Pub Date : 2022-01-01DOI: 10.7199/PED.ONCALL.2022.9
S. Pimenta, A. R. Soares, Sara Soares, L. Machado
{"title":"The diagnosis of pre-symptomatic diseases","authors":"S. Pimenta, A. R. Soares, Sara Soares, L. Machado","doi":"10.7199/PED.ONCALL.2022.9","DOIUrl":"https://doi.org/10.7199/PED.ONCALL.2022.9","url":null,"abstract":"","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"136 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86834554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/ped.oncall.2022.38
Yash Sonagra, I. Shah
{"title":"Tenofovir and Hepatitis B - How to manage?","authors":"Yash Sonagra, I. Shah","doi":"10.7199/ped.oncall.2022.38","DOIUrl":"https://doi.org/10.7199/ped.oncall.2022.38","url":null,"abstract":"","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75356554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/ped.oncall.2023.18
N. Amenzoui, K. Gharib, S. Kalouche, A. Chlilek, F. Ailal, A. Bousfiha
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a worldwide pandemic, manifested commomly by infectious pneumonia, some patients also develop gastrointestinal (GI) and hepatic manifestations. To understand the clinical features and possible pathogenic mechanisms leading to gastrointestinal lesions in COVID-19 to formulate therapeutic strategy. Thus, we report the case of a girl with an acute febrile digestive picture revealing COVID19 infection, having direct contact with a COVIDpositive person. Surgical exploration was performed when white, on the balance sheet a PCR covid was negative and serology covid 19 (IgM positive and IgG positive). In conclusion, we are slowly starting to understand the complex pathogenesis of SARS-CoV-2 infections. The widespread organospecific complications of COVID-19, including those of the gastrointestinal system, are now increasingly appreciated. A thorough understanding of the gastrointestinal damage and clinical manifestations of this multi-organ disease remains imperative. Introduction Severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) is a global pandemic, manifested mainly by respiratory symptoms. An increasing number of extra-pulmonary symptoms and manifestations linked to COVID-19 have been observed, including gastrointestinal (GI) and hepatic manifestations. Very few adult case series have reported acute abdomen as a symptom of SARS-COV-2 infection.1 The objective of our work is to update physicians working with suspected cases of the Covid-19 on acute abdominal events. Case Report This is a 9-year-old head girl, with no significant past medical history, having direct contact with his mother who was covid positive two weeks before, admitted for an acute abdomen with shock. The history of the disease dates back to a week before its admission with fever over 39° C, complicated three days later by diffuse acute abdominal pain associated with watery diarrhea and vomiting post meals, without associated respiratory symptoms. The child was initially admitted in pediatric resuscitation in shock, on clinical examination she was drowsy with Glasgow 12/15, febrile at 39° C, capillary refill time above 3 seconds, tachycardia of 160 beats per minute, polypnea to 53 cycles per minute, 96% oxygen saturation in room air, blood pressure at 80 / 60mmg, severe abdominal pain generalized on palpation associated with contracture of the abdominal muscles, without hepatomegaly or splenomegaly. After the conditioning, an abdominal ultrasound was performed and showed a hypoecogenic ledure in favour of an intraperitoneal fluid effusion of medium abundance. Faced with this clinico-radiological picture, peritonitis was suspected but the surgical exploration carried out urgently, came back unremarkable. Biologically, we note the presence of a high crp, high ferritinémia, lymphopenia, as well as thrombocytopenia. More details are given in Table 1. Table 1. Hematological and Biochemical profile of the our patien
{"title":"Intriguing Acute Abdomen and Covid-19 in children : A case report","authors":"N. Amenzoui, K. Gharib, S. Kalouche, A. Chlilek, F. Ailal, A. Bousfiha","doi":"10.7199/ped.oncall.2023.18","DOIUrl":"https://doi.org/10.7199/ped.oncall.2023.18","url":null,"abstract":"Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a worldwide pandemic, manifested commomly by infectious pneumonia, some patients also develop gastrointestinal (GI) and hepatic manifestations. To understand the clinical features and possible pathogenic mechanisms leading to gastrointestinal lesions in COVID-19 to formulate therapeutic strategy. Thus, we report the case of a girl with an acute febrile digestive picture revealing