Neurological Presentation of Severe Dengue in Children From a Colombian Hyperendemic Area

2020 ◽  
Author(s):  
Jaime E. Castellanos ◽  
Paula Esteban ◽  
Juanita Panqueba-Salgado ◽  
Daniela Benavides-del-Castillo ◽  
Valentina Pastrana ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hypovolemic Shock ◽  
University Hospital ◽  
Severe Dengue ◽  
Laboratory Findings ◽  
Dengue Disease ◽  
Neurological Signs ◽  
Csf Analysis ◽  
Neurological Patients ◽  
The University

Abstract Objective: Dengue transmission is sustained in Colombia with increasing prevalence mainly in children. This work was aimed to describe a cases series of children diagnosed with dengue presenting neurological disease in the Huila province of Colombia. Eleven pediatric febrile patients confirmed to dengue disease and presenting neurological signs were studied in the University Hospital of Neiva, Huila province. Clinical and laboratory findings, CSF cytochemical analysis, neurology images, and serology and molecular studies were performed. Results. Viral RNA was detected in all patients’ sera by RT-PCR. Nine out of 11 were primary infections. Tonic-clonic seizures (73%), consciousness alterations (27%), irritability (27%) and ataxia (18%) were the most frequent neurological signs. None of the patients had plasma leakage, hypovolemic shock or liver disease, confirming the encephalitis diagnosis. Diagnostic images did not show abnormal findings neither bacterial or fungal infections were detected in CSF analysis. All patients survived without sequelae except in one patient that presented ataxia for months. In conclusion, we described a group of children with neurological signs during severe dengue disease as the main finding, indicating the importance of include dengue as a differential diagnosis in neurological patients from endemic areas.

scholarly journals A Case Series of Severe Dengue with Neurological Presentation in Children from a Colombian Hyperendemic Area

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Jaime E. Castellanos ◽  
Paula Esteban ◽  
Juanita Panqueba-Salgado ◽  
Daniela Benavides-del-Castillo ◽  
Valentina Pastrana ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hypovolemic Shock ◽  
Case Series ◽  
University Hospital ◽  
Severe Dengue ◽  
Laboratory Findings ◽  
Dengue Disease ◽  
Neurological Signs ◽  
Csf Analysis ◽  
Neurological Patients

Dengue transmission is sustained in Colombia with increasing prevalence mainly in children. This work aimed to describe a case series of children diagnosed with dengue presenting neurological disease in Huila Province of Colombia. Eleven pediatric febrile patients confirmed for dengue disease and presenting neurological signs were studied in the University Hospital of Neiva, Huila Province. Clinical and laboratory findings, CSF cytochemical analysis, neurology images, and serology and molecular studies were performed. Viral RNA was detected in all patients’ sera by RT-PCR. Nine out of 11 were primary infections. Tonic-clonic seizures (73%), consciousness alterations (27%), irritability (27%), and ataxia (18%) were the most frequent neurological signs. None of the patients had plasma leakage, hypovolemic shock, or liver disease, confirming the encephalitis diagnosis. Diagnostic images did not show abnormal findings, but neither bacterial nor fungal infections were detected in CSF analysis. All patients survived without sequelae except for one patient that presented ataxia for months. In conclusion, we described a group of children with neurological signs during severe dengue disease as the main finding, indicating the importance to including dengue as a differential diagnosis in neurological patients from endemic areas.

scholarly journals Effective Treatment of Neurological Symptoms with Normal Doses of Botulinum Neurotoxin in Wilson’s Disease: Six Cases and Literature Review

Toxins ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 241
Author(s):  
Harald Hefter ◽  
Sara Samadzadeh
Keyword(s):  
Botulinum Neurotoxin ◽  
Wilson’S Disease ◽  
Animal Experiments ◽  
Symptomatic Treatment ◽  
Wilson's Disease ◽  
University Hospital ◽  
Laboratory Findings ◽  
Dose Information ◽  
High Doses ◽  
The University

Background: Recent cell-based and animal experiments have demonstrated an effective reduction in botulinum neurotoxin A (BoNT/A) by copper. Aim: We aimed to analyze whether the successful symptomatic BoNT/A treatment of patients with Wilson’s disease (WD) corresponds with unusually high doses per session. Methods: Among the 156 WD patients regularly seen at the outpatient department of the university hospital in Düsseldorf (Germany), only 6 patients had been treated with BoNT/A during the past 5 years. The laboratory findings, indications for BoNT treatment, preparations, and doses per session were extracted retrospectively from the charts. These parameters were compared with those of 13 other patients described in the literature. Results: BoNT/A injection therapy is a rare (<4%) symptomatic treatment in WD, only necessary in exceptional cases, and is often applied only transiently. In those cases for which dose information was available, the dose per session and indication appear to be within usual limits. Conclusion: Despite the evidence that copper can interfere with the botulinum toxin in preclinical models, patients with WD do not require higher doses of the toxin than other patients with dystonia.

