Association of a Network of Immunologic Response and Clinical Features With the Functional Recovery From Crotalinae Snakebite Envenoming

BackgroundThe immunologic pathways activated during snakebite envenoming (SBE) are poorly described, and their association with recovery is unclear. The immunologic response in SBE could inform a prognostic model to predict recovery. The purpose of this study was to develop pre- and post-antivenom prognostic models comprised of clinical features and immunologic cytokine data that are associated with recovery from SBE. Materials and MethodsWe performed a prospective cohort study in an academic medical center emergency department. We enrolled consecutive patients with Crotalinae SBE and obtained serum samples based on previously described criteria for the Surgical Critical Care Initiative (SC2i)(ClinicalTrials.gov Identifier: NCT02182180). We assessed a standard set of clinical variables and measured 35 unique cytokines using Luminex Cytokine 35-Plex Human Panel pre- and post-antivenom administration. The Patient-Specific Functional Scale (PSFS), a well-validated patient-reported outcome of functional recovery, was assessed at 0, 7, 14, 21 and 28 days and the area under the patient curve (PSFS AUPC) determined. We performed Bayesian Belief Network (BBN) modeling to represent relationships with a diagram composed of nodes and arcs. Each node represents a cytokine or clinical feature and each arc represents a joint-probability distribution (JPD).ResultsTwenty-eight SBE patients were enrolled. Preliminary results from 24 patients with clinical data, 9 patients with pre-antivenom and 11 patients with post-antivenom cytokine data are presented. The group was mostly female (82%) with a mean age of 38.1 (SD ± 9.8) years. In the pre-antivenom model, the variables most closely associated with the PSFS AUPC are predominantly clinical features. In the post-antivenom model, cytokines are more fully incorporated into the model. The variables most closely associated with the PSFS AUPC are age, antihistamines, white blood cell count (WBC), HGF, CCL5 and VEGF. The most influential variables are age, antihistamines and EGF. Both the pre- and post-antivenom models perform well with AUCs of 0.87 and 0.90 respectively.DiscussionPre- and post-antivenom networks of cytokines and clinical features were associated with functional recovery measured by the PSFS AUPC over 28 days. With additional data, we can identify prognostic models using immunologic and clinical variables to predict recovery from SBE.

Download Full-text

Rate of Surgery and Baseline Characteristics Associated With Surgery Progression in Young Athletes With Prearthritic Hip Disorders

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120969863 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096986

Author(s):

Reid W. Collis ◽

Andrea B. McCullough ◽

Chris Ng ◽

Heidi Prather ◽

Graham A. Colditz ◽

...

Keyword(s):

Conservative Management ◽

Academic Medical Center ◽

Tertiary Care ◽

Specific Treatment ◽

Adolescent And Young Adult ◽

Harris Hip Score ◽

Patient Specific ◽

Patient Reported ◽

Functional Scores ◽

Competitive Athletes

Background: Prearthritic hip disorders (PAHD), such as femoroacetabular impingement (FAI), acetabular dysplasia, and acetabular labral tears, are a common cause of pain and dysfunction in adolescent and young adult athletes, and optimal patient-specific treatment has not been defined. Operative management is often recommended, but conservative management may be a reasonable approach for some athletes. Purpose: To identify (1) the relative rate of progression to surgery in self-reported competitive athletes versus nonathletes with PAHD and (2) baseline demographic, pain, and functional differences between athletes who proceeded versus those who did not proceed to surgery within 1 year of evaluation. Study Design: Cohort study; Level of evidence, 3. Methods: An electronic medical record review was performed of middle school, high school, and college patients who were evaluated for PAHD at a single tertiary-care academic medical center between June 22, 2015, and May 1, 2018. Extracted variables included patients’ self-reported athlete status, decision to choose surgery within 1 year of evaluation, and baseline self-reported pain and functional scores on Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the Hip disability and Osteoarthritis Outcome Score (HOOS), and the modified Harris Hip Score. Results: Of 260 eligible patients (289 hips), 203 patients (78%; 227 hips) were athletes. Athletes were no more likely to choose surgery than nonathletes (130/227 hips [57%] vs 36/62 hips [58%]; relative risk [RR], 0.99 [95% CI, 0.78-1.25]). Among athletes, those who proceeded to surgery over conservative care were more likely to be female (81% vs 69%; RR, 1.34 [95% CI, 0.98-1.83]) and had more known imaging abnormalities (FAI: 82% vs 69%, RR, 1.47 [95% CI, 1.09-1.99]; dysplasia: 48% vs 27%, RR, 1.44 [95% CI, 1.16-1.79]; mixed deformity: 30% vs 10%, RR, 2.91 [95% CI, 1.53-5.54]; known labral tear: 84% vs 40%, RR, 2.79 [95% CI, 2.06-3.76]). Athletes who chose surgery also reported worse baseline hip-specific symptoms on all HOOS subscales (mean difference, 10.8-17.7; P < .01 for all). Conclusion: Similar to nonathletes, just over half of athletes with PAHD chose surgical management within 1 year of evaluation. Many competitive athletes with PAHD continued with conservative management and deferred surgery, but more structural hip pathology and worse hip-related baseline physical impairment were associated with the choice to pursue surgery.

