scholarly journals Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Dzulfikar D. L. Hakim ◽  
Ahmad Faried ◽  
Adila Nurhadiya ◽  
Ericko H. Laymena ◽  
Muhammad Z. Arifin ◽  
...  
Keyword(s):  
Rare Case ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Pediatric Intensive Care ◽  
Toxin Production ◽  
Clostridium Tetani ◽  
Anesthetic Care ◽  
Middle Income ◽  
Depressed Skull Fracture ◽  
Low Middle Income Countries

Abstract Background Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low–middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group. Case presentation We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw.” Perioperative management of this rare case is reported and discussed. Conclusion The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.

scholarly journals Infected Open Depressed Skull Fracture Complicated with Tetanus Grade I in an Unimmunized Child: A Rare Case Report with Literature Review

2020 ◽  
Author(s):  
Dzulfikar Lukmanul ◽  
Ahmad Faried ◽  
Adila Nurhadiya ◽  
Ericko H. Laymena ◽  
Muhammad Z. Arifin ◽  
...  
Keyword(s):  
Rare Case ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Pediatric Intensive Care ◽  
Toxin Production ◽  
Clostridium Tetani ◽  
Middle Income ◽  
Depressed Skull Fracture ◽  
Anaesthetic Care ◽  
Low Middle Income Countries

Abstract Background: Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low-middle income countries, tetanus still occurs (mostly in adult) due to the lack of immunization related to religious tenets, cultural belief or inaccesibility to medical care. In addition, tetanus in pediatric population shows features which are quite distinct from the adult group. Case Description: We reported a 7 year old girl that presented to our institution with a history of falling 10 days prior the admission, with only skin laceration of her forehead. Since one day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed as unimmunized child with open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw”. Perioperative management of that rare case is reported and discussed. Conclusion: This case is so exceptional, since the infected open depressed skull fracture complicated with trismus in an unimmunized child occurrence in our center is extremely rare; the pediatric intensive care of such patients requires halting further toxin production, neutralisation of circulating toxin and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tents of anaesthetic care in such case had to well managed and planned prior the surgery.

scholarly journals Management of early appendicular lump in children - laparoscopic technique versus open surgery: a comparative study in low-middle income country perspective

2020 ◽  
Vol 3 (2) ◽  
pp. e000131
Author(s):  
Mohammad Zonaid Chowdhury ◽  
Md Abdullah Al Farooq ◽  
M A Mushfiqur Rahman ◽  
Tanvir Kabir Chowdhury
Keyword(s):  
Pediatric Population ◽  
Treatment Plan ◽  
Open Appendectomy ◽  
Laparoscopic Technique ◽  
Eligibility Criteria ◽  
Laboratory Findings ◽  
Middle Income ◽  
Medical College ◽  
Low Middle Income Countries ◽  
Surgery Department

BackgroundIn the pediatric population, appendectomy is one of the most common emergency operations. Laparoscopic appendectomy (LA) is an accepted way of dealing with suspected uncomplicated appendicitis in children. The role of laparoscopy in appendicular lump is more controversial and remains undefined and is not well practiced in low-middle income countries. The aim of this study was to determine a better surgical treatment plan for early appendicular lump in children.MethodsThis prospective observational study was performed in Pediatric Surgery Department of Chittagong Medical College and Hospital for a period of 1 year from April 2018 to March 2019. Sixty children with appendicular lump selected consecutively as per eligibility criteria underwent either LA or open appendectomy (OA), that is, 30 children per group. They were followed up until hospital discharge to observe outcomes.ResultsThere were no differences in terms of patient’s age, sex, clinical presentation and laboratory findings between the two groups. Postoperative pain severity was significantly less in the LA group than that in the OA group (p<0.01). The incidence of wound infection was significantly lower in the LA group than that in the OA group (6.7% in LA and 46.7% in OA; p<0.01). Children in the LA group had a shorter duration of hospital stay in comparison to the OA group [median (IQR) was 8 (5.75–11.25) days and 12 (7.75–18.00) days, respectively, in LA and OA groups; p=0.01].ConclusionThe study findings suggest that LA is feasible and should replace OA in cases of early appendicular lump in children.

scholarly journals Cost analysis of pediatric intensive care: a low-middle income country perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amrit Kaur ◽  
Muralidharan Jayashree ◽  
Shankar Prinja ◽  
Ranjana Singh ◽  
Arun K. Baranwal
Keyword(s):  
Intensive Care ◽  
Health System ◽  
Pediatric Intensive Care ◽  
Major Portion ◽  
Severe Illness ◽  
Tertiary Level ◽  
Middle Income ◽  
System Cost ◽  
Health System Cost ◽  
Low Middle Income Countries