COVID19 infection, having direct contact with a COVIDpositive person. Surgical exploration was performed when white, on the balance sheet a PCR covid was negative and serology covid 19 (IgM positive and IgG positive). In conclusion, we are slowly starting to understand the complex pathogenesis of SARS-CoV-2 infections. The widespread organospecific complications of COVID-19, including those of the gastrointestinal system, are now increasingly appreciated. A thorough understanding of the gastrointestinal damage and clinical manifestations of this multi-organ disease remains imperative. Introduction Severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) is a global pandemic, manifested mainly by respiratory symptoms. An increasing number of extra-pulmonary symptoms and manifestations linked to COVID-19 have been observed, including gastrointestinal (GI) and hepatic manifestations. Very few adult case series have reported acute abdomen as a symptom of SARS-COV-2 infection.1 The objective of our work is to update physicians working with suspected cases of the Covid-19 on acute abdominal events. Case Report This is a 9-year-old head girl, with no significant past medical history, having direct contact with his mother who was covid positive two weeks before, admitted for an acute abdomen with shock. The history of the disease dates back to a week before its admission with fever over 39° C, complicated three days later by diffuse acute abdominal pain associated with watery diarrhea and vomiting post meals, without associated respiratory symptoms. The child was initially admitted in pediatric resuscitation in shock, on clinical examination she was drowsy with Glasgow 12/15, febrile at 39° C, capillary refill time above 3 seconds, tachycardia of 160 beats per minute, polypnea to 53 cycles per minute, 96% oxygen saturation in room air, blood pressure at 80 / 60mmg, severe abdominal pain generalized on palpation associated with contracture of the abdominal muscles, without hepatomegaly or splenomegaly. After the conditioning, an abdominal ultrasound was performed and showed a hypoecogenic ledure in favour of an intraperitoneal fluid effusion of medium abundance. Faced with this clinico-radiological picture, peritonitis was suspected but the surgical exploration carried out urgently, came back unremarkable. Biologically, we note the presence of a high crp, high ferritinémia, lymphopenia, as well as thrombocytopenia. More details are given in Table 1. Table 1. Hematological and Biochemical profile of the our patien","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81497051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/PED.ONCALL.2022.11
Natalie Ho, M. Lam, W. Chan
Fibrodysplasia ossificans progressive (FOP) is an extremely rare noninflammatory disease that involves heterotrophic bone formation after tissue injury. Diagnosis of FOP is based on clinical suspicion for children presenting with bilateral hallux valgus and acute soft tissue swelling after trauma. Genetic analysis for mutation of the ACVR1 gene is considered a confirmatory test. We present 2 children with FOP that were diagnosed at seven years and twenty months of age respectively. The first patient presented with acute tissue swelling over the back and an incidental finding of hallux valgus. Genetic study revealed heterozygous c617G>A mutation in exon 4 of the ACVR1 gene suggestive of FOP. She had several relapses, and management pitfalls are highlighted. This first case alerted early diagnosis of FOP in a twentymonth-old boy with bilateral hallux valgus. Introduction Fibrodysplasia ossificans progressive is a rare noninflammatory disease involving genetic mutation of the ACVR1 gene, characterised by heterotopic bone formation and recurrent episodes of painful soft tissue swelling that arises spontaneously or is triggered by minor trauma.1 As with almost all rare diseases, there are various scientific and medical challenges in FOP diagnosis and management. As trauma is a stimulant event, biopsy and surgical interventions can cause devastating results at the site of ossification. Thus, it is essential to recognise early features of FOP including bilateral hallux valgus and recurrent soft tissue swelling and avoid tissue biopsy in suspected cases. We present 2 children with FOP and the management issues. Case 1 A 7-year-old girl presented with progressive left upper back swelling for three weeks after a minor contusion against the table corner. She had a history of mild bilateral conductive hearing impairment, otherwise unremarkable past health. Physical examination revealed mild scoliosis with diffuse