratory source for their chest pain, whereas an adolescent is more likely to
have a psychogenic cause. Children having an organic cause of chest pain are more likely to have acute pain, sleep disturbance
due to pain and associated fever or abnormal examination findings, whereas those with non-organic chest pain are more likely
to have pain for a longer duration. Chest radiograph is required in some, especially in patients with history of trauma .
In children, myocardial ischemia is rare, thus routine ECG is not required on every patient. However, both pericarditis and
myocarditis can present with chest pain and fever. Musculoskeletal chest pain, such as caused by costochondritis and trauma,
is generally reproducible on palpation and is exaggerated by physical activity or breathing. Pneumonia with or without pleural
effusion, usually presents with fever and tachypnea; chest pain may be presenting symptom sometimes. In asthmatic children
bronchospasm and persistent coughing can lead to excess use of chest wall muscles and chest pain. Patients’ who report acute
pain and subsequent respiratory distress should raise suspicion of a spontaneous pneumothorax or pneumomediastinum. ED management
includes analgesics, specific treatment directed at underlying etiology and appropriate referral. 相似文献
94.
95.
Raised intracranial pressure is a life threatening condition; unless recognized and treated early, it may progress into herniation
syndrome and death. Symptoms and signs are neither sufficiently sensitive nor specific, hence a high index of suspicion and
vigilance are needed for early recognition. Immediate goal of management is to prevent / reverse herniation and to maintain
good cerebral perfusion pressure. The therapeutic measures include stabilization of airway, breathing and circulation, along
with neutral neck position, head end elevation by 30°, adequate sedation and analgesia, minimal stimulation, and hyperosmolar
therapy (mannitol or 3% saline). Short-term hyperventilation (to achieve PCO2 ≈ 30 mm Hg) using bag ventilation can be resorted to if signs of impending herniation are present. 相似文献
96.
Objectives
To understand the characteristics of autistic regression and to compare the clinical and developmental profile of children with autism spectrum disorders (ASD) in whom parents report developmental regression with age matched ASD children in whom no regression is reported. 相似文献97.
98.
Bloodstream infections (BSI) are the commonest cause of nosocomial infections (NI) in PICU. Knowledge about their magnitude, risk factors and outcome are important in devising appropriate prevention and control measures. Our objective was to study the incidence, etiology, risk factors and outcome of primary BSI in PICU. A prospective cohort of 285 patients consecutively admitted to PICU from July 2003-04, having a stay of >48 h, were enrolled and monitored for BSI till discharge from ICU or death. Primary BSI was defined as per CDC criteria 1988. Data of patients with BSI was compared with those without BSI with respect to demographic details, PRISM III, primary diagnosis, nutritional status, device utilization and invasive procedures to identify risk factors for BSI. Variables significant on univariate analysis were subjected to multiple logistic regression analysis. Outcome was measured as length of PICU stay (LOS) and survival or death. There were 116 episodes of primary BSI in 86 (30%) patients; the incidence being 31.2 episodes/1000 patient days. The mean age of the patients with BSI was 3.7 +/- 3.5 years. Predominant isolates were Gram-negative (53.5%); Klebsiella pneumoniae (n = 21) being the commonest. Staphylococcus aureus (n = 18) was the most common Gram-positive organism. Seven of the 9 (77.8%) yeast isolates were Candida tropicalis. Younger age, higher PRISM III, lower hemoglobin, pre-existing infection, higher frequency and duration of device utilization (CVC, urinary catheter, endotracheal tube, mechanical ventilation) were significant risk factors on univariate analysis. On multiple logistic regressions, hemoglobin (OR 1.24, 95% CI 1.1-1.4, p = 0.002) duration of urinary catheter (OR 0.91, 95% CI 0.84-0.98, p = 0.015) and pre-existing infection (OR 0.46, 95% CI 0.23-0.93, p = 0.03) were independent risk factors for primary BSI. The median LOS was significantly longer in patients with BSI compared to those without (16 vs. 7 days, p = 0.0001) 47% of patients with BSI died as compared to 26% deaths in the whole cohort (p = 0.002). Just over half the cases of BSI in our PICU were caused by Gram-negative bacteria. Lower hemoglobin, pre-existing infection and prolonged duration of urinary catheter were independent risk factors identified on multivariate analysis. BSI was associated with significantly higher mortality and longer stay in our PICU. 相似文献
99.
Strangulation is a common method of committing murder, though underreported in Indian literature. We managed a girl child,
victim of child abuse who later succumbed to its neurological complications. This case report describes the clinical features
associated with such injuries and complications which should be anticipated in such cases. 相似文献
100.
Dhanalakshmi Angappan Jitendra K. Sahu Prahbhjot Malhi Pratibha Singhi 《European journal of paediatric neurology》2019,23(1):136-142
West syndrome is a distinct, infantile onset, epileptic encephalopathy, associated with poor neurodevelopmental outcome. The present study was designed as a randomized, open-label, pilot study to evaluate the safety, feasibility, and effectiveness of oral zonisamide therapy in comparison with adrenocorticotropic hormone therapy in infants with West syndrome. Thirty infants with West syndrome were randomized to receive treatment with either synthetic, intramuscular adrenocorticotropic hormone (30–60 IU) or oral zonisamide (4–25 mg/kg/day). The study participants had a long treatment lag and preponderance of male sex (90%). The primary effectiveness outcome measure was the cessation of epileptic spasms at 2 weeks of initiation of therapy and persistent till 6 weeks as per West Delphi consensus statement recommendations. Comparison of efficacies of zonisamide versus adrenocorticotropic hormone was as following: the cessation of epileptic spasms (27% vs. 40%, p = 0.70), resolution of hypsarrhythmia at 14 days (20% vs. 33%, p = 0.68) and resolution of hypsarrhythmia at 6 weeks (36% vs. 71%, p = 0.14). Overall, the study observed a poor efficacy of both adrenocorticotropic hormone and zonisamide therapy, which is probably due to long treatment lag and a high proportion of structural aetiology. However, oral zonisamide appeared to be safe and tolerable in the study. 相似文献