Diphtheria outbreak in Jakarta and Tangerang, Indonesia: Epidemiological and clinical predictor factors for death

Background In 2017, a diphtheria outbreak occurred in several provinces in Indonesia. The aim of this study was to identify predictors of mortality outcome of pediatric patients with clinical diphtheria. Methods A retrospective cohort study was conducted using patient medical records at five referral hospitals in the Province of Jakarta and one in Tangerang District, Banten Province during January 2017 to 31 August 2018. All children in the age group of 1–18 years old discharged with diagnosis of clinical diphtheria formed the study group. All anonymized patient data were evaluated for demographic issues, clinical features, immunization status, complication, laboratory profiles and outcome. Results A total of 283 patients with clinical diphtheria were included in the study group with case fatality rate of 3.5%. All mortal patients had the complication of myocarditis. Regression analyses revealed factors for predicting mortality. Incomplete primary diphtheria toxoid immunization, stridor, bull neck, leukocytosis ≥15 x109 cells/L and thrombocytopenia ≤150 x109 cells/L in each combination for 2 predictors modeling were correlated with death. Conclusions We report key predictors of mortality in pediatric patients with clinical diphtheria. The presence of these features when admitted to the hospital must be taken into account, because they can lead to fatal outcome.

Download Full-text

Clinical Course and Disease`s Outcome Aspects of COVID-19 Pediatric Patients in Ibn Al-Khateeb Isolation Hospital

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v17i2.251 ◽

2021 ◽

Vol 17 (2) ◽

pp. 84-90

Author(s):

Abbas Oweid Oleiw ◽

Kholod Dhaher Habib ◽

Kadhim Abed Mohammed ◽

Oday Yassen Abbas ◽

Zainab Ali Jaber

Keyword(s):

Medical Records ◽

Pediatric Patients ◽

Virus Disease ◽

Communicable Disease ◽

Imaging Techniques ◽

Demographic Data ◽

White Blood Cells ◽

Age Group ◽

X Ray ◽

Chest X Ray

Background: Corona virus disease 2019 (COVID-19) is a communicable disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has since spread globally, leading to an ongoing pandemic. Aim of study: to review the clinical, lab investigation and imaging techniques, in pediatric age group affected COVID-19 to help medical experts better understand and supply timely diagnosis and treatment. Subjects and methods: this study is a retrospective descriptive clinical study. The medical records of patients were analyzed. Information’s recorded include demographic data, exposure history, symptoms, signs, laboratory findings, chest x- ray, and chest computed tomographic (CT) scans. Data were obtained with data collection forms from paper medical records. Results: there were 76 COVID-19 pediatric patients, 46.1% of those patients were within the age group 6 -10 years. The female to male ratio was 1:1, and 92.1% of them were living within the urbane area. About 60.5% of patients were pupils. Seventy-one (93.4%) patients of them had no comorbidity. Twenty (26.3%) patients were asymptomatic. Regarding the duration of hospital stay, 39(51.31) patients had <7 days. All of the patients were nonsmokers. All patients had recovered and discharged from hospital after 2 negative real technique-polymerase chain reaction (RT-PCR) tests, no death was reported. Only 16(21.1%) patients had severe symptoms. Conclusions: the most common symptoms were fever, Cough, Loss of appetite, Shortness of breath & Fatigue. There was a statistically significant association between white blood cells counts, neutrophil number, Chest X-Ray results, with case severity and a statistically significant association between form of treatment in patients who received Oxygen, Oseltamivir, Azithromycin, Paracetamol, Dexamethasone, and case severity.

Download Full-text

Interaction of Chloral Hydrate and Furosemide

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002807701100601 ◽

1977 ◽

Vol 11 (6) ◽

pp. 332-335 ◽

Cited By ~ 2

Author(s):

M. Peter Pevonka ◽

Richard L. Yost ◽

Ronald G. Marks ◽

William S. Howell ◽

Ronald B. Stewart

Keyword(s):