Download Full-text

Application of a Computer Vision Tool for Automated Glottic Tracking to Vocal Fold Paralysis Patients

Otolaryngology ◽

10.1177/0194599821989608 ◽

2021 ◽

pp. 019459982198960

Author(s):

Tiffany V. Wang ◽

Nat Adamian ◽

Phillip C. Song ◽

Ramon A. Franco ◽

Molly N. Huston ◽

...

Keyword(s):

Vocal Fold ◽

Assessment Tool ◽

Medical Center ◽

Characteristic Curve ◽

Academic Medical Center ◽

Vocal Fold Paralysis ◽

Control Group ◽

Large Patient ◽

Patient Reported ◽

Before And After

Objectives (1) Demonstrate true vocal fold (TVF) tracking software (AGATI [Automated Glottic Action Tracking by artificial Intelligence]) as a quantitative assessment of unilateral vocal fold paralysis (UVFP) in a large patient cohort. (2) Correlate patient-reported metrics with AGATI measurements of TVF anterior glottic angles, before and after procedural intervention. Study Design Retrospective cohort study. Setting Academic medical center. Methods AGATI was used to analyze videolaryngoscopy from healthy adults (n = 72) and patients with UVFP (n = 70). Minimum, 3rd percentile, 97th percentile, and maximum anterior glottic angles (AGAs) were computed for each patient. In patients with UVFP, patient-reported outcomes (Voice Handicap Index 10, Dyspnea Index, and Eating Assessment Tool 10) were assessed, before and after procedural intervention (injection or medialization laryngoplasty). A receiver operating characteristic curve for the logistic fit of paralysis vs control group was used to determine AGA cutoff values for defining UVFP. Results Mean (SD) 3rd percentile AGA (in degrees) was 2.67 (3.21) in control and 5.64 (5.42) in patients with UVFP ( P < .001); mean (SD) 97th percentile AGA was 57.08 (11.14) in control and 42.59 (12.37) in patients with UVFP ( P < .001). For patients with UVFP who underwent procedural intervention, the mean 97th percentile AGA decreased by 5 degrees from pre- to postprocedure ( P = .026). The difference between the 97th and 3rd percentile AGA predicted UVFP with 77% sensitivity and 92% specificity ( P < .0001). There was no correlation between AGA measurements and patient-reported outcome scores. Conclusions AGATI demonstrated a difference in AGA measurements between paralysis and control patients. AGATI can predict UVFP with 77% sensitivity and 92% specificity.

Download Full-text

Native α-Synuclein, 3-Nitrotyrosine Proteins, and Patterns of Nitro-α-Synuclein-Immunoreactive Inclusions in Saliva and Submandibulary Gland in Parkinson’s Disease

Antioxidants ◽

10.3390/antiox10050715 ◽

2021 ◽

Vol 10 (5) ◽

pp. 715

Author(s):

Emilio Fernández-Espejo ◽

Fernando Rodríguez de Fonseca ◽

Juan Suárez ◽

Eduardo Tolosa ◽

Dolores Vilas ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Nervous System ◽