Abstract Background Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. In low middle-income countries, out of pocket expenditure (OOP) constitutes a major portion of the total expenditure. This makes it important to gain insights into the cost of pediatric intensive care. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during PICU stay. Methods Prospective study conducted in a state of the art tertiary level PICU of a teaching and referral hospital. Bottom-up micro costing methods were used to assess the health system cost. Annual data regarding hospital resources used for PICU care was collected from January to December 2018. Data regarding OOP was collected from 299 patients admitted from July 2017 to December 2018. The latter period was divided into four intervals, each of four and a half months duration and data was collected for 1 month in each interval. Per patient and per bed day costs for treatment were estimated both from health system and patient’s perspective. Results The median (inter-quartile range, IQR) length of PICU stay was 5(3–8) days. Mean ± SD Pediatric Risk of Mortality Score (PRISM III) score of the study cohort was 22.23 ± 7.3. Of the total patients, 55.9% (167) were ventilated. Mean cost per patient treated was US$ 2078(₹ 144,566). Of this, health system cost and OOP expenditure per patient were US$ 1731 (₹ 120,425) and 352 (₹ 24,535) respectively. OOP expenditure of a ventilated child was twice that of a non- ventilated child. Conclusions The fixed cost of PICU care was 3.8 times more than variable costs. Major portion of cost was borne by the hospital. Severe illness, longer ICU stay and ventilation were associated with increased costs. This study can be used to set the reimbursement package rates under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Tertiary level intensive care in a public sector teaching hospital in India is far less expensive than developed countries.

scholarly journals COVID-19 IN CHILDREN AND ADOLESCENT: CHARACTERISTICS AND SPECIFICITIES IN IMMUNOCOMPETENT AND ONCOHEMATOLOGICAL PATIENTS

2022 ◽  
Vol 14 (1) ◽  
pp. e2022009
Author(s):  
Federico Mercolini ◽  
Simone Cesaro
Keyword(s):  
Risk Factors ◽  
Pediatric Population ◽  
Treatment Options ◽  
Attributable Mortality ◽  
Prevention Measures ◽  
Middle Income ◽  
Children And Adolescent ◽  
Middle Income Countries ◽  
Care Givers ◽  
Low Middle Income Countries

SARS-CoV-2 pandemic affected less children and adolescents, morbidity and mortality figures being inferior to that reported for adults. In this review we focused on the clinical course, risk factors for severe COVID-19, mortality, treatment options and prevention measures in the pediatric and adolescent setting with special attention to the pediatric oncohematological patients. In this subgroups of patients, SARS-CoV-2 infection was often asyntomatic but 47 to 68% of patients require hospitalization and 9-10% of those hospitalized needed intensive care with a COVID-19 attributable mortality of about 4%. The multisystem inflammatory syndrome associated to Coronavirus 2019 was less frequent than that reported in the non-oncohematological pediatric population. Noteworthy, the course of COVID-19 was more severe in low-middle income countries. The key measures to prevent SARS-CoV-2 infection are the reduction of patients exposure to the SARS-CoV-2 and vaccination, now available fore care givers and parents and for patients and siblings > 12 years old. The treatment of COVID-19 in pediatric patients was mainly based on supportive care with dexamethasone and heparin prophylaxis for severely ill patients. Other measures, such as convalescent plasma, remdesivir and monoclonal antibodies have been used in limited case or within experimental protocols. Further studies are needed on the risk factors and outcome of SARS-CoV-2 infection in the pediatric immunocompromised patients. 

scholarly journals Management Of Depressed Skull Fracture

2021 ◽  
Vol 11 (1) ◽  
pp. 30-33
Author(s):  
Liaqat Ali ◽  
Adnan Badar
Keyword(s):  
Head Injury ◽  
Surgical Management ◽  
Medical Center ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Perioperative Period ◽  
Dural Defect ◽  
Wound Debridement ◽  
Depressed Skull Fracture ◽  
Csf Leakage

Background: Head injury is the most serious problem all around the world. Over the last 200 years both surgical and conservativemanagement have been evolved. Chronological surgical management yields better outcome by decreasing mortality andmorbidity. Wound debridement, repair of dural defect and closure of wound are standard principles in management.Objective: To study the outcomes of surgical management of depressed skull fracture.Material and methods: This study was conducted in Shifa Medical center from 1st June 2016 to 30thJune 2019. Clinical featurescause, and computerized tomography (CT) pictures were compiled in proforma. Whenever depressed fracture size exceeded than5mm, cosmetically disfiguring and fracture over the sinus were operated. All the patients were followed for six months.Results: Total of 60 patients were included 42 patients (70%) were male and 18(30%) were female. Pediatric population was majorcontributor 36 out of 60 patients (ratio60%). 56 patients (93.33%)operated, 4 patients (6.67%) were treated conservatively. These 4patients(6.67%) had severe head injury and were put on ventilator 32 patients (53.3%)fully recovered, 12 patients (20%) hadmoderate disability, 8 patients (13%) had severe disability and 3 patients(4.8%)pass away in this study.Conclusion: It was found that, depressed skull fracture was mostly common in children. Usage of antibiotic and anticonvulsantshad effective results in term of preventing infection and epilepsy during perioperative period. Initial stage surgical treatment isexceptionally required where size of fracture exceed 5mm. Outcome depended upon the sternness of injury and existence ofassociated intra cerebral lesion.Key words: surgical management, depressed skull fracture (DSF) and CSF leakage.

