Acute Exposure to European Viper Bite in Children: Advocating for a Pediatric Approach

Background: Viper bite is an uncommon but serious cause of envenoming in Europe, especially in children. Our study aim is to better describe and analyze the clinical course and treatment of viper bite envenoming in a pediatric population. Methods: We retrospectively reviewed 24 cases of pediatric viper bites that were admitted to the Pediatric Emergency Department and the Pediatric Intensive Care Unit of the Bambino Gesù Children Hospital in Rome between 2000 and 2020. Epidemiological characteristics of the children, localization of the bite, clinical and laboratory findings, and treatment approaches were evaluated. Results: The median age of the patients was 4.2 years, with male predominance. Most cases of viper bite occurred in the late summer. Most patients required admission to the ward for prolonged observation. The most common presenting signs were pain, local oedema, and swelling. Patients with a high severity score also had a significantly higher white blood cell count and an increase of INR, LDH, and CRP levels. No fatality was reported. Conclusions: Viper bite envenomation is a rare pediatric medical emergency in Italy but may sometimes be severe. A new pediatric severity score may be implemented in the screening of children with viper bites to favor a selective and prompt administration of antivenom.

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Bacterial Meningitis Profile in Newborns: Is the Epidemiology Changing?

The Open Infectious Diseases Journal ◽

10.2174/1874279301810010160 ◽

2018 ◽

Vol 10 (1) ◽

pp. 160-165

Author(s):

F. Bennaoui ◽

N. El Idrissi Slitine ◽

S.B. Cissé ◽

N. Soraa ◽

F.M.R Maoulainine

Keyword(s):

Bacterial Meningitis ◽

Neonatal Intensive Care ◽

University Hospital ◽

Medical Emergency ◽

Klebsiella Pneumonia ◽

Microbiological Analysis ◽

Glycopeptide Antibiotics ◽

Male Predominance ◽

Neurologic Sequelae ◽

Epidemiological Characteristics

Objective: The aim of the study was to determine the epidemiological characteristics of bacterial meningitis observed in neonates. Materials and Methods: A retrospective study of all cases of meningitis, hospitalized in the neonatal intensive care unit, Mohamed VI University Hospital, from January 2016 to December 2016. Results: Twenty of 794 neonates admitted (2.5%) developed meningitis,with a male predominance (12 boys). The mean age of symptom presentation was 5 days. All patients were symptomatic. The most common clinical features were: fever, respiratory distress and seizure. Microbiological analysis of cerebrospinal fluid was positive in 14 cases and resulted in the isolation of several unusual species such as, Streptococcus pneumoniae (4 cases), Coagulase-negative Staphylococci (3 cases), Enterococci (2 cases), Acinetobacter baumannii (2 cases) and one case each of Escherichia coli , Neisseria meningitidis and Klebsiella pneumonia. Interestingly, the two A. baumannii cases were nosocomially-acquired, while the origins of the other infections were community-acquired. Gram-positive bacteria were more frequently responsible (9/14, 64%). All cases were treated with a combination of third-generation cephalosporins-aminoglycosides, 1 case as treated by by adding ciprofloxacin and 3 cases were treated by adding glycopeptide antibiotics to the clinical therapeutic regimes. We reported 3 cases complicated with hydrocephalus. The mortality rate was 25%. Conclusion: Bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause so that appropriate antimicrobial therapy can be initiated. Even with optimal therapy, morbidity and mortality may occur. Neurologic sequelae are common among survivors.

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

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00346-9 ◽

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.

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P040: Epidemiology of gun related injuries among Canadian children and youth from 2005-2013: a CHIRPP study

CJEM ◽

10.1017/cem.2017.242 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S91

Author(s):

C.M. Cox ◽

S. Stewart ◽

K.F. Hurley

Keyword(s):