Clinical Features ◽

Clinical Feature ◽

Similar Concentration ◽

Duct Cells ◽

Nitrative Stress ◽

Salivary Concentration

Background. Salivary α-synuclein (aSyn) and its nitrated form, or 3-nitrotyrosine-α-synuclein (3-NT-αSyn), hold promise as biomarkers for idiopathic Parkinson’s disease (IPD). Nitrative stress that is characterized by an excess of 3-nitrotyrosine proteins (3-NT-proteins) has been proposed as a pathogenic mechanism in IPD. The objective is to study the pathological role of native αSyn, 3-NT-αSyn, and 3-NT-proteins in the saliva and submandibulary glands of patients with IPD. Methods. The salivary and serum αSyn and 3-NT-proteins concentration is evaluated with ELISA in patients and controls. Correlations of αSyn and 3-NT-proteins content with clinical features of the disease are examined. Immunohistochemical 3-NT-αSyn expression in submandibulary gland sections is analyzed. Results. (a) Salivary concentration and saliva/serum ratios of native αSyn and 3-NT-proteins are similar in patients and controls; (b) salivary αSyn and 3-NT-proteins do not correlate with any clinical feature; and (c) three patterns of 3-NT-αSyn-positive inclusions are observed on histological sections: rounded “Lewy-type” aggregates of 10–25 µm in diameter, coarse deposits with varied morphology, and spheroid inclusions or bodies of 3–5 µm in diameter. “Lewy-type” and coarse inclusions are observed in the interlobular connective tissue of the gland, and small-sized bodies are located within the cytoplasm of duct cells. “Lewy-type” inclusions are only observed in patients, and the remaining patterns of inclusions are observed in both the patients and controls. Conclusions. The patients’ saliva presents a similar concentration of native αSyn and 3-nitrotyrosine-proteins than that of the controls, and no correlations with clinical features are found. These findings preclude the utility of native αSyn in the saliva as a biomarker, and they indicate the absence of nitrative stress in the saliva and serum of patients. As regards nitrated αSyn, “Lewy-type” inclusions expressing 3-NT-αSyn are observed in the patients, not the controls—a novel finding that suggests that a biopsy of the submandibulary gland, if proven safe, could be a useful technique for diagnosing IPD. Finally, to our knowledge, this is also the first description of 3-NT-αSyn-immunoreactive intracytoplasmic bodies in cells that are located outside the nervous system. These intracytoplasmic bodies are present in duct cells of submandibulary gland sections from all subjects regardless of their pathology, and they can represent an aging or involutional change. Further immunostaining studies with different antibodies and larger samples are needed to validate the data.

Download Full-text

Implementation of pharmacogenomic testing in oncology care (PhOCus): study protocol of a pragmatic, randomized clinical trial

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920974118 ◽

2020 ◽

Vol 12 ◽

pp. 175883592097411

Author(s):

Natalie Reizine ◽

Everett E. Vokes ◽

Ping Liu ◽

Tien M. Truong ◽

Rita Nanda ◽

...

Keyword(s):

Clinical Laboratory ◽

Drug Effects ◽

Dose Intensity ◽

Progression Free Survival ◽

Clinical Decision ◽

Drug Dose ◽

Patient Specific ◽

Drug Dosing ◽

Patient Reported ◽

Dose Modifications

Background: Many cancer patients who receive chemotherapy experience adverse drug effects. Pharmacogenomics (PGx) has promise to personalize chemotherapy drug dosing to maximize efficacy and safety. Fluoropyrimidines and irinotecan have well-known germline PGx associations. At our institution, we have delivered PGx clinical decision support (CDS) based on preemptively obtained genotyping results for a large number of non-oncology medications since 2012, but have not previously evaluated the utility of this strategy for patients initiating anti-cancer regimens. We hypothesize that providing oncologists with preemptive germline PGx information along with CDS will enable individualized dosing decisions and result in improved patient outcomes. Methods: Patients with oncologic malignancies for whom fluoropyrimidine and/or irinotecan-inclusive therapy is being planned will be enrolled and randomly assigned to PGx and control arms. Patients will be genotyped in a clinical laboratory across panels that include actionable variants in UGT1A1 and DPYD. For PGx arm patients, treating providers will be given access to the patient-specific PGx results with CDS prior to treatment initiation. In the control arm, genotyping will be deferred, and dosing will occur as per usual care. Co-primary endpoints are dose intensity deviation rate (the proportion of patients receiving dose modifications during the first treatment cycle), and grade ⩾3 treatment-related toxicities throughout the treatment course. Additional study endpoints will include cumulative drug dose intensity, progression-free survival, dosing of additional PGx supportive medications, and patient-reported quality of life and understanding of PGx. Discussion: Providing a platform of integrated germline PGx information may promote personalized chemotherapy dosing decisions and establish a new model of care to optimize oncology treatment planning.