scholarly journals Children’s poisoning profile during the Covid-19 pandemic – Experience of Hassan II University Hospital in Fez, MOROCCO

2021 ◽  
Vol 319 ◽  
pp. 01077
Author(s):  
Amrani Hanchi Sahar ◽  
Hoummani Hasnae ◽  
Mourabiti Hajar ◽  
Chebaibi Mohammed ◽  
Chaouki Sana ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
University Hospital ◽  
Accidental Poisoning ◽  
Pediatric Emergency Department ◽  
Neurological Signs ◽  
Snake Bites ◽  
Scorpion Stings ◽  
The University ◽  
Evolutionary Aspects

Introduction. —The Covid-19 pandemic and the containment situation, has generated enormous risks for children. Indeed, with the closure of schools, children, forced to stay at home, found themselves in permanent contact with dangerous products (drugs, disinfectants, plants) exposing them to accidental poisoning. Objective. —To describe the epidemiological, clinical and evolutionary aspects of the cases of pediatric intoxications in the UHC during the period of Covid-19, in order to assess the repercussions of this pandemic on the profile of these intoxications, in terms of number and incriminated products. Material and method. — This is a retrospective descriptive comparative study of intoxication cases admitted to the pediatric emergency department of the University Hospital of Fez spread over 2 years; from March 1, 2019 to February 2021; comparing intoxications admitted during the period of Covid-19 with the previous year. Results. — The emergency department recorded 132 cases of intoxication during the Covid-19 period (compared to 104 cases in 2019). Fez was always the most concerned city (66.21% against 69.02% in 2019). The cases emanated from the urban environment in (58.78%). The accidental circumstance was the most frequent, with an increase from 77.88% in 2019 to 82.02%. The rate of cases of envenomation that consulted was almost similar; children are more exposed to scorpion stings (73.52%) than snake bites. The analysis of incriminated products was marked by the increase of Caustics (20.38% in 2019 to 24.24% in 2020), and the decrease of pesticides (19.41% in 2019 to 13.63%). The symptomatology was dominated by neurological signs in 25.75% of cases, followed by respiratory disorders (18.18%). The evolution was favorable in 95.46%, and death occurred in 4.54% of cases compared to 3.84% in2019. The Covid-19 pandemic has changed the use of antidotes.

scholarly journals Medullar Kock without Pott: 13 cases observed at the university hospital center of Conakry, Guinea

2019 ◽  
Author(s):  
Fode Abass Cisse ◽  
Foksouna Sakadi ◽  
Nana Rahamatou Aminou Tassiou ◽  
Amadou Talibe Balde ◽  
Arcel Steven Nitcheu Woga ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
University Hospital ◽  
Resonance Imaging ◽  
Neurological Signs ◽  
Diagnostic Certainty ◽  
Magnetic Resonance Imaging Mri ◽  
Compressive Myelopathy ◽  
The University ◽  
Hospital Center

Background: The diagnostic certainty of medullar tuberculosis (TB) without Pott disease is difficult to establish in a tropical environment with the large group of infectious, parasitic, and systemic myelopathies, despite the increasing availability of magnetic resonance imaging (MRI) data and improvement of biological exploration platforms. Methods: We retrospectively analyzed the files of 186 patients hospitalized in the Department of Neurology and Neurosurgery of the University Hospital Center of Conakry, Guinea, between 2008 and 2016 for the management of non-compressive and compressive myelopathy. Biological evidence of TB infection was demonstrated for 13 (6.9%) patients.  Results: Infectious clinical picture prior to the development of neurological signs was reported in 11 patients (84.6%). The neurological signs were summed up by the existence of a sensitivo-motor semiology of progressive evolution (100% of cases) with sphincter disorders in 11 patients (84.6%) and a medullary compression symptomatology with a lesion and under lesion syndrome from the outset in 4 patients (30.8%). Medullary MRI revealed an extensive intramedullary hypersignal in 9 patients with non-compressive myelopathy and in 4 cases, the lesions appeared in T1 hypersignal and T2 isosignal were localized. Lumbar puncture (LP) revealed lymphocytic pleocytosis, hypoglucorrhage (0.3 to 0.5 g/l), and leukocytosis. Conclusion: This study reveals a classic clinical, biological, neuroradiological, and evolutionary profile of compressive and non-compressive myelopathies. These results are important for the  therapeutic and evolutionary discussion of TB myelopathies for good management.