Teaching Hospital ◽

Medical Records ◽

Chloral Hydrate ◽

Pediatric Patients ◽

Epidemiologic Study ◽

Concomitant Administration ◽

Study Group ◽

Control Groups ◽

Final Study ◽

Study Population

Untoward reactions were recently reported in six patients following the concomitant administration of chloral hydrate orally and furosemide intravenously. A retrospective epidemiologic study was initiated to evaluate this report. Medication records of adult medical and pediatric patients who received care at Shand's Teaching Hospital from July, 1969 to May, 1975 were scanned by computer to identify patients exposed to either chloral hydrate or flurazepam and furosemide. Five thousand two hundred and sixty-two patients were found to have received furosemide alone or in combination with either chloral hydrate or flurazepam. Computer records of these patients were reviewed to identify patients who received either chloral hydrate or flurazepam and then, in the twenty-four hours following the administration of the sedative-hypnotic, received furosemide. This procedure resulted in a final study population consisting of 43 patients who received both chloral hydrate and furosemide. Medical records of the study group and three control groups were then reviewed to determine if untoward symptoms similar to those reported previously were evident. One patient in the study group exhibited symptoms of the reaction and two patients were identified as having possible reactions. No patient in any of the control groups exhibited manifestations of the reaction.

Download Full-text

Insidensi Kista Duktus Tiroglosus di Bagian Bedah RSUP Prof. Dr. R. D. Kandou Manado Periode Januari 2014 - Desember 2016

e-CliniC ◽

10.35790/ecl.6.1.2018.18712 ◽

2018 ◽

Vol 6 (1) ◽

Author(s):

Meidina Kinontoa ◽

Nico Lumintang ◽

Andreissanto C. Lengkong

Keyword(s):

Medical Records ◽

Pediatric Patients ◽

Neck Region ◽

Thyroglossal Duct Cyst ◽

Age Group ◽

Duct Cyst ◽

Thyroglossal Duct ◽

Thyroglossal Duct Cysts ◽

Male Patients ◽

Surgery Department

Abstract: Thyroglossal duct cyst is the most common asymptomatic congenital mass found in the neck region. It is more commonly occurs in pediatric patients but not uncommon in adult patients. According to epidemiologic data, there is no difference in predilection among sexes. Diagnosis of thyroglossal duct cyst is ascertained by anamnesis, physical examination, and ancillary examination. Treatment of thyroglossal duct cyst is surgery. This study was aimed to establish the incidence of thyroglossal duct cysts at the Surgery Department of Prof. Dr. R. D. Kandou Hospital Manado in the period of January 2014 - December 2016 based on age, gender, surgical treatment, as well as the location of thyroglossal duct cysts. This was a descriptive retrospective study using all thyroglossal duct cyst medical records at the Surgery Department of Prof. Dr. R. D. Kandou Hospital Manado in the period of January 2014-December 2016. The results showed that the highest incidence of thyroglossal duct cyst was in 2014 (37%), and in the age group of 6-11 years old. Male patients were more common than females. Meanwhile, the most common locations of this cyst were suprahyoid and subhyoid (25%) and the most common surgical procedure used was modified Sistrunk (88%). Conclusion: Thyroglossal duct cyst was more common in age group of 6-11 years, males, suprahyoid and subhyoid locations, and treated with modified Sistrunk surgeryKeywords: thyroglossal duct cyst Abstrak: Kista duktus tiroglosus merupakan massa kongenital asimtomatik yang paling sering ditemukan di daerah leher. Kasus ini lebih sering terjadi pada anak tetapi juga tidak jarang ditemukan pada orang dewasa. Secara epidemiologi tidak ada perbedaan predileksi jenis kelamin antara laki-laki dan perempuan. Diagnosis kista duktus tiroglosus ditegakkan berdasarkan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang. Penatalaksanaan dari kista duktus tiroglosus adalah tindakan pembedahan. Penelitian ini bertujuan unuk mengetahui insidensi kista duktus tiroglosus di Bagian Bedah RSUP Prof. Dr. R. D. Kandou Manado periode Januari 2014-Desember 2016, berdasarkan tahun, usia, jenis kelamin, tindakan pembedahan, serta letak kista duktus tiroglosus. Jenis penelitian ialah deskriptif retrospektif dengan menggunakan semua data rekam medik pasien kista duktus tiroglosus di Bagian Bedah RSUP Prof. Dr. R. D. Kandou Manado periode Januari 2014-Desember 2016. Hasil penelitian menunjukkan bahwa insidensi kista duktus tiroglosus selama periode Januari 2014-Desember 2016 tertinggi pada tahun 2014 (37%) dan pada kelompok usia 6-11 tahun (37%). Jumlah pasien laki-laki ditemukan lebih banyak daripada perempuan. Letak kista tersering ditemukan di suprahioid dan subhioid (25%) dan tindakan pembedahan yang tersering dilakukan ialah modifikasi Sistrunk (88%). Simpulan: Kista tiroglosus paling sering ditemukan pada kelompok usia 6-11 tahun, jenis kelamin laki-laki, dengan letak kista suprahiod dan subhiod, serta tindakan pembedahan modifikasi Sistrunk.Kata kunci: kista duktus tiroglosus