Download Full-text

Synovial Tissue Proteins and Patient-Specific Variables as Predictive Factors for Temporomandibular Joint Surgery

Diagnostics ◽

10.3390/diagnostics11010046 ◽

2020 ◽

Vol 11 (1) ◽

pp. 46

Author(s):

Mattias Ulmner ◽

Rachael Sugars ◽

Aron Naimi-Akbar ◽

Nikolce Tudzarovski ◽

Carina Kruger-Weiner ◽

...

Keyword(s):

Temporomandibular Joint ◽

Synovial Tissue ◽

Surgical Outcome ◽

Clinical Decision Making ◽

Protein Profile ◽

Strong Association ◽

Tissue Inhibitor Of Metalloproteinase ◽

Patient Specific ◽

Disc Displacement ◽

Patient Reported

Our knowledge of synovial tissues in patients that are scheduled for surgery as a result of temporomandibular joint (TMJ) disorders is limited. Characterising the protein profile, as well as mapping clinical preoperative variables, might increase our understanding of pathogenesis and forecast surgical outcome. A cohort of 100 patients with either disc displacement, osteoarthritis, or chronic inflammatory arthritis (CIA) was prospectively investigated for a set of preoperative clinical variables. During surgery, a synovial tissue biopsy was sampled and analysed via multi-analytic profiling. The surgical outcome was classified according to a predefined set of outcome criteria six months postoperatively. Higher concentrations of interleukin 8 (p = 0.049), matrix metalloproteinase 7 (p = 0.038), lumican (p = 0.037), and tissue inhibitor of metalloproteinase 2 (p = 0.015) were significantly related to an inferior surgical outcome. Several other proteins, which were not described earlier in the TMJ synovia, were detected but not related to surgical outcome. Bilateral masticatory muscle palpation pain had strong association to a poor outcome that was related to the diagnoses disc displacement and osteoarthritis. CIA and the patient-reported variable TMJ disability might be related to an unfavourable outcome according to the multivariate model. These findings of surgical predictors show potential in aiding clinical decision-making and they might enhance the understanding of aetiopathogenesis in TMJ disorders.

Download Full-text

TMJ Replacement Following Pseudoarthrosis of Condylar Neck Fracture With Dislocation of the Condylar Neck Within the Infra-Temporal Fossa

Craniomaxillofacial Trauma & Reconstruction Open ◽

10.1177/24727512211036849 ◽

2021 ◽

Vol 6 ◽

pp. 247275122110368

Author(s):

Sergio Olate ◽

Claudio Huentequeo-Molina ◽

Alejandro Unibazo ◽

Juan Pablo Alister

Keyword(s):

Temporal Bone ◽

Orthognathic Surgery ◽

Patient Specific ◽

Dental Occlusion ◽

Facial Trauma ◽

Class Iii ◽

Oral Rehabilitation ◽

Tmj Dislocation ◽

Patient Reported ◽

Condylar Neck

Study Design: Case Report Objective: To present a patient with long-standing TMJ dislocation and pseudoarthrosis in the temporal bone treated with orthognathic surgery and unilateral joint replacement. Method: The patient, a 52-year-old female, came to our department to treat facial asymmetry and oral rehabilitation. The patient reported early facial trauma at 7 years old showing partial edentoulism, dental occlusion class III and a 19 mm mandibular midline deviation. Cone beam computed tomography showed the left TMJ in long-standing dislocation into the fossa temporalis, creating a new articular fossa in the temporal bone and adaptation of the hard and soft tissue. Results: Orthognathic surgery and TMJ replacement using a patient-specific implant and dental rehabilitation were planned; surgery was performed with no complications, and the 1-year follow-up showed that this treatment was a good option for long-standing TMJ dislocation. Conclusion: The long-term TMJ dislocation can be successfully treated by TMJ replacement using a patient-specific implant to obtain facial balance and oral function and avoid relapse.