swelling, erythema, and tenderness over the left paraspinal muscles. There was reduced movement over her back in all directions, especially over left lateral flexion, and reduced range of movement of both hips on internal and external rotation. Bilateral hallux valgus was noted. Autoimmune markers including anti-nuclear antibody, rheumatoid factor and anti-extractable nuclear antigen were negative. Magnetic resonance imaging (figure 1) revealed T2 hyper-intensity with soft tissue swelling around both scapulae, more severe over the left side. Bony structures appeared unremarkable. She was initially managed with regular physiotherapy for suspected muscle strain and treated with nonsteroidal anti-inflammatory drugs (NSAIDS) to control the inflammation. The treatment did not reduce the muscle discomfort, but stretching exercise aggravated the extent of muscle pain and subsequent “disease flared” over her right sternocleidomastoid muscle. The diagnosis of FOP was then considered. Genetic study revealed heterozygous c617G>A mutation in exon 4 of the ACVR1
{"title":"Fibrodysplasia Ossificans Progressiva - Recognising the Early features and Avoid Doing Harm","authors":"Natalie Ho, M. Lam, W. Chan","doi":"10.7199/PED.ONCALL.2022.11","DOIUrl":"https://doi.org/10.7199/PED.ONCALL.2022.11","url":null,"abstract":"Fibrodysplasia ossificans progressive (FOP) is an extremely rare noninflammatory disease that involves heterotrophic bone formation after tissue injury. Diagnosis of FOP is based on clinical suspicion for children presenting with bilateral hallux valgus and acute soft tissue swelling after trauma. Genetic analysis for mutation of the ACVR1 gene is considered a confirmatory test. We present 2 children with FOP that were diagnosed at seven years and twenty months of age respectively. The first patient presented with acute tissue swelling over the back and an incidental finding of hallux valgus. Genetic study revealed heterozygous c617G>A mutation in exon 4 of the ACVR1 gene suggestive of FOP. She had several relapses, and management pitfalls are highlighted. This first case alerted early diagnosis of FOP in a twentymonth-old boy with bilateral hallux valgus. Introduction Fibrodysplasia ossificans progressive is a rare noninflammatory disease involving genetic mutation of the ACVR1 gene, characterised by heterotopic bone formation and recurrent episodes of painful soft tissue swelling that arises spontaneously or is triggered by minor trauma.1 As with almost all rare diseases, there are various scientific and medical challenges in FOP diagnosis and management. As trauma is a stimulant event, biopsy and surgical interventions can cause devastating results at the site of ossification. Thus, it is essential to recognise early features of FOP including bilateral hallux valgus and recurrent soft tissue swelling and avoid tissue biopsy in suspected cases. We present 2 children with FOP and the management issues. Case 1 A 7-year-old girl presented with progressive left upper back swelling for three weeks after a minor contusion against the table corner. She had a history of mild bilateral conductive hearing impairment, otherwise unremarkable past health. Physical examination revealed mild scoliosis with diffuse swelling, erythema, and tenderness over the left paraspinal muscles. There was reduced movement over her back in all directions, especially over left lateral flexion, and reduced range of movement of both hips on internal and external rotation. Bilateral hallux valgus was noted. Autoimmune markers including anti-nuclear antibody, rheumatoid factor and anti-extractable nuclear antigen were negative. Magnetic resonance imaging (figure 1) revealed T2 hyper-intensity with soft tissue swelling around both scapulae, more severe over the left side. Bony structures appeared unremarkable. She was initially managed with regular physiotherapy for suspected muscle strain and treated with nonsteroidal anti-inflammatory drugs (NSAIDS) to control the inflammation. The treatment did not reduce the muscle discomfort, but stretching exercise aggravated the extent of muscle pain and subsequent “disease flared” over her right sternocleidomastoid muscle. The diagnosis of FOP was then considered. Genetic study revealed heterozygous c617G>A mutation in exon 4 of the ACVR1","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91328427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/PED.ONCALL.2022.32
S. Costa, G. Lopes