Download Full-text

Skull and Face Injuries and Associated Factors in Pedestrian Victims of Traffic Accidents: A Single Trauma Center Analysis

Current Dentistry ◽

10.2174/2542579x02999200608131337 ◽

2020 ◽

Vol 2 (1) ◽

pp. 53-59

Author(s):

Josimara A. de Araújo Varela ◽

Tatiana F.T. Palitot ◽

Smyrna L.X. de Souza ◽

Alidianne F.C. Cavalcanti ◽

Alessandro L. Cavalcanti

Keyword(s):

Medical Records ◽

Associated Factors ◽

Traffic Accidents ◽

Age Group ◽

Chi Square ◽

Cross Sectional ◽

Significance Level ◽

The Face ◽

Chi Square Test ◽

The City

Objective: This study aimed to analyze the presence of lesions in the skull and face and the associated factors in pedestrian victims of traffic accidents. Methods: A cross-sectional, descriptive-analytical study carried out through the analysis of medical records of pedestrian victims of traffic accidents in an emergency service in the city of Campina Grande, Brazil, during the year of 2016. Information was collected regarding gender, age group, day of the week, time of the accident, type of vehicle involved, presence of trauma to the skull and face, and outcomes. The Chi-square and Fisher's Exact tests were used, with a significance level of 5%. Results: A total of 1,884 medical records were evaluated, out of which 7.1% (n = 133) involved pedestrians. Men were the most frequent victims (68.4%), and victims of age 60 years old or over (30.5%) predominated. Almost one-third of the cases were recorded during the weekends (30.5%), and the most prevalent time was at night (52.7%). Regarding the type of vehicle involved, motorcycles predominated (47.4%). Head trauma was present in 37.6% of victims, while facial injuries corresponded to 8.2%. In 12% of cases, the victims died. The variables of gender, age group, occurrence on weekends, and trauma to the face showed a statistically significant association with the occurrence of traffic accidents (Chi-square test; p<0.05). Conclusion: Among pedestrian victims of traffic accidents, there is a predominance of men aged 65 years or over. Accidents are frequent at night, and motorcycles are the main vehicles involved. The presence of trauma to the skull and face regions is high.

Download Full-text

Paranasal Mass in a Healthy Male Toddler

Ear Nose & Throat Journal ◽

10.1177/01455613211007944 ◽

2021 ◽

pp. 014556132110079

Author(s):

Melonie Anne Phillips ◽

Meredith Lind ◽

Gerd McGwire ◽

Diana Rodriguez ◽

Suzanna Logan

Keyword(s):

Differential Diagnosis ◽

Pediatric Patients ◽

Pediatric Population ◽

Age Group ◽

Significant Morbidity ◽

Healthy Male ◽

Neck Tumors ◽

Complete Surgical Resection ◽

Maxilla And Mandible ◽

Benign Mass

Head and neck tumors are rare in pediatric patients but should be kept in the differential when a patient presents with a new swelling or mass. One of these tumors is a myxoma, which is an insidiously growing, benign mass originating from the mesenchyme. They most commonly arise in the myocardium but can also develop in facial structures, particularly in the maxilla and mandible. When arising in facial structures, ocular, respiratory, and digestive systems can be affected based on local invasion. Complete surgical resection is curative but can lead to significant morbidity as well. Here, we present a case of a 15-month-old toddler presenting with a paranasal mass, which was ultimately diagnosed as a maxillary myxoma. This tumor is very rare in the pediatric population, especially in the toddler age-group, reminding clinicians to broaden the differential diagnosis when a patient’s course is atypical.