Pediatric Population ◽

Gun Control ◽

Simple Linear Regression ◽

Eye Injuries ◽

Unintentional Injuries ◽

Exact Test ◽

Male Predominance ◽

Self Harm ◽

Ed Visits ◽

Injury Reporting

Introduction: Gun related injuries were last reported by the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) in 2005. Since that time, Canadian gun control is less stringent and non-powder guns are increasingly popular. We aim to describe trends in pediatric gun related injuries and deaths since 2005. Methods: This is a retrospective review of CHIRPP data. The dataset included pediatric (age 0-19 years) gun-related injuries and deaths reported by participating CHIRPP emergency departments (ED) from 2005-2013. Variables were tested using Fisher’s exact test and simple linear regression. Results: There were 421 records of gun-related injuries in the database. Three hundred and twenty-nine occurred from use of non-powder guns, 85 occurred from use of powder-guns, and in 7 cases the type of gun was not clear. The number of gun-related injuries per 100 000 ED visits remained stable from 2005-2013 with a male predominance (n=366, 87%). Most injuries resulted from non-powder guns and were unintentional. Injuries most often occurred in the context of recreation (n=181) and sport (n=51). One hundred fifty four eye injuries were reported, 98% of which were from a non-powder gun. Forty-six individuals required admission to hospital and 2 died in the ED. Nine of 10 intentional self-harm injuries were inflicted with a powder gun. Conclusion: This study describes the injuries and circumstances in which pediatric gun-related injury and death occur in Canada. Unintentional injuries caused by non-powder guns were most common. Though less fatal than powder guns, non-powder guns can still cause life-altering eye injuries. This evidence can inform injury prevention programs to target specific circumstances in which the pediatric population is most vulnerable.

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Using cervical spine clearance guidelines in a pediatric population: a survey of physician practices and opinions

CJEM ◽

10.2310/8000.2011.100220 ◽

2011 ◽

Vol 13 (01) ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Emma C. Burns ◽

Natalie L. Yanchar

Keyword(s):

Cervical Spine ◽

Design Method ◽

Pediatric Population ◽

Trauma Team ◽

Pediatric Emergency ◽

Team Leaders ◽

Physician Practices ◽

Clinical Criteria ◽

Radiologic Imaging ◽

National Emergency

ABSTRACT Background: Unlike in adults, there are currently no standardized, validated guidelines to aid practitioners in clearing the pediatric cervical spine (C-spine). Many pediatric centres in Canada have locally produced, adult-modified guidelines, but the extent to which these or other guidelines are used is unknown. Objective: The purpose of this study was to determine if Canadian physicians are using either locally produced or adult C-spine guidelines to clear the C- spines of patients < 16 years of age. The study also characterized the common methods used by physicians to clear pediatric C-spine injuries in terms of clinical examination and radiologic imaging. Methods: A 20-question survey was distributed to 240 Canadian pediatric emergency physicians and trauma team leaders using the Dillman Total Design Method. Results: The response rate was 68%. The results showed that 61% of physicians currently use guidelines to assist in the clearance of pediatric C-spines. Of those physicians not using guidelines, 85% stated that they would use them if they were available. The clinical criteria most often used to clear pediatric C-spines were a normal neurologic examination (97%) and the absence of C-spine tenderness (95%), intoxication (94%), and distracting injuries (87%). Conclusions: Guidelines are commonly used by Canadian physicians when clearing the pediatric C-spine, yet few are validated in children. Those most commonly used are locally developed guidelines, the Canadian C-spine guidelines, or National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria.

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Meningoencephalitis in intensive care unit: Do Japanese Encephalitis cases go unsuspected?

Journal of Chitwan Medical College ◽

10.3126/jcmc.v7i1.17362 ◽

2017 ◽

Vol 7 (1) ◽

pp. 7-10

Author(s):