{"title":"Are Emergency Department Visits Missed Opportunities for Secondary Diagnosis","authors":"S. Costa, G. Lopes","doi":"10.7199/PED.ONCALL.2022.32","DOIUrl":"https://doi.org/10.7199/PED.ONCALL.2022.32","url":null,"abstract":"","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81983172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/ped.oncall.2022.47
Jeannette Epée Ngoué, Suzanne Sap Ngo Um, Jocelyn Tony Nengom, I. M. Nkwele, Helene Kamo Doka, Madeleine Onguene Ngambi, E. Epée, H. M. Awa
{"title":"Incidence and pattern of neurologic emergencies in children at the mother and child center of the chantal biya foundation","authors":"Jeannette Epée Ngoué, Suzanne Sap Ngo Um, Jocelyn Tony Nengom, I. M. Nkwele, Helene Kamo Doka, Madeleine Onguene Ngambi, E. Epée, H. M. Awa","doi":"10.7199/ped.oncall.2022.47","DOIUrl":"https://doi.org/10.7199/ped.oncall.2022.47","url":null,"abstract":"","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"147 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75509271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/ped.oncall.2022.26
J. Ribeiro, Carolina dos Santos Folques Alves, M. M. Zarcos
Introduction: Inhalers are recommended for asthma prophylactic and crisis therapy. In order to have a good deposition of drugs at pulmonary tissue, the correct use of the devices is necessary. Objective: To verify the inhaler use technique with pressurized metered-dose inhalers (pMDIs) with spacers and dry-powder inhalers (DPIs) in a pediatric sample (ages between 1 and 17 years old). Material and Methods: Descriptive, observational and cross-sectional study. Application of a checklist that included the steps of the correct inhaler use technique, which was performed under physician observation, and other questions related to the use of the devices. Results: We observed a total of 83 inhaler use techniques: 46 pMDIs with spacers and 37 DPIs. About 54% of pMDIs with spacers users and 27% of DPIs users performed the inhaler use technique correctly, p=0.012. The most frequent mistakes in pMDIs with spacers users were: 50% didn’t waste the first puff, 17.4% didn’t shake the device prior to use and 28.3% didn’t wait between inhalations. The mistakes observed in DPIs users were: 43.2% didn’t perform a forced expiration before inhaler use, 13.5% didn’t start with a forced inspiration, 24.3% didn’t pause at the end of inspiration, 32.4% didn’t exhale slowly and 35.1% didn ́t wait between inhalations. Conclusion: Multiple mistakes were observed even in the users who had been followed up for several years. The most frequent mistakes occurred in DPIs users. Thus, the inhaler use technique must always be observed by the physician in all appointments, especially in users of DPIs in which the correct use depends on their autonomy. Introduction Asthma is the most common chronic disease of childhood and is characterized by a chronic airway inflammation.1 It’s a global health problem and its prevalence is increasing.1 Treatment goals are to achieve symptoms control, maintain normal activity levels and minimize risk of exacerbations or sequelae.1 Inhalation is the recommended route for both exacerbations and prophylactic therapy.1,2 There is a wide variety of devices available on the market with different inhaler use technique.3 The selection of the right inhaler must take into consideration the age of the child, inspiratory capacity and collaborative ability.1,4 It is very important that inhaled particles deposit in the lungs, and the only way to achieve it is with a correct inhaler use technique.5 The correct use of devices is associated with the control of asthma.2,4,6 The incorrect use is associated with exacerbations, more use of systemic corticosteroids, more visits to the hospital, absences from school, reduction and limitation of sports activities.5 The aims of this study were to characterize and verify the inhaler use technique with pressurized metereddose inhalers (pMDIs) with spacers and dry-powder inhalers (DPIs). Methods & Materials Descriptive, observational and cross-sectional study. We included all children (between 1 and 17 years old) who used inha