Download Full-text

Physician Survey of a Laboratory Medicine Interpretive Service and Evaluation of the Influence of Interpretations on Laboratory Test Ordering

Archives of Pathology & Laboratory Medicine ◽

10.5858/2004-128-1424-psoalm ◽

2004 ◽

Vol 128 (12) ◽

pp. 1424-1427 ◽

Cited By ~ 12

Author(s):

Martha E. Laposata ◽

Michael Laposata ◽

Elizabeth M. Van Cott ◽

Dion S. Buchner ◽

Mohammed S. Kashalo ◽

...

Keyword(s):

Laboratory Testing ◽

Medical Center ◽

Academic Medical Center ◽

Physician Satisfaction ◽

Patient Specific ◽

Diagnostic Process ◽

Reference Laboratory ◽

Academic Medical ◽

Coagulation Testing ◽

Test Ordering

Abstract Context.—Complex coagulation test panels ordered by clinicians are typically reported to clinicians without a patient-specific interpretive paragraph. Objectives.—To survey clinicians regarding pathologist-generated interpretations of complex laboratory testing panels and to assess the ability of the interpretations to educate test orderers. Design.—Surveys were conducted of physicians ordering complex coagulation laboratory testing that included narrative interpretation. Evaluation of order requisitions was performed to assess the interpretation's influence on ordering practices. Setting.—Physicians ordering coagulation testing at a large academic medical center hospital in Boston, Mass, and physicians from outside hospitals using the academic medical center as a reference laboratory for coagulation testing. Outcome Measures.—Physician surveys and evaluation of laboratory requisition slips. Results.—In nearly 80% of responses, the ordering clinicians perceived that the interpretive comments saved them time and improved the diagnostic process. Moreover, the interpretations were perceived by ordering clinicians to help prevent a misdiagnosis or otherwise impact the differential diagnosis in approximately 70% of responses. In addition, interpretations appeared to be able to train the ordering clinicians as to the standard ordering practices. Conclusions.—The results demonstrate physician satisfaction with an innovative information delivery approach that provides laboratory diagnostic interpretation and test-ordering education to clinicians in the context of their daily workflow.

Download Full-text

Patient-Reported Symptom Interference as a Measure of Postsurgery Functional Recovery in Lung Cancer

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2016.07.005 ◽

2016 ◽

Vol 52 (6) ◽

pp. 822-831 ◽

Cited By ~ 12

Author(s):

Qiuling Shi ◽

Xin Shelley Wang ◽

Ara A. Vaporciyan ◽

David C. Rice ◽

Keyuri U. Popat ◽

...

Keyword(s):

Lung Cancer ◽

Functional Recovery ◽

Patient Reported

Download Full-text

Patient and Family Engagement during Treatment Change to Emicizumab at a Hemophilia Treatment Center

Blood ◽

10.1182/blood-2019-131030 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5796-5796

Author(s):

Susan U Lattimore ◽

Madolyn T Hofstetter

Keyword(s):