scholarly journals Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score

2020 ◽  
Author(s):  
Ian Levenfus ◽  
Enrico Ullmann ◽  
Edouard Battegay ◽  
Macé M. Schuurmans
Keyword(s):  
Time Frame ◽  
University Hospital ◽  
Emergency Setting ◽  
Clinical Experiences ◽  
Emergency Rooms ◽  
Laboratory Findings ◽  
Student’S T ◽  
The University ◽  
Post Hoc ◽  
Short Time

Clinical prediction scores support the assessment of patients in the emergency setting to determine the need for further diagnostic and therapeutic steps. During the current COVID-19 pandemic, physicians in emergency rooms (ER) of many hospitals have a considerably higher patient load and need to decide within a short time frame whom to hospitalize. Based on our clinical experiences in dealing with COVID-19 patients at the University Hospital Zurich, we created a triage score with the acronym AIFELL consisting of clinical, radiological and laboratory findings. The score was then evaluated in a retrospective analysis of 122 consecutive patients with suspected COVID-19 from March until mid-April 2020. Descriptive statistics, Student's t-test, ANOVA and Scheffe's post hoc analysis confirmed the diagnostic power of the score. The results suggest that the AIFELL score has potential as a triage tool in the ER setting intended to select probable COVID-19 cases for hospitalization in spontaneously presenting or referred patients with acute respiratory symptoms.

scholarly journals Autopsy findings after long-term treatment of COVID-19 patients with microbiological correlation

2021 ◽  
Author(s):  
Katja Evert ◽  
Thomas Dienemann ◽  
Christoph Brochhausen ◽  
Dirk Lunz ◽  
Matthias Lubnow ◽  
...  
Keyword(s):  
Macrophage Activation Syndrome ◽  
Macrophage Activation ◽  
Fungal Infections ◽  
Diffuse Alveolar Damage ◽  
Fungal Species ◽  
Term Treatment ◽  
University Hospital ◽  
Long Term Treatment ◽  
The University

AbstractBetween April and June 2020, i.e., during the first wave of pandemic coronavirus disease 2019 (COVID-19), 55 patients underwent long-term treatment in the intensive care unit at the University Hospital of Regensburg. Most of them were transferred from smaller hospitals, often due to the need for an extracorporeal membrane oxygenation system. Autopsy was performed in 8/17 COVID-19-proven patients after long-term treatment (mean: 33.6 days). Autopsy revealed that the typical pathological changes occurring during the early stages of the disease (e.g., thrombosis, endothelitis, capillaritis) are less prevalent at this stage, while severe diffuse alveolar damage and especially coinfection with different fungal species were the most conspicuous finding. In addition, signs of macrophage activation syndrome was detected in 7 of 8 patients. Thus, fungal infections were a leading cause of death in our cohort of severely ill patients and may alter clinical management of patients, particularly in long-term periods of treatment.

scholarly journals Clinical and Laboratoy Characteristics of Parvovirus B19 Infection During 2013/2014 Outbreak in Zagreb, Croatia

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S319-S320
Author(s):  
Mia Ajdukovic ◽  
Lucija Pejic ◽  
Neven Papic ◽  
Adriana Vince
Keyword(s):  
Clinical Presentation ◽  
Parvovirus B19 ◽  
Age Groups ◽  
Clinical Manifestations ◽  
University Hospital ◽  
Complication Rates ◽  
Laboratory Findings ◽  
Mild Anemia ◽  
Parvovirus B19 Infection ◽  
The University

Abstract Background Human Parvovirus B19 (HPV-B19) occurs worldwide and causes mild, acute exanthematous disease that occurs in a form of cyclic local epidemics. The aim of this study was to analyze clinical features and complication rates of acute HPV-B19 infection in different age groups. Methods We retrospectively reviewed the charts of 718 consecutive patients clinicaly diagnosed with acute HPV-B19 infection who visited outpatient department at the University Hospital for Infectious Diseases in Zagreb, Croatia during 2013–2014 outbreak. In 212 patients (of 298 tested) diagnosis was confirmed by positive IgM antibodies and/or HPV-B19 DNA in peripheral blood. Results Outbreak started in June 2013 and had a peak in April 2014, with highest prevalence in schoolchildren. There were no difference in clinical presentation or laboratory findings between clinicaly and serologicaly diagnosed patients. Biphasic presentation, fever, myalgia, arthralgia, headache and peripheral edema were more frequent in adults, but „slapped cheeks” was found predominantly in children. Complications were more common in adults, most commonly hematological disordes (mild anemia, thrombocytopenia and leukopenia), vasculitis, hepatitis and aseptic meningitis. There were no deaths in our cohort. Conclusion Parvovirus B19 infection has different clinical presentation, laboratory findings and complications in children and adults. Since the diversity of the clinical manifestations in adults may be misleading, the infection in adults should be suspected when disease is prevalent in children. Disclosures `All authors: No reported disclosures.