{"title":"Evaluation of inhaler use technique in a pediatric appointment","authors":"J. Ribeiro, Carolina dos Santos Folques Alves, M. M. Zarcos","doi":"10.7199/ped.oncall.2022.26","DOIUrl":"https://doi.org/10.7199/ped.oncall.2022.26","url":null,"abstract":"Introduction: Inhalers are recommended for asthma prophylactic and crisis therapy. In order to have a good deposition of drugs at pulmonary tissue, the correct use of the devices is necessary. Objective: To verify the inhaler use technique with pressurized metered-dose inhalers (pMDIs) with spacers and dry-powder inhalers (DPIs) in a pediatric sample (ages between 1 and 17 years old). Material and Methods: Descriptive, observational and cross-sectional study. Application of a checklist that included the steps of the correct inhaler use technique, which was performed under physician observation, and other questions related to the use of the devices. Results: We observed a total of 83 inhaler use techniques: 46 pMDIs with spacers and 37 DPIs. About 54% of pMDIs with spacers users and 27% of DPIs users performed the inhaler use technique correctly, p=0.012. The most frequent mistakes in pMDIs with spacers users were: 50% didn’t waste the first puff, 17.4% didn’t shake the device prior to use and 28.3% didn’t wait between inhalations. The mistakes observed in DPIs users were: 43.2% didn’t perform a forced expiration before inhaler use, 13.5% didn’t start with a forced inspiration, 24.3% didn’t pause at the end of inspiration, 32.4% didn’t exhale slowly and 35.1% didn ́t wait between inhalations. Conclusion: Multiple mistakes were observed even in the users who had been followed up for several years. The most frequent mistakes occurred in DPIs users. Thus, the inhaler use technique must always be observed by the physician in all appointments, especially in users of DPIs in which the correct use depends on their autonomy. Introduction Asthma is the most common chronic disease of childhood and is characterized by a chronic airway inflammation.1 It’s a global health problem and its prevalence is increasing.1 Treatment goals are to achieve symptoms control, maintain normal activity levels and minimize risk of exacerbations or sequelae.1 Inhalation is the recommended route for both exacerbations and prophylactic therapy.1,2 There is a wide variety of devices available on the market with different inhaler use technique.3 The selection of the right inhaler must take into consideration the age of the child, inspiratory capacity and collaborative ability.1,4 It is very important that inhaled particles deposit in the lungs, and the only way to achieve it is with a correct inhaler use technique.5 The correct use of devices is associated with the control of asthma.2,4,6 The incorrect use is associated with exacerbations, more use of systemic corticosteroids, more visits to the hospital, absences from school, reduction and limitation of sports activities.5 The aims of this study were to characterize and verify the inhaler use technique with pressurized metereddose inhalers (pMDIs) with spacers and dry-powder inhalers (DPIs). Methods & Materials Descriptive, observational and cross-sectional study. We included all children (between 1 and 17 years old) who used inha","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74030042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/PED.ONCALL.2022.6
R. Uppuluri, I. Shah
Cytomegalovirus (CMV) is an important cause of neonatal hepatitis. Untreated, though hepatomegaly may spontaneously regress, these children may develop portal hypertension and chronic liver disease. Also, these children can progress to develop biliary atresia. Long term sequelae may be sensorineural deafness and intellectual impairment. Role of ganciclovir and its prodrug valganciclovir for treatment of congenital CMV infection is not completely established. There have been few case series and case reports that have documented resolution of CMV hepatitis on treatment with ganciclovir. However, there is very little literature on role of valganciclovir in neonatal CMV hepatitis. We report for the first time in India, effectiveness of valganciclovir in 3 infants with neonatal hepatitis and CMV. All 3 infants in age group of 2-4 months with neonatal hepatitis and variable CMV viral load were treated with oral valganciclovir (125250 mg/m2/day) for 6 weeks and had clinical improvement and undetectable viral load at the end of therapy. One patient however developed long term sequelae of CMV in form of sensorineural deafness and delayed development. Thus, valganciclovir appears safe and effective in neonatal hepatitis with CMV. However, randomized controlled trials in larger groups are required to determine its efficacy. Introduction Cytomegalovirus (CMV) is the most common cause of congenital infection in humans.1,2 Severe jaundice and granulomatous hepatitis have been established due to neonatal CMV infection.3,4 Isolated neonatal hepatitis with CMV has been reported in literature but response to antivirals has been encouraging.5,6,7,8,9,10 We present 3 infants with neonatal hepatitis and associated CMV and their response to valganciclovir. Case 1: A 21⁄2 months old boy presented with jaundice and clay-colored stools since birth. Baby was born at 34 weeks by caesarean section