The knowledge level and practices on childhood injuries and interventions among parents at home

Background: There are many common household emergencies that may involve children. This includes poisoning, falls, burns, choking, animal bites, very high fever and also febrile fits. Knowledge about preventive measures to prevent these accidents as home as well as knowing what to do when it occurs may help in preventing further complications and may aid in recovery. Therefore, this study aims to find out the general public knowledge regarding the preventive steps and early emergency steps that can be taken upon emergencies occurring among children. Methods: A cross sectional study incorporating a questionnaire/instrument that included brief sociodemographic data and a total of 10 questions on common household injuries and emergencies, and either preventive steps or early interventions was used. The topics covered were 6 core topics on poisoning, falls, burns, choking, animal bites, high fever and also febrile fits. Results: The total number of respondents was 119 parents. This study overall showed a good knowledge, attitude and practice among the parents towards common emergency inflicting children. Older aged and female parent were found to have more knowledge and positive attitude towards common emergencies among children, respectively. Conclusion: Group identified as having a lower knowledge, attitude and/or practice should be targeted in future community education programmes to increase the knowledge as well positive attitudes and practices towards identifying and managing common emergencies among children. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 140-144

Familial Hemophagocytic Lymphohistiocytosis Secondary to PRF1 Mutation

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that causes systemic inflammation which can progress to multiorgan failure and death. Symptoms and signs commonly seen in HLH include high fever, hepatosplenomegaly, pancytopenia, and hypertriglyceridemia. This report describes the 8-month clinical course of a 17-year-old male with G6PD deficiency who presented with intermittent high fever of unknown origin for 8 months accompanied by pancytopenia and bilateral lower limb weakness. A pathogenic homozygous missense mutation (c.1081A > T p.(Arg361Trp)) in the PRF1 gene was detected by whole exome sequencing (WES). The brain and the whole spine MRI showed leptomeningeal enhancement at different levels involving both the brain and the spine. Therefore, a diagnosis of familial HLH type 2 with CNS involvement was confirmed. Accordingly, treatment with dexamethasone, cyclosporin, and etoposide in addition to intrathecal methotrexate and hydrocortisone was given. The patient showed a dramatic response with significant neurological improvement of the bilateral lower limb weakness. Genetic analysis has helped the patient’s family with appropriate genetic counselling. This case highlights the importance of immediate treatment with immunosuppressants and the high clinical suspicion of physicians regarding HLH in areas where consanguinity is common.

Ruxolitinib versus dexamethasone in hospitalized adults with COVID-19: multicenter matched cohort study

Background Several anti-cytokine therapies were tested in the randomized trials in hospitalized patients with severe acute respiratory syndrome coronavirus 2 infection (COVID-19). Previously, dexamethasone demonstrated a reduction of case-fatality rate in hospitalized patients with respiratory failure. In this matched control study we compared dexamethasone to a Janus kinase inhibitor, ruxolitinib. Methods The matched cohort study included 146 hospitalized patients with COVID-19 and oxygen support requirement. The control group was selected 1:1 from 1355 dexamethasone-treated patients and was matched by main clinical and laboratory parameters predicting survival. Recruitment period was April 7, 2020 through September 9, 2020. Results Ruxolitinib treatment in the general cohort of patients was associated with case-fatality rate similar to dexamethasone treatment: 9.6% (95% CI [4.6–14.6%]) vs 13.0% (95% CI [7.5–18.5%]) respectively (p = 0.35, OR = 0.71, 95% CI [0.31–1.57]). Median time to discharge without oxygen support requirement was also not different between these groups: 13 vs. 11 days (p = 0.13). Subgroup analysis without adjustment for multiple comparisons demonstrated a reduced case-fatality rate in ruxolitnib-treated patients with a high fever (≥ 38.5 °C) (OR 0.33, 95% CI [0.11–1.00]). Except higher incidence of grade 1 thrombocytopenia (37% vs 23%, p = 0.042), ruxolitinib therapy was associated with a better safety profile due to a reduced rate of severe cardiovascular adverse events (6.8% vs 15%, p = 0.025). For 32 patients from ruxolitinib group (21.9%) with ongoing progression of respiratory failure after 72 h of treatment, additional anti-cytokine therapy was prescribed (8–16 mg dexamethasone). Conclusions Ruxolitinib may be an alternative initial anti-cytokine therapy with comparable effectiveness in patients with potential risks of steroid administration. Patients with a high fever (≥ 38.5 °C) at admission may potentially benefit from ruxolitinib administration. Trial registration The Ruxolitinib Managed Access Program (MAP) for Patients Diagnosed With Severe/Very Severe COVID-19 Illness NCT04337359, CINC424A2001M, registered April, 7, 2020. First participant was recruited after registration date

COVID-19 MIS-C ( MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN) LIKE PRESENTATION WITH RARE ASSOCIATION OF SCRUB TYPHUS : A CASE SERIES.

Introduction: Recently there is a surge of post COVID-19 MIS-C cases worldwide. Its diagnosis becomes challenging when a case presented with MIS-C like feature associated with scrub typhus infection. Method: Our cases presented with high fever, neurological and gasrtointestinal symptoms, rash and non-purulant conjunctivitis . All the cases have high inammatory markers like ESR,CRP,LDH,ferritin,IL6 with elevated D-dimer and CPK-MB in case 1 and 2. Echocardiographic abnormality was present in rst two cases and SARS-CoV-2 Ab was positive in all . Due to their MIS-C like presentation we treated with methyl prednisolone , IVIG, enoxaparin and oral aspirin but fever did not responded .Then after getting the Scrub IgM Ab positive and discovering eschar in third case we started doxycycline and the patients were discharged in stable condition. Conclusion: Tropical infections like scrub typhus may be associated with a post COVID-19 MIS-C like presentation.

Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature

Background Fever and hypothermia have been observed in septic patients. Their influence on prognosis is subject to ongoing debates. Methods We did a secondary analysis of a large clinical dataset from a quality improvement trial. A binary logistic regression model was calculated to assess the association of the thermal response with outcome and a multinomial regression model to assess factors associated with fever or hypothermia. Results With 6542 analyzable cases we observed a bimodal temperature response characterized by fever or hypothermia, normothermia was rare. Hypothermia and high fever were both associated with higher lactate values. Hypothermia was associated with higher mortality, but this association was reduced after adjustment for other risk factors. Age, community-acquired sepsis, lower BMI and lower outside temperatures were associated with hypothermia while bacteremia and higher procalcitonin values were associated with high fever. Conclusions Septic patients show either a hypothermic or a fever response. Whether hypothermia is a maladaptive response, as indicated by the higher mortality in hypothermic patients, or an adaptive response in patients with limited metabolic reserves under colder environmental conditions, remains an open question. Trial registration The original trial whose dataset was analyzed was registered at ClinicalTrials.gov (NCT01187134) on August 23, 2010, the first patient was included on July 1, 2011.

The Polar Legionella Icm/Dot T4SS Establishes Distinct Contact Sites with the Pathogen Vacuole Membrane

Legionnaires’ disease is a life-threatening pneumonia, which is characterized by high fever, coughing, shortness of breath, muscle pains, and headaches. The disease is caused by the amoeba-resistant bacterium L. pneumophila found in various soil and aquatic environments and is transmitted to humans via the inhalation of small bacteria-containing droplets.