Sudanese journal of paediatrics最新文献

Kawasaki disease (KD) is characterised by high fever lasting more than 5 days, conjunctivitis, oedema of hands or feet, erythema of the palms and soles, polymorphic rash, cervical lymphadenopathy and alteration of oral mucosa and lips. It is most frequently seen in children between the ages of 6 months and 5 years. The diagnosis of KD remains challenging, primarily due to its incomplete presentation. In this report, we present a 3.5-month-old patient who has persistent fever and bilateral nonpurulent conjunctivitis and high acute phase reactants, diagnosed with incomplete KD and coronary aneurysm. The patient was given intravenous immunoglobulin (IVIG) at 2 g/kg with oral aspirin at 80 mg/kg/d. On follow-up 48 hours later, marked clinical improvement was observed. Monthly cardiac evaluations were performed. Echocardiogram in the 3rd month of treatment showed the internal dimension of the proximal section of the left main coronary artery measuring 3 mm (Z-score = 3.8) and the aneurysm regressed. Even if cases with prolonged fever do not meet the diagnostic criteria for KD, they should be considered as atypical KD and IVIG should be considered.

Gastroesophageal reflux (GOR) is a normal phenomenon that occurs in children and adults after meals, mostly asymptomatic and lasting less than 3 minutes. The prevalence is 50% and 5% at 3 months and 1 year of age, respectively. Diagnosis is with multi-channel intraluminal impedance-pH (MII-pH) study. Our aim is to evaluate the physiological values of MII-pH in children less than 16 years of age. Two groups, infants less than 1 year old and older children 1-16 years, were studied separately. We also studied group 1-6 years of age to study the age effect. We used the MII-pH analysis results of patients with no risk factors for Gastroesophageal reflux disease (GORD) who were referred for assessment of GORD during the study period to calculate the mean ± 2SD deviations (or the median if data are skewed), which we propose to be the near-normal values. Out of 1,183 patients, 849 were enrolled. Data distribution was skewed. We found that our population's values are in general different from the currently used ones. Our data showed that total reflux episodes (in the children group only), acid exposure time and percentage of exposure more than 5 minutes (in both groups) are all higher than the currently used values. We found no age effect between older and young children 1-6 years of age. To our knowledge, this is the largest study to assess normal values of GOR in paediatrics to date. Our study showed that currently used values could over-diagnose GORD in children.

Brain abscess in pediatric patients carries significant morbidity and mortality risk, requiring prompt diagnosis and multidisciplinary management approach. We report the case of a previously healthy 15-year-old male presenting with complaints of fever, headache, and somnolence. Magnetic resonance imaging identified a brain abscess, leading to empiric treatment with ceftriaxone, vancomycin, and metronidazole, followed by urgent surgical drainage. Abscess culture yielded Streptococcus constellatus, and treatment was narrowed to ceftriaxone. This case emphasises the importance of early recognition and immediate intervention for suspected brain abscess in healthy children.

Head trauma, in general, can lead to several life-threatening complications including subdural hematoma (SDH). Trauma is the most common cause in children less than 2 years of age, which can be non-inflicted or inflicted. To differentiate between inflicted and non-inflicted SDH in children <2 years of age, a retrospective study of children with SDH managed at King Abdullah Specialized Children Hospital in Riyadh, Saudi Arabia, from 2014 to 2019 was performed. Data were collected from the electronic hospital system and the Suspected Child Abuse and Neglect team records. Sixty-three patients aged <2 years with SDH were included. Of these, 17 (27%) were due to abusive head trauma and 46 (73%) were non-inflicted; 23 (50%) fall, 13 (28%) medical reasons, and six (9.5%) motor vehicle accidents. Most were male (43; 68.3%), and 20 (32%) were female. Children with inflicted injuries were predominantly males (p = 0.018). Children with inflicted SDH have severe symptoms and worse outcomes compared to other causes of SDH.

Background: Patients diagnosed with type 1 diabetes mellitus (T1DM) have an increased risk of developing other autoimmune disorders, which may complicate the natural history and management of these patients, however, data are scarce from T1DM patients in Saudi Arabia.

Objectives: The aim of this study was to determine the prevalence of autoimmune disorders in T1DM patients as well as to compare metabolic parameters such as glycemic control, anemia, and vitamin D status in those with and without celiac disease (CD).

Methods: This was a retrospective study that was conducted on patients with T1DM receiving care at King Fahad Medical City (KFMC). Data were gathered from medical records on additional autoimmune disorders , including autoimmune markers for thyroid disease, CD, and other laboratory findings such as hemoglobin (Hb), vitamin D, parathyroid hormone (PTH), and glycated hemoglobin (HbA1c).

Results: The study included 322 T1DM patients, with a mean age of 17.4 ± 7.35 years and 55.6% were female. Mean diabetes duration was 10.0 ± 4.9 years. At least one autoimmune disease was identified in 36.9% of T1DM patients. Among the cohort, 22.7% had CD, and 12.4% had autoimmune Hashimoto's thyroiditis (HT), making these as the most predominant autoimmune conditions in this cohort. Additionally, 18.3% of family members of patients with T1DM also had T1DM. No significant differences were found in HbA1c, TSH, and diabetes duration between patients with or without CD. However, CD patients had lower serum free thyroxine (FT4) and Hb levels and exhibited lower serum ferritin. However, serum PTH and vitamin D levels were similar across both groups.

Conclusion: This study highlights a significant prevalence of autoimmune disorders, particularly CD and HT, among this Saudi patients with T1DM. Further research could explore potential links between HLA types and autoimmune disease susceptibility in individuals with T1DM.

Scorpions are venomous arthropods with approximately 100 scorpion species worldwide. Scorpion stings (SSs) primarily occur due to accidental contact and are more common in children. SS resulting in envenomation is a life-threatening emergency and causes serious health problems in tropical and subtropical regions. Medically significant scorpion envenomation (SE) is almost always associated with intense localized pain. Systemic effects may occur in fewer cases. The severity of SE is classified as minor, moderate or severe, and treatment strategies are based on this grading. Deaths are usually due to cardiogenic shock and pulmonary oedema. This is a descriptive, observational, cross-sectional and hospital-based study aiming for the clinical presentation and outcome of SS among children aged 1-15 years in Kassala Teaching and Specialized Hospital, Sudan. Data were entered and analysed using SPSS version 27.0. A total of 76 children were included, with a male-to-female ratio of 1:1. The Majority of stings occurred in children aged 1-5 years (42.1%) and in rural areas (75%). The most common symptom was pain at the sting site (84.2%), hyperemia (85.5%) and sweating (53.9%). The lower extremities were the most frequent sites of envenomation, in 46.1%. Stings were predominantly reported at night, in 63.2%. The clinical outcomes were graded, with most of cases classified as minor (Grade I, 44.7%). Two-thirds of children (65.8%) fully recovered. The mortality rate was 14.5%. Causes of death were cardiogenic shock, seizures, respiratory failure and multiorgan failure. Delayed presentation and severe systemic manifestations contribute to increased mortality risk.