in view of premature labour, had a birth weight of 1.75 kg and was put in neonatal intensive care unit (NICU) for 7 days. On examination, weight was 2.75 kg, length was 47 cms and head circumference was 35 cms. He had hepatosplenomegaly and umbilical hernia. Other systems were normal. Investigations are depicted in Table 1. Liver biopsy showed balloon degeneration of hepatocytes with multinucleated giant cells without inclusion bodies. In view of CMV infection, child was started on oral Valganciclovir (250 mg/m2/dose BD for 21 days, and then 125 mg/m2/dose BD for 21 days) following which liver function tests improved at end of 6 weeks (Bilirubin = 1.2 mg/dl, SGPT = 62 IU/L, Total proteins = 6.1 gm/dl, Albumin = 3.8 gm/dl), CMV viral load was undetectable. At 8 months of age, child is asymptomatic. Case 2: A 3-month-old girl was referred in view of jaundice. There were no clay-colored stools. She was born at 9 months gestation with birth weight of 2.75 kg and had achieved milestones appropriately for age. On examination, weight was 4 kg, length was 60 cms. She had with jaundice wit
{"title":"Role of Valganciclovir in Neonatal Hepatitis with Cytomegalovirus","authors":"R. Uppuluri, I. Shah","doi":"10.7199/PED.ONCALL.2022.6","DOIUrl":"https://doi.org/10.7199/PED.ONCALL.2022.6","url":null,"abstract":"Cytomegalovirus (CMV) is an important cause of neonatal hepatitis. Untreated, though hepatomegaly may spontaneously regress, these children may develop portal hypertension and chronic liver disease. Also, these children can progress to develop biliary atresia. Long term sequelae may be sensorineural deafness and intellectual impairment. Role of ganciclovir and its prodrug valganciclovir for treatment of congenital CMV infection is not completely established. There have been few case series and case reports that have documented resolution of CMV hepatitis on treatment with ganciclovir. However, there is very little literature on role of valganciclovir in neonatal CMV hepatitis. We report for the first time in India, effectiveness of valganciclovir in 3 infants with neonatal hepatitis and CMV. All 3 infants in age group of 2-4 months with neonatal hepatitis and variable CMV viral load were treated with oral valganciclovir (125250 mg/m2/day) for 6 weeks and had clinical improvement and undetectable viral load at the end of therapy. One patient however developed long term sequelae of CMV in form of sensorineural deafness and delayed development. Thus, valganciclovir appears safe and effective in neonatal hepatitis with CMV. However, randomized controlled trials in larger groups are required to determine its efficacy. Introduction Cytomegalovirus (CMV) is the most common cause of congenital infection in humans.1,2 Severe jaundice and granulomatous hepatitis have been established due to neonatal CMV infection.3,4 Isolated neonatal hepatitis with CMV has been reported in literature but response to antivirals has been encouraging.5,6,7,8,9,10 We present 3 infants with neonatal hepatitis and associated CMV and their response to valganciclovir. Case 1: A 21⁄2 months old boy presented with jaundice and clay-colored stools since birth. Baby was born at 34 weeks by caesarean section in view of premature labour, had a birth weight of 1.75 kg and was put in neonatal intensive care unit (NICU) for 7 days. On examination, weight was 2.75 kg, length was 47 cms and head circumference was 35 cms. He had hepatosplenomegaly and umbilical hernia. Other systems were normal. Investigations are depicted in Table 1. Liver biopsy showed balloon degeneration of hepatocytes with multinucleated giant cells without inclusion bodies. In view of CMV infection, child was started on oral Valganciclovir (250 mg/m2/dose BD for 21 days, and then 125 mg/m2/dose BD for 21 days) following which liver function tests improved at end of 6 weeks (Bilirubin = 1.2 mg/dl, SGPT = 62 IU/L, Total proteins = 6.1 gm/dl, Albumin = 3.8 gm/dl), CMV viral load was undetectable. At 8 months of age, child is asymptomatic. Case 2: A 3-month-old girl was referred in view of jaundice. There were no clay-colored stools. She was born at 9 months gestation with birth weight of 2.75 kg and had achieved milestones appropriately for age. On examination, weight was 4 kg, length was 60 cms. She had with jaundice wit","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85079171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.7199/ped.oncall.2022.34
D. Tolani, J. Ahmed, K. Mullanfiroze, I. Shah
