Wasp and bees are venomous arthropods belonging to the order Hymenoptera, group Vespoidea. Most wasp sting victims do not seek medical attention due to the minor self-limiting and localizing nature of symptoms. Fatal anaphylaxis is rare. However, it is a common indication for emergency room visit. Acute kidney injury is the most serious complication with a mortality rate of 20%. Herein, we report the case of a 3-year 4-month-old female child, who presented with acute renal failure, after being stung by a swarm of wasps. She was managed successfully in the intensive care unit with renal replacement therapy.
{"title":"Acute kidney injury following multiple wasp stings: A case report","authors":"B. Meher, Siddhartha Pati, I. Panda, Sarthak Naik","doi":"10.4103/jpcc.jpcc_62_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_62_22","url":null,"abstract":"Wasp and bees are venomous arthropods belonging to the order Hymenoptera, group Vespoidea. Most wasp sting victims do not seek medical attention due to the minor self-limiting and localizing nature of symptoms. Fatal anaphylaxis is rare. However, it is a common indication for emergency room visit. Acute kidney injury is the most serious complication with a mortality rate of 20%. Herein, we report the case of a 3-year 4-month-old female child, who presented with acute renal failure, after being stung by a swarm of wasps. She was managed successfully in the intensive care unit with renal replacement therapy.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46591323","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}
Tuberculosis is common in chronic kidney disease (CKD). There are reports of adults with CKD experiencing hypertensive crises and an increase in dosages and number of antihypertensive drugs after starting antitubercular therapy (ATT). Studies have demonstrated that rifampicin could increase the metabolism of beta-blockers, calcium channel blockers, and prazosin. There are no studies or reports of worsening blood pressure (BP) control in children with CKD after starting ATT. Here, we report three cases of children who developed hypertensive crises after starting ATT. All patients presented in emergency with the acute severe rise of BP with breathlessness and or visual blurring. All of them showed retinal changes suggestive of malignant hypertension. They needed parenteral therapy to control BP. They also needed the escalation of antihypertensives and the addition of other drugs. One patient needed a withdrawal of rifampicin. It is suggested that children with CKD should be monitored for BP control after instituting ATT.
{"title":"Hypertensive crisis in children with chronic kidney disease after instituting antitubercular therapy: A case series","authors":"Alok Kumar, D. Khrime, Utkarsh Sharma","doi":"10.4103/jpcc.jpcc_64_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_64_22","url":null,"abstract":"Tuberculosis is common in chronic kidney disease (CKD). There are reports of adults with CKD experiencing hypertensive crises and an increase in dosages and number of antihypertensive drugs after starting antitubercular therapy (ATT). Studies have demonstrated that rifampicin could increase the metabolism of beta-blockers, calcium channel blockers, and prazosin. There are no studies or reports of worsening blood pressure (BP) control in children with CKD after starting ATT. Here, we report three cases of children who developed hypertensive crises after starting ATT. All patients presented in emergency with the acute severe rise of BP with breathlessness and or visual blurring. All of them showed retinal changes suggestive of malignant hypertension. They needed parenteral therapy to control BP. They also needed the escalation of antihypertensives and the addition of other drugs. One patient needed a withdrawal of rifampicin. It is suggested that children with CKD should be monitored for BP control after instituting ATT.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46000122","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}
M. Matti, M. Maralihalli, Meghana Mummadi, S. Reddy
Background: Children with multisystem inflammatory syndrome in children (MIS-C) often develop shock and require vasoactive agents. The vasoactive-inotropic score (VIS) is a potential scoring system to assess the amount of vasoactive agent support required. The study was conducted to correlate VIS at 6 and 12 h with the length of intensive care unit (ICU) stay and with COVID immunoglobulin G (IgG) antibody titers in cases of MIS-C with shock. Subjects and Methods: Demographic and clinical details were collected from patients with the diagnosis of MIS-C with shock requiring vasoactive agents. VIS was calculated at 6 and 12 h following initiation of the first inotropic/vasoactive agent. Results: Twenty-nine children admitted with the diagnosis of MIS-C who presented with shock or developed shock during hospital stay were the study population. On performing Spearman's correlation, a positive correlation was observed between COVID IgG titers and VIS at 6 h. There was no significant association between VIS and length of ICU stay. Conclusions: VIS had limited significance in predicting the length of ICU stay and the need for vasoactive agents required.