Ashish Ghimire ◽

Balkrishna Bhattarai ◽

Basudha Khanal ◽

Suchana Marhatta ◽

Gopendra Prasad Deo

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Adult Patients ◽

Medical Emergency ◽

Real Problem ◽

Cerebrospinal Fluid Analysis ◽

Laboratory Findings ◽

Fluid Analysis ◽

Intensive Approach ◽

Serology Testing

Background: Meningoencephalitis (ME) is a medical emergency. Acute infective encephalitis is usually viral. Nepal has the second highest prevalence of JE in South East Asia. About one third of the JE cases results in death. The records of the JE in the laboratory of B.P. Koirala Institute of Health Sciences (BPKIHS) showed 760 samples to have the evidence of JE infection out of 3352 tested during the period of 2001-2011 AD. The present study aimed to conduct an audit on meningoencephalitis cases admitted in the ICU of our hospital in an attempt to find its burden.Methods: Medical records of all the adult patients with the provisional diagnosis of Meningoencephalitis at BPKIHS over the period of 2009-2011 AD were examined. Laboratory findings of all the patients diagnosed with ME who were admitted to the eight bedded general intensive care unit (ICU) were also reviewed. The diagnosis was made based on the findings of medical history, clinical examination and cerebrospinal fluid analysis for biochemistry and cytology, results of anti JE IgM test performed on CSF and/or serum.Results: Altogether 127 samples of CSF were obtained from adult patients admitted in different inpatient department of BPKIHS with the clinical diagnosis of meningo encephalitis between 2009-2011 AD. Out of them, 25 (19.68%) were tested positive of JE. A total of 684 patients were admitted over the same period with different diagnoses in 8 bedded ICU of hospital. Fifteen (2.19%) were transferred to the ICU with the ME. In the ICU, 9(60%) were treated as viral encephalitis. Among them CSF of only 4 patients’ were sent for testing for JE and found positive in 2 cases. Seven (46.6%) patients expired while 4(26.6%) were taken home by the relatives against medical advice in critically ill conditions and remaining 4 (26.6%) improved and transferred to ward. Among the expired patients 5 (71.4%) had viral encephalitis.Conclusion: JE is a real problem but many cases are likely to have been gone undetected. Adoption of a more intensive approach with much liberal serology testing policy seems to be appropriate for better detecting JE cases in the setting.

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The bicuspid aortic valve and related disorders

Sao Paulo Medical Journal ◽

10.1590/s1516-31802010000500010 ◽

2010 ◽

Vol 128 (5) ◽

pp. 296-301 ◽

Cited By ~ 7

Author(s):

Shi-Min Yuan ◽

Hua Jing

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Thrombus Formation ◽

Beta Blockers ◽

Ductus Arteriosus ◽

Treatment Strategies ◽

Hereditary Diseases ◽

Laboratory Findings ◽

Male Predominance ◽

Congenital Cardiac Malformation

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, affecting 1-2% of the population, with strong male predominance. Individuals may have a normally functioning BAV, and may be unaware of its presence and the potential risk of complications. However, they may easily develop aortic valve disorders: either stenotic or regurgitant, or both. Today, BAV is recognized as a syndrome incorporating aortic valve disorders and aortic wall abnormalities, including aortic dilation, dissection or rupture. Congenital or hereditary diseases such as ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, Turner's syndrome, Marfan's syndrome etc., may frequently be associated with BAV. Infective endocarditis and occasionally thrombus formation may develop during the lives of BAV patients. Elevated cholesterol or C-reactive protein may be seen in laboratory findings of these patients. Beta-blockers and statins are the possibilities for medical treatment, and aortic valve repair/replacement and ascending aorta replacement are indicated for patients with a severely diseased aortic valve and aorta. Rigorous follow-up throughout life is mandatory after BAV has been diagnosed. The aim of the present article was to describe the implications of BAV and its associated disorders, and to discuss diagnostic and treatment strategies.

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Paediatric visceral leishmaniasis: a retrospective study on clinical manifestations, demographic features and laboratory findings of hospitalised cases in Iran between 2006 and 2016

Tropical Doctor ◽

10.1177/0049475518811513 ◽

2018 ◽

Vol 49 (1) ◽

pp. 59-61 ◽

Cited By ~ 1

Author(s):

Manijeh Nourian ◽

Aliehsan Heidari ◽

Saleheh Tajali ◽

Erfan Ghasemi ◽

Mehdi Mohebali ◽

...

Keyword(s):

Retrospective Study ◽

Visceral Leishmaniasis ◽

Clinical Manifestations ◽

Laboratory Findings ◽

Neglected Disease ◽

Paediatric Hospital ◽

Geographical Regions ◽

Epidemiological Characteristics ◽

Demographic Features

Visceral leishmaniasis (VL) is a neglected disease. Our retrospective study describes 38 clinical and epidemiological characteristics of VL in patients admitted to a paediatric hospital in Tehran, Iran, who came from different geographical regions, indicating that the disease has spread to most parts of the country. Some 76.3% of the children documented suffered with symptoms of the disease for two months before admission.

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The toll of COVID-19 on African children: A descriptive analysis on the COVID-19-related morbidity and mortality among the pediatric population in Sub-Saharan Africa

10.1101/2021.07.02.21259857 ◽

2021 ◽

Author(s):

Sabina Rodriguez Velasquez ◽

Lea Jacques ◽

Jyoti Dalal ◽

Paolo Sestito ◽

Zahra Habibi ◽

...