Neonatal hemochromatosis (NH) due to Gestational alloimmune liver disease (GALD) is a rare form of fulminant liver disease of unknown cause characterized by diffuse deposition of iron in the liver and extra hepatic sites without any evidence of increased iron intake. Neonatal cholestasis is characterized by persistent elevation of conjugated bilirubin. It can be caused by infections, biliary atresia, by toxins or by metabolic disorders of the liver. GALD is rarely reported as a cause of fulminant neonatal cholestasis. We present three cases of infants who presented with neonatal cholestasis and were found to have NH as well. Case Report Neonatal hemochromatosis (NH) is a rare and severe disorder characterized by excessive iron deposition in liver and extra hepatic sites. It is characterized by neonatal liver failure with an in utero onset.1 Gestational alloimmune liver disease (GALD) is a leading cause of NH. The pregnancy may be complicated either by oligohyraminous or growth retardation and sometimes may cause stillbirth.2 Neonatal cholestasis is defined as the prolonged elevation of serum levels of conjugated bilirubin beyond the first 14 days of life. The overall incidence of neonatal cholestasis is estimated to be 1 in every 2500 live births.3 The most common causes of neonatal cholestasis include biliary tract anomalies of which biliary atresia is the commonest, metabolic disorders of the liver, infections or it may be idiopathic.4 A study has shown metabolic disorders of the liver to contribute to 8.6% of the total cases of neonatal cholestasis.5 Amongst the metabolic disorders causing neonatal cholestasis, alpha-1antitrypsin deficiency is the commonest; others include tyrosinemia, galactosemia, and hypothyroidism, inborn errors of bile acid metabolism, Alagille syndrome. Though NH can cause neonatal cholestasis, however it is not listed as a common metabolic cause of neonatal cholestasis.6 We report three cases of infants who fit the diagnostic criteria for NH and were found to have fulminant neonatal cholestasis without evidence of any other etiology of cholestasis. Case 1: A 1 month old boy born of non consanguineous marriage presented with jaundice and high coloured urine since birth, progressive abdominal distension for 15 days and blood in stools since yesterday. There is no clay coloured stools. Mother had no fever or rash during pregnancy. On examination, there is jaundice with anasarca and splenomegaly. Child was altered with left sided hemiparesis. Investigations are depicted in Table 1. Ultrasound abdomen (USG) showed splenomegaly. Urine aminoacidogram showed increased cysteine. Serum alpha fetoprotein was normal. TORCH titres were negative. Triglycerides were normal and Fibrinogen was< 45 ng/ml. He was treated with fresh frozen plasma, lactulose, metronidazole and intravenous fluids. Child subsequently died next day before any further tests could be done. Case 2: A 2 day old newborn was referred to for evaluation of conjugated
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Pub Date : 2021-08-27DOI: 10.7199/ped.oncall.2022.13
Ankita Shah, Sunayna Gurnani
Aim: To determine the age distribution, clinical and laboratory findings, and outcomes of patients with tuberculous pleural effusion (TPE). Methods: This retrospective study was done over a period of 5 years in children between 1 month -15 years of age who were referred to our tertiary referral center with TPE. Results: Seventy-six (5.3%) children were diagnosed with pleural effusion of which 43 (56.6%) patients had right-sided affection, 31 (40.8%) had left sided affection and 2 (2.6%) bilateral involvement. Mean age of presentation was 6.8±3.2 years. Mean ADA values in pleural fluid were 107.6±115.7 IU/L. High ESR was found in 58 (77.8%) with mean values of 79.1±28.5 mm at end of 1 hour. Left sided effusion was seen at a mean age of 7.9±3.5 whereas right sided effusion was seen at a mean age of 6.1± 2.8 (p=0.016). Conclusion: Most of the pleural effusions are seen in children < 10 years of age and does not have a predilection for adolescents as mentioned in literature. Elevated ADA and ESR may suggest TPE. Though right sided effusion is more common, left sided effusion is seen in older children. Introduction Tuberculosis (TB) is most common cause of infections related death globally. It is estimated that childhood TB constitutes 10–20% of all TB in high-burden countries.1 Tuberculous pleurisy is the second most common form of extrapulmonary tuberculosis (TB)2 and a common cause of pleural effusion in endemic TB areas. There is limited data regarding the prevalence of tuberculous pleural effusion (TPE) in children but estimated literature has shown that frequency of pleural involvement in pediatric tuberculosis ranges from 238%.3,4,5,6 