背景:患有儿童多系统炎症综合征(MIS-C)的儿童经常发生休克，需要血管活性药物。血管活性-肌力评分(VIS)是一种评估所需血管活性药物支持量的潜在评分系统。该研究旨在将休克合并MIS-C患者6和12 h VIS与重症监护病房(ICU)住院时间以及COVID免疫球蛋白G (IgG)抗体滴度联系起来。对象和方法:收集诊断为misc并需要血管活性药物治疗的休克患者的人口学和临床资料。在开始使用第一种肌力/血管活性药物后6和12小时计算VIS。结果:29名诊断为misc的儿童在住院期间出现休克或发生休克是研究人群。经Spearman相关分析，6 h时COVID - IgG滴度与VIS呈正相关，VIS与ICU住院时间无显著相关性。结论:VIS在预测ICU住院时间和所需血管活性药物的需求方面意义有限。
{"title":"Correlation of the vasoactive-inotropic score with the length of intensive care unit stay and COVID IgG titers, in multisystem inflammatory syndrome in children: A prospective observational study","authors":"M. Matti, M. Maralihalli, Meghana Mummadi, S. Reddy","doi":"10.4103/jpcc.jpcc_39_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_39_22","url":null,"abstract":"Background: Children with multisystem inflammatory syndrome in children (MIS-C) often develop shock and require vasoactive agents. The vasoactive-inotropic score (VIS) is a potential scoring system to assess the amount of vasoactive agent support required. The study was conducted to correlate VIS at 6 and 12 h with the length of intensive care unit (ICU) stay and with COVID immunoglobulin G (IgG) antibody titers in cases of MIS-C with shock. Subjects and Methods: Demographic and clinical details were collected from patients with the diagnosis of MIS-C with shock requiring vasoactive agents. VIS was calculated at 6 and 12 h following initiation of the first inotropic/vasoactive agent. Results: Twenty-nine children admitted with the diagnosis of MIS-C who presented with shock or developed shock during hospital stay were the study population. On performing Spearman's correlation, a positive correlation was observed between COVID IgG titers and VIS at 6 h. There was no significant association between VIS and length of ICU stay. Conclusions: VIS had limited significance in predicting the length of ICU stay and the need for vasoactive agents required.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46879510","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}
Ravi Sharma, S. Pandey, Pooja Agarwala, Rajiv Bansal
Misuse of organophosphate insecticides, even in case of domestic application, can be life threatening. We report a case of accidental consumption of organophosphorus substance by a 3-year-old female child presented to us with unconsciousness and nicotinic manifestation of organophosphate poisoning unlike classical toxidrome of muscarinic manifestation.
{"title":"Unusual presentation of organophosphate poisoning: A case Report","authors":"Ravi Sharma, S. Pandey, Pooja Agarwala, Rajiv Bansal","doi":"10.4103/jpcc.jpcc_58_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_58_22","url":null,"abstract":"Misuse of organophosphate insecticides, even in case of domestic application, can be life threatening. We report a case of accidental consumption of organophosphorus substance by a 3-year-old female child presented to us with unconsciousness and nicotinic manifestation of organophosphate poisoning unlike classical toxidrome of muscarinic manifestation.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46858466","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}
{"title":"Protocolized care in sepsis: Does it improve outcomes?","authors":"G. Benakatti, J. Ismail","doi":"10.4103/jpcc.jpcc_83_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_83_22","url":null,"abstract":"","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48760379","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}
{"title":"Peripheral venous-related bloodstream infection in pediatric intensive care unit – Is it worthy of surveillance?","authors":"K. Ramaswamy","doi":"10.4103/jpcc.jpcc_68_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_68_22","url":null,"abstract":"","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43991999","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}
Background: Pediatric visits to children's hospitals are mostly outpatient and emergency room (ER) based. In busy outpatient departments (OPD) and ERs, children are reviewed quickly, and instructions are given to parents for management at home. Communication from physicians to the parents of the child may be deficient and incomplete, due to the high workload and other priority tasks. The purpose of this study was to assess the utility of simple color-coded information stickers for the OPD/ER file of the child for parents to recognize danger signs in their child to seek help early again if required. Subjects and Methods: This is a prospective observational study conducted on 1036 children in the age group of 1 month–18 years at a tertiary care hospital in Telangana state of India, for 1 year from January 2018 to January 2019. Results: Fifty-three of the patients were male, and the majority of them were in the 1–5-year age group. The perceived utility of the stickers was 85.3% in the affirmative. Only 14.7% felt they were not useful. Reasons for revisits to the ER/OPD were fever (33%), respiratory causes (37.7%), gastroenteritis causes (18%), head injury (9%), and epistaxis (1.5%). Conclusions: A simple color-coded sticker system used in busy OPDs and ERs in children's hospitals might prove to be a low-cost-effective communication tool for parents to utilize to recognize danger signs and report back for care when necessary.