scholarly journals In-hospital Mortality Among Neurological Patients over the Period of 5 years — a Retrospective, Single-center Study

2020 ◽  
Vol 9 (1) ◽  
pp. 20-26
Author(s):  
Adam Wiśniewski ◽  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Neurological Disorders ◽  
Hemorrhagic Stroke ◽  
University Hospital ◽  
Hospital Death ◽  
Single Center Study ◽  
Neurological Patients ◽  
Neurology Clinic ◽  
The University

Introduction. Neurological disorders have been considered for many years dangerous and are associated with higher risk of in-hospital death. Brain vascular disorders are widely considered as the most severe and related to the highest mortality rate. Aim. The aim of the study was to assess the mortality rate in subjects hospitalized in the Neurology ward within 5 years, in particular the etiology, direct cause and predictability of deaths. Material and Methods. This study is retrospective. The documentation analysis concerned the last 5 years, i.e. from 2015 to 2019. From among the entire database of 8247 patients hospitalized in the Neurology Clinic of the University Hospital No. 1 in Bydgoszcz, 429 deaths were reported and analyzed. Results. The mortality rate was 5.2% among all subjects, 6.6% among all vascular patients and 1.16% among non-vascular subjects. The highest mortality was reported among hemorrhagic stroke (28.4%) and it was significantly higher compared to ischemic stroke (OR = 6.25, 95% CI 4.9–7.8, p < 0.0001). Patients with stroke had significantly higher mortality compared to other neurological disorders (OR = 11.08 95% CI 7.7–15.9, p < 0.0001). The main direct reason of death (80%) was primary cerebral as a result of baseline disease. 7% of deaths were considered as sudden, unexpected and 10.7% were related to complications developed during hospitalization. Conclusions. Stroke, especially hemorrhagic subtype, still remains the cause of the highest in-hospital mortality rate in the Neurology Ward. It is worth to notice that special attention should be paid to patients with coexisting infectious diseases, that contribute to higher mortality risk. (JNNN 2020;9(1):20–26) Key Words: in-hospital mortality, neurological disorders, stroke, prognosis

Extradural Hematoma: Toward Zero Mortality

Neurosurgery ◽  
1984 ◽  
Vol 14 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Albino P. Bricolo ◽  
Luisa M. Pasut
Keyword(s):  
Mortality Rates ◽  
University Hospital ◽  
Good Recovery ◽  
Extradural Hematoma ◽  
Neurological Signs ◽  
Head Injured ◽  
Gcs Score ◽  
The University ◽  
Injured Patients ◽  
Overall Mortality

Abstract This is a prospective analysis of 107 consecutive cases of extradural hematoma treated during the last 3 years at the Department of Neurosurgery of the University Hospital of Verona (Italy). The overall mortality was 5%; 89% of the patients made a good recovery or had only moderate residual disability. We regard this as meaningful progress compared to recent reports from other sources showing mortality rates of approximately 20%. The majority of our patients (57%) underwent operation within 6 hours of injury; 60% went into surgery with a Glasgow coma scale (GCS) score between 8 and 15. No deaths occurred among patients reaching surgery with a GCS score of 8 or better; all patients with scores of 8 to 15 made a good recovery (63 cases). Seventeen patients went into surgery while still free of neurological signs, and 8 had only one dilated pupil; all 25 made good recoveries. A flexion posture at admission cuts the chances of a good outcome by one-half; an extension posture cuts the chances to one-fourth. Ninety-five per cent of the patients had fractures of the skull; only 21% had the classical lucid interval. The cause of all 5 deaths was identified as stemming from avoidable errors in management in outlying hospitals (2 cases) or in our own department (3 cases). The results of this study indicate that zero mortality from extradural hematoma is a realistic goal for a modern, well-run care system for head-injured patients that includes prompt referral by community doctors and suitable hospital facilities for constant access to emergency neurosurgery.

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