A simple depressed skull fracture in an old man with Paget disease: forensic implications in a rare case

2014 ◽  
Vol 55 (1) ◽  
pp. 44-49
Author(s):  
Lorenzo Gitto ◽  
Ponni Arunkumar ◽  
Aniello Maiese ◽  
Giorgio Bolino
Keyword(s):  
Rare Case ◽  
Skull Fracture ◽  
Depressed Skull Fracture ◽  
Paget Disease ◽  
Forensic Implications

The Impact of Covid 19 on Pregnant Women and Child Health

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1367-1373
Author(s):  
Nikhil Sanjay Mujbaile ◽  
Smita Damke
Keyword(s):  
Social Issues ◽  
Middle Income ◽  
Web Based ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
The Social ◽  
Social Separation ◽  
The Impact ◽  
And Child Health ◽  
General Wellbeing

The Covid illness (COVID-19) pandemic has spread rapidly all through the world and has had a drawn-out impact. The Pandemic has done incredible damage to society and made genuine mental injury to numerous individuals. Mental emergencies frequently cause youngsters to deliver sentiments of relinquishment, despondency, insufficiency, and fatigue and even raise the danger of self-destruction. Youngsters with psychological instabilities are particularly powerless during the isolate and colonial removing period. Convenient and proper assurances are expected to forestall the event of mental and social issues. The rising advanced applications and wellbeing administrations, for example, telehealth, web-based media, versatile wellbeing, and far off intuitive online instruction can connect the social separation and backing mental and conduct wellbeing for youngsters. Because of the mental advancement qualities of youngsters, this investigation additionally outlines intercessions on the mental effect of the COVID-19 Pandemic. Further difficulties in Low Middle-Income Countries incorporate the failure to actualize successful general wellbeing estimates, for example, social separating, hand cleanliness, definitive distinguishing proof of contaminated individuals with self-disconnection and widespread utilization of covers The aberrant impacts of the Pandemic on youngster wellbeing are of extensive concern, including expanding neediness levels, upset tutoring, absence of admittance to the class taking care of plans, decreased admittance to wellbeing offices and breaks in inoculation and other kid wellbeing programs. Kept tutoring is critical for kids in Low Middle-Income Countries. Arrangement of safe situations is mainly testing in packed asset obliged schools. 

Risk Factors of Mortality Among Patients with Stroke in Low Middle-Income Countries:  A Series of 180 Patients

2020 ◽  
Author(s):  
Larrey Kamabu ◽  
Hervé Monka Lekuya ◽  
Bienvenu Muhindo Kasusula ◽  
Nicole Kavugho Mutimani ◽  
Louange Maha Kathaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

scholarly journals A Fatal and Rare Case of Hydatid Cyst in the Pouch of Douglas

2021 ◽  
Author(s):  
Ritu Asnani ◽  
Sunil Kumar Yeshvanth ◽  
Lancelot Lobo ◽  
Shipra Sonkusare
Keyword(s):  
Hydatid Cyst ◽  
Rare Case ◽  
Frozen Section ◽  
Public Health Problem ◽  
Zoonotic Infection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Significant Public Health Problem ◽  
Significant Public Health ◽  
Pouch Of Douglas

Abstract Hydatid cyst is a zoonotic infection and a significant public health problem in low- and middle-income countries. A 79-year-old female patient was presented to the gynecology outpatient department with complaints of pain in the abdomen and difficulty in micturition, with a mass palpable per speculum. The ultrasound was suggestive of an ovarian cystadenocarcinoma, whereas computed tomography of the abdomen favored hydatid cyst with adnexal neoplasm as a differential diagnosis. Considering the contradictory findings, a frozen section was sent to confirm the diagnosis, which showed hooklets of Echinococcus granulosus/hydatid cyst under the microscope. This was a rare case of pelvic hydatid cyst mimicking ovarian malignancy and was associated with a less-preferred mode of investigation (frozen section). This article focuses on how a frozen section, despite its limitations and being expensive, can still be considered for accurate patient management.

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