{"title":"Critical illness color-coded warning stickers: A novel parent education method – A single-center observational study","authors":"VS V Prasad, S. H. Shabbeer Basha, Anju Dayal","doi":"10.4103/jpcc.jpcc_24_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_24_22","url":null,"abstract":"Background: Pediatric visits to children's hospitals are mostly outpatient and emergency room (ER) based. In busy outpatient departments (OPD) and ERs, children are reviewed quickly, and instructions are given to parents for management at home. Communication from physicians to the parents of the child may be deficient and incomplete, due to the high workload and other priority tasks. The purpose of this study was to assess the utility of simple color-coded information stickers for the OPD/ER file of the child for parents to recognize danger signs in their child to seek help early again if required. Subjects and Methods: This is a prospective observational study conducted on 1036 children in the age group of 1 month–18 years at a tertiary care hospital in Telangana state of India, for 1 year from January 2018 to January 2019. Results: Fifty-three of the patients were male, and the majority of them were in the 1–5-year age group. The perceived utility of the stickers was 85.3% in the affirmative. Only 14.7% felt they were not useful. Reasons for revisits to the ER/OPD were fever (33%), respiratory causes (37.7%), gastroenteritis causes (18%), head injury (9%), and epistaxis (1.5%). Conclusions: A simple color-coded sticker system used in busy OPDs and ERs in children's hospitals might prove to be a low-cost-effective communication tool for parents to utilize to recognize danger signs and report back for care when necessary.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42674240","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}
Background: Myocarditis, disseminated intravascular coagulation, and renal failure have been reported to be the leading causes of mortality in patients of severe diphtheria. The aim of this article was to study the clinico-demographic profile of diphtheria patients and also to evaluate the performance of Pediatric Risk of Mortality (PRISM) III on the prediction of mortality in such patients. The objective was to study the clinical profile of severe diphtheria cases in children. Subjects and Methods: During the study period, 170 patients were admitted to the pediatric emergency unit, out of whom 26 patients were admitted with the diagnosis of clinical diphtheria. Results: Majority of the patients were categorized as having either central nervous system or respiratory illness at the time of admission. The third largest category was patients with suspected clinical diphtheria. Forty-five out of 170 were nonsurvivors among which the highest mortality was noted in patients of diphtheria. All the nonsurvivors with clinical diphtheria had signs and symptoms of myocarditis either at the time of admission or developed later during the hospital stay. On comparing the mean PRISM scores of survivors versus nonsurvivors, it was not found to be statistically significant. Conclusions: The presence of myocarditis in patients of diphtheria is highly fatal and PRISM III alone is not sufficient for mortality prediction in patients of severe diphtheria.
{"title":"A clinical profile of severe diphtheria in pediatric intensive care units of North India: A single-center, prospective observational study","authors":"Rahul Jaiswal, Atul Kumar, Sandhya Chauhan","doi":"10.4103/jpcc.jpcc_16_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_16_22","url":null,"abstract":"Background: Myocarditis, disseminated intravascular coagulation, and renal failure have been reported to be the leading causes of mortality in patients of severe diphtheria. The aim of this article was to study the clinico-demographic profile of diphtheria patients and also to evaluate the performance of Pediatric Risk of Mortality (PRISM) III on the prediction of mortality in such patients. The objective was to study the clinical profile of severe diphtheria cases in children. Subjects and Methods: During the study period, 170 patients were admitted to the pediatric emergency unit, out of whom 26 patients were admitted with the diagnosis of clinical diphtheria. Results: Majority of the patients were categorized as having either central nervous system or respiratory illness at the time of admission. The third largest category was patients with suspected clinical diphtheria. Forty-five out of 170 were nonsurvivors among which the highest mortality was noted in patients of diphtheria. All the nonsurvivors with clinical diphtheria had signs and symptoms of myocarditis either at the time of admission or developed later during the hospital stay. On comparing the mean PRISM scores of survivors versus nonsurvivors, it was not found to be statistically significant. Conclusions: The presence of myocarditis in patients of diphtheria is highly fatal and PRISM III alone is not sufficient for mortality prediction in patients of severe diphtheria.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43621371","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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