Download Full-text

Endoscopic retrograde cholangiopancreatography in infants and children

Endoscopy International Open ◽

10.1055/a-1337-2212 ◽

2021 ◽

Vol 09 (03) ◽

pp. E292-E296

Author(s):

Tone Lise Åvitsland ◽

Lars Aabakken

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Medical Records ◽

Pediatric Patients ◽

Biliary Stricture ◽

Infants And Children ◽

University Hospital ◽

Older Children ◽

Endoscopic Retrograde ◽

Procedure Codes ◽

In Infants And Children

Abstract Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients < 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic.Complications were uncommon in infants; only two episodes of infection were registered. In children (> 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children.

Download Full-text

Correlation between age, sex, and severity of Coronavirus disease-19 based on chest computed tomography severity scoring system

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00408-1 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Shimaa Farghaly ◽

Marwa Makboul

Keyword(s):

Computed Tomography ◽

Scoring System ◽

Fatal Outcome ◽

Age Groups ◽

Significant Risk ◽

Chest Ct ◽

Age Group ◽

Severity Scoring ◽

Chest Computed Tomography ◽

Severity Of The Disease

Abstract Background Coronavirus disease 2019 (COVID-19) is the most recent global health emergency; early diagnosis of COVID-19 is very important for rapid clinical interventions and patient isolation; chest computed tomography (CT) plays an important role in screening, diagnosis, and evaluating the progress of the disease. According to the results of different studies, due to high severity of the disease, clinicians should be aware of the different potential risk factors associated with the fatal outcome, so chest CT severity scoring system was designed for semi-quantitative assessment of the severity of lung disease in COVID-19 patients, ranking the pulmonary involvement on 25 points severity scale according to extent of lung abnormalities; this study aims to evaluate retrospectively the relationship between age and severity of COVID-19 in both sexes based on chest CT severity scoring system. Results Age group C (40–49 year) was the commonest age group that was affected by COVID-19 by 21.3%, while the least affected group was group F (≥ 70 years) by only 6.4%. As regards COVID-RADS classification, COVID-RADS-3 was the most commonly presented at both sexes in all different age groups. Total CT severity lung score had a positive strong significant correlation with the age of the patient (r = 0.64, P < 0.001). Also, a positive strong significant correlation was observed between CT severity lung score and age in both males and females (r = 0.59, P < 0.001) and (r = 0.69, P < 0.001) respectively. Conclusion We concluded that age can be considered as a significant risk factor for the severity of COVID-19 in both sexes. Also, CT can be used as a significant diagnostic tool for the diagnosis of COVID-19 and evaluation of the progression and severity of the disease.

Download Full-text

Association between Physical Activity and Sport Participation on Hemoglobin A1c Among Children and Adolescents with Type 1 Diabetes

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147490 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7490

Author(s):

Kristi M. King ◽

Jason R. Jaggers ◽

Lindsay J. Della ◽

Timothy McKay ◽

Sara Watson ◽

...

Keyword(s):

Physical Activity ◽

Type 1 Diabetes ◽

Medical Records ◽

Hemoglobin A1c ◽

Pediatric Patients ◽

Sport Participation ◽

Multiple Linear Regression Model ◽

Significant Difference ◽

Hba1c Levels

Purpose: To determine associations between physical activity (PA) and sport participation on HbA1c levels in children with type 1 diabetes (T1D). Method: Pediatric patients with T1D were invited to complete a PA and sport participation survey. Data were linked to their medical records for demographic characteristics, diabetes treatment and monitoring plans, and HbA1c levels. Results: Participants consisted of 71 females and 81 males, were 13 ± 3 years old with an average HbA1c level of 8.75 ± 1.81. Children accumulating 60 min of activity 3 days or more a week had significantly lower HbA1c compared to those who accumulated less than 3 days (p < 0.01) of 60 min of activity. However, there was no significant difference in HbA1c values based on sport participation groups. A multiple linear regression model indicated that PA, race, age, duration of diagnosis, and CGM use all significantly predicted HbA1c (p < 0.05). Conclusion: This study demonstrated the significant relationship between daily PA and HbA1c. Those in this sample presented with lower HbA1c values even if accumulating less than the recommended number of days of activity. Further, it was shown that sport participation alone may not be adequate enough to impact HbA1c in a similar manner.