Keyword(s):

Cumulative Incidence ◽

Pediatric Population ◽

Adult Population ◽

Age Groups ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

African Countries ◽

Regional Office ◽

Sub Saharan ◽

Epidemiological Characteristics

Introduction: Since the beginning of the COVID-19 pandemic, very little data on the epidemiological characteristics among the pediatric population in Africa has been published. This paper examines the age and sex distribution of the morbidity and mortality rate in children with COVID-19 and compares it to the adult population within 15 Sub-Saharan African countries. Methods: A merge line listing dataset using a reverse engineering model shared by countries within the Regional Office for Africa was analyzed. Patients diagnosed within 1 March 2020 and 1 September 2020 with confirmed positive RT-PCR test for SARS-CoV-2 were analyzed. Children data were stratified into three age groups: 0-4 years, 5-11 years, and 12-17 years, while adults were combined. The cumulative incidence of cases including its medians and 95% confidence intervals were calculated. Results: 9% of the total confirmed cases and 2.4% of the reported deaths were pediatric cases. The 12-17 age group in all 15 countries showed the highest cumulative incidence proportion in children. COVID-19 cases in males and females under the age of 18 were evenly distributed. Among adults, a higher case incidence per 100,000 people was observed compared to children. Conclusion: The cases and deaths within the children population was smaller than the adult population. These differences can reflect biases in COVID-19 testing protocols and reporting implemented by countries, highlighting the need for more extensive investigation and focus on the effects of COVID-19 in children.

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Accidental tramadol ingestion in children admitted in tertiary care centre

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195200 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2661

Author(s):

Vadlakonda Sruthi ◽

Annaladasu Narendra

Keyword(s):

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Ventilatory Support ◽

Case Series ◽

Pediatric Intensive Care ◽

Hemodynamic Instability ◽

Tertiary Care Centre ◽

Medical College ◽

History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

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Clinical Manifestations of Orbital Involvement in IgG4-Related Disease: A Retrospective Study of 573 Patients

10.21203/rs.3.rs-712045/v1 ◽

2021 ◽

Author(s):

Linyang Gan ◽

Xuan Luo ◽

Yunyun Fei ◽

Linyi Peng ◽

Jiaxin Zhou ◽

...

Keyword(s):

Lacrimal Gland ◽

Clinical Laboratory ◽

Clinical Manifestations ◽

Chinese Patients ◽

Laboratory Findings ◽

Male Predominance ◽

Orbital Involvement ◽

Related Disease ◽

Igg4 Related Disease ◽

Serum Igg4

Abstract Purpose: To investigate the clinical manifestations of orbital involvement in a large cohort of Chinese patients with IgG4-related disease (IgG4-RD). Methods: A total of 573 patients with IgG4-related disease were included. We described and compared the demographic, clinical, laboratory and histopathologic findings from 314 patients with IgG4-related ophthalmic disease (IgG4-ROD) and 259 with extra-ophthalmic IgG4-RD.Results: Male predominance was found significant in extra-ophthalmic IgG4-RD only. Patients with IgG4-ROD showed younger age at diagnosis and longer duration from onset till diagnosis. In patients with extra-ophthalmic IgG4-RD, the most commonly involved extra-ophthalmic organ was pancreas; while in IgG4-ROD patients, salivary gland was most frequently affected. Multivariate analysis exhibited IgG4-ROD was associated with allergy history, higher serum IgG4/IgG ratio, multiple organs involvement and sialoadenitis. Orbital images were reviewed in 173 (55.1%) IgG4-ROD patients. Fifty-one (29.5%) patients had multiple lesions. Lacrimal gland involvement was detected in 151 (87.3%) patients, followed by extraocular muscles (40, 23.1%), other orbital soft tissue (40, 23.1%) and trigeminal nerve (8, 4.6%). Biopsy was performed from various organs in 390 cases. A dense lymphoplasmacytic infiltration and fibrosis were the main feature in orbital specimens. Storiform fibrosis and obliterative phlebitis were absent in lacrimal gland.Conclusions: Lacrimal gland involvement was the most common orbital manifestation of IgG4-ROD. Patients with IgG4-ROD showed different characteristic in demographic, clinical, laboratory findings compared to patients with extra-ophthalmic IgG4-RD. These features might indicate potential differences in the pathogenesis of these two subgroups of IgG4-RD.

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