Quality Improvement ◽

Hemophilia A ◽

Family Engagement ◽

Patient Specific ◽

Maternal Child Health ◽

Bleeding Events ◽

Treatment Change ◽

Health Maintenance ◽

Patient Reported

Introduction: Treatment options to prevent bleeding events in people with hemophilia A expanded with the FDA-approval of emicizumab. Safety and efficacy of emicizumab have been reported, but patient-specific health goals and expectations for switching to emicizumab are unpublished. Federally-supported Hemophilia Treatment Centers (HTCs), under the Maternal Child Health Bureau's Regional Hemophilia Network, are working to increase patient and family engagement in care decisions through quality improvement initiatives. Placing patients and families at the center of their care has been found to correlate with the ability to undertake personal health maintenance, adhere to complex treatment regimens and improve health outcomes. Objective: We sought to engage patients and families in their care by capturing patient-reported goals and gaps in education when changing treatment to emicizumab prophylaxis in people with hemophilia A at The Hemophilia Center at Oregon Health & Science University. Methods: A member of the HTC team not directly involved in the patient's care asked baseline questions at emicizumab initiation. Two follow-up questions were asked 5 weeks and 3 months after baseline, in clinic or via phone. Five open-ended baseline questions facilitated conversation and addressed patient/caregiver stated goals of treatment change and unanswered questions regarding emicizumab. Two follow-up questions assessed progress toward goals identified at baseline and information they wish they knew before switching. Participation was voluntary. No age or disease severity exclusions, but patients with active inhibitor were not included in this pilot project. For patients age < 18, both patient and caregiver were able to respond. Results: Thirty patients changing treatment to emicizumab were engaged. Fourteen patients and 5 caregivers responded independently. Eleven pediatric patients had a response by both patient and caregiver to total 41 baseline responses. Eighteen patients were <18 years and mean age was 19 (range: 1 to 70). 20 patients had severe hemophilia; 10 had moderate hemophilia. Most patients and caregivers said they were well informed prior to treatment change regarding the drug, administration, safety, and reported experience. Unanswered questions were categorized and included: side effects/drug interactions (17%), treating bleeds/amount of factor to have on hand (20%), and subcutaneous injections (13%). 47% had no outstanding questions at baseline. Patient-/caregiver-reported goals were categorized. Among all goals, 43% aligned with an increase/change in physical activity, 23% decrease in bleeding events, 17% less bruising, 10% fewer infusions, 3% more convenience, and 3% becoming more independent. Follow up data is available for 26 (87%) patients. At follow up visits, gaps in pre-switch education included unexpected painful injections (27%), ordering emicizumab and/or supplies (14%), maintaining peripheral infusion skills (4.5%), preparing emicizumab (4.5%), and assessing/treating bleeds (4.5%). 50% of patients/caregivers reported no outstanding education needs. All patients/caregivers (100%) stated they met their baseline-identified goals by month 3. Additional information derived from conversations prompted by the questions and offered by patients and families included reports of increased convenience, decreased parental worry, increased activity, fewer bleeding events, fewer work absences, and decreased pain. Discussion: Patients and caregivers are receptive to providing information regarding expectations surrounding treatment change to emicizumab. Respondents were able to identify personal goals in regard to their care and provide input into additional education that may inform other patients switching to emicizumab. Progress on patient-reported goals remains ongoing at this time. Although 50% of respondents indicated that there was information they wished they knew prior to changing treatment, none of the patients approached under this project have discontinued the use of emicizumab. It is feasible to engage patients and families with bleeding disorders in their care, as exampled by progress under this quality improvement initiative. Further analysis is needed to understand longer-term engagement of patients who use emicizumab for treatment of hemophilia A. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.12.6490 ◽

2021 ◽

Vol 28 (12) ◽

pp. 1701-1704

Author(s):

Farhan Zahoor ◽

Bushra Madni ◽

Muhammad Imran ◽

Muhammad Naveed ◽

Fazal ur Rehman ◽

...

Keyword(s):

Clinical Features ◽

Rural Areas ◽

Tertiary Care Hospital ◽

Acute Myocarditis ◽

Tertiary Care ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Clinical Feature ◽

Care Hospital ◽

Male Predominance

Objective: To find out characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital. Study Design: Observational Study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: February 2020 to February 2021. Material & Methods: A total of 71 children aged 1 month to 15 years admitted with acute myocarditis were enrolled. Acute myocarditis was labeled as short history of illness in otherwise healthy child, echocardiography evident of left ventricular dysfunctioning, cardiac biomarkers showing cardiac damage as well as electrocardiography showing acute myocarditis. Age was represented as mean and standard deviation whereas qualitative variables like gender, area of residence and clinical features were shown as frequency and percentages. Results: Out of a total of 71 children, there were 38 (53.5%) were male. Median age was recorded to be 16.6 months. Majority of the cases, 42 (59.2%) belonged to rural areas of residence. Tachycardia was the commonest clinical feature noted in 65 (91.5%) children, irritability was seen in 50 (70.4%), tachypnea in 48 (67.6%) while poor feeding was noted 44 (62.0%) children. Hepatomegaly was noted in 39 (54.9%) children. Hypotension was recorded in 35 (49.3%) children. Conclusion: Male predominance was seen among children presenting with acute myocarditis. Tachycardia, irritability, tachypnea and poor feeding were the commonest clinical features observed.

Download Full-text