Download Full-text

Multimodal Treatment of Pediatric Ruptured Brain Arteriovenous Malformations: A Single-Center Study

Children ◽

10.3390/children8030215 ◽

2021 ◽

Vol 8 (3) ◽

pp. 215

Author(s):

Lukasz Antkowiak ◽

Monika Putz ◽

Marta Rogalska ◽

Marek Mandera

Keyword(s):

Medical Records ◽

Arteriovenous Malformations ◽

Pediatric Patients ◽

Interventional Treatment ◽

Digital Subtraction ◽

Brain Arteriovenous Malformations ◽

Single Center Study ◽

Complete Obliteration ◽

Multimodality Approach ◽

Related Mortality

Bleeding from ruptured brain arteriovenous malformations (bAVMs) represents the most prevalent cause of pediatric intracranial hemorrhage, being also the most common initial bAVM manifestation. A therapeutic approach in these patients should aim at preventing rebleeding and associated significant morbidity and mortality. The purpose of this study was to determine the clinical outcomes of pediatric patients who initially presented at our institution with ruptured bAVMs and to review our experience with a multimodality approach in the management of pediatric ruptured bAVMs. We retrospectively reviewed pediatric patients’ medical records with ruptured bAVMs who underwent interventional treatment (microsurgery, embolization, or radiosurgery; solely or in combination) at our institution between 2011 and 2020. We identified 22 patients. There was no intraoperative and postoperative intervention-related mortality. Neither procedure-related complications nor rebleeding were observed after interventional treatment. Modified Rankin Scale (mRS) assessment at discharge revealed 19 patients (86.4%) with favorable outcomes (mRS 0–2) and 3 patients (13.6%) classified as disabled (mRS 3). Microsurgery ensured the complete obliteration in all patients whose postoperative digital subtraction angiography (DSA) was available. Management of high-grade bAVMs with radiosurgery or embolization can provide satisfactory outcomes without a high disability risk.

Download Full-text

Estimating effective infection fatality rates during the course of the COVID-19 pandemic in Germany

BMC Public Health ◽

10.1186/s12889-021-11127-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christian Staerk ◽

Tobias Wistuba ◽

Andreas Mayr

Keyword(s):

Age Distribution ◽

Age Groups ◽

Case Fatality ◽

Time Dependent ◽

Temporary Increase ◽

International Studies ◽

Age Group ◽

Fatality Rate ◽

Substantial Fraction ◽

Second Wave

Abstract Background The infection fatality rate (IFR) of the Coronavirus Disease 2019 (COVID-19) is one of the most discussed figures in the context of this pandemic. In contrast to the case fatality rate (CFR), the IFR depends on the total number of infected individuals – not just on the number of confirmed cases. In order to estimate the IFR, several seroprevalence studies have been or are currently conducted. Methods Using German COVID-19 surveillance data and age-group specific IFR estimates from multiple international studies, this work investigates time-dependent variations in effective IFR over the course of the pandemic. Three different methods for estimating (effective) IFRs are presented: (a) population-averaged IFRs based on the assumption that the infection risk is independent of age and time, (b) effective IFRs based on the assumption that the age distribution of confirmed cases approximately reflects the age distribution of infected individuals, and (c) effective IFRs accounting for age- and time-dependent dark figures of infections. Results Effective IFRs in Germany are estimated to vary over time, as the age distributions of confirmed cases and estimated infections are changing during the course of the pandemic. In particular during the first and second waves of infections in spring and autumn/winter 2020, there has been a pronounced shift in the age distribution of confirmed cases towards older age groups, resulting in larger effective IFR estimates. The temporary increase in effective IFR during the first wave is estimated to be smaller but still remains when adjusting for age- and time-dependent dark figures. A comparison of effective IFRs with observed CFRs indicates that a substantial fraction of the time-dependent variability in observed mortality can be explained by changes in the age distribution of infections. Furthermore, a vanishing gap between effective IFRs and observed CFRs is apparent after the first infection wave, while an increasing gap can be observed during the second wave. Conclusions The development of estimated effective IFR and observed CFR reflects the changing age distribution of infections over the course of the COVID-19 pandemic in Germany. Further research is warranted to obtain timely age-stratified IFR estimates, particularly in light of new variants of the virus.

Download Full-text