Effusion is not a common characteristic of primary pulmonary TB in young children and it is more probable to be detected in adolescents and adults.7 The aim of this study was to describe the age distribution of pediatric patients with TPE, with the clinical and laboratory findings and outcome of these patients. Methods & Materials This was a retrospective study done over 5 years in children between 1 month -15 years of age who were referred to our tertiary referral center. Patients identified as TPE were included in the analysis. TPE was diagnosed if the chest radiograph depicted a pleural effusion and at least one of the following criteria: (1) positive culture or positive cartridge based nuclear acid amplification test (CBNAAT) or presence of acid-fast bacilli (AFB) for Mycobacterium tuberculosis (MTB) from pleural fluid, (2) Compatible clinical picture with pleural fluid showing lymphocytic predominance or levels of adenosine deaminase activity (ADA) more than 35 IU/l with/without a positive tuberculin skin test or contact with an adult having TB. Records of all patients were evaluated and clinical history; examination findings and laboratory investigations were noted. Malnutrition was defined as weight or height less than 3 centile as per Agarwal charts.8 Associated ser
{"title":"Clinical profile of Tuberculous Pleural Effusion in Children","authors":"Ankita Shah, Sunayna Gurnani","doi":"10.7199/ped.oncall.2022.13","DOIUrl":"https://doi.org/10.7199/ped.oncall.2022.13","url":null,"abstract":"Aim: To determine the age distribution, clinical and laboratory findings, and outcomes of patients with tuberculous pleural effusion (TPE). Methods: This retrospective study was done over a period of 5 years in children between 1 month -15 years of age who were referred to our tertiary referral center with TPE. Results: Seventy-six (5.3%) children were diagnosed with pleural effusion of which 43 (56.6%) patients had right-sided affection, 31 (40.8%) had left sided affection and 2 (2.6%) bilateral involvement. Mean age of presentation was 6.8±3.2 years. Mean ADA values in pleural fluid were 107.6±115.7 IU/L. High ESR was found in 58 (77.8%) with mean values of 79.1±28.5 mm at end of 1 hour. Left sided effusion was seen at a mean age of 7.9±3.5 whereas right sided effusion was seen at a mean age of 6.1± 2.8 (p=0.016). Conclusion: Most of the pleural effusions are seen in children < 10 years of age and does not have a predilection for adolescents as mentioned in literature. Elevated ADA and ESR may suggest TPE. Though right sided effusion is more common, left sided effusion is seen in older children. Introduction Tuberculosis (TB) is most common cause of infections related death globally. It is estimated that childhood TB constitutes 10–20% of all TB in high-burden countries.1 Tuberculous pleurisy is the second most common form of extrapulmonary tuberculosis (TB)2 and a common cause of pleural effusion in endemic TB areas. There is limited data regarding the prevalence of tuberculous pleural effusion (TPE) in children but estimated literature has shown that frequency of pleural involvement in pediatric tuberculosis ranges from 238%.3,4,5,6 Effusion is not a common characteristic of primary pulmonary TB in young children and it is more probable to be detected in adolescents and adults.7 The aim of this study was to describe the age distribution of pediatric patients with TPE, with the clinical and laboratory findings and outcome of these patients. Methods & Materials This was a retrospective study done over 5 years in children between 1 month -15 years of age who were referred to our tertiary referral center. Patients identified as TPE were included in the analysis. TPE was diagnosed if the chest radiograph depicted a pleural effusion and at least one of the following criteria: (1) positive culture or positive cartridge based nuclear acid amplification test (CBNAAT) or presence of acid-fast bacilli (AFB) for Mycobacterium tuberculosis (MTB) from pleural fluid, (2) Compatible clinical picture with pleural fluid showing lymphocytic predominance or levels of adenosine deaminase activity (ADA) more than 35 IU/l with/without a positive tuberculin skin test or contact with an adult having TB. Records of all patients were evaluated and clinical history; examination findings and laboratory investigations were noted. Malnutrition was defined as weight or height less than 3 centile as per Agarwal charts.8 Associated ser","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87114559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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