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Renal Tuberculosis in a 14-Years-Old Boy Presented as Pyrexia of an Unknown Origin (PUO): A First Case Report
Sam Hassan,
Ali Hassan Abro
Issue:
Volume 4, Issue 2, June 2018
Pages:
21-24
Received:
11 March 2018
Accepted:
9 April 2018
Published:
14 May 2018
Abstract: Tuberculosis remains an important public health problem, especially in developing countries. Mycobacterium Tuberculosis mainly affects the lungs but extra-pulmonary Tuberculosis is not uncommon. However, renal involvement is very rare particularly in paediatric age group. This article is reporting a case of 14 years old Emirati boy who presented with history of fever, mild cough and night sweats after admission. The patient was treated as a case of fever of unknown origin, most likely secondary to community acquired pneumonia. On further investigations, he was found to have pulmonary tuberculosis with miliary pattern of the both lungs and also renal tuberculosis as the urine culture grew Acid Fast Bacilli (AFB) (Mycobacterium Tuberculosis). The patient responded very well to the Anti-tuberculosis treatment and became symptom free.
Abstract: Tuberculosis remains an important public health problem, especially in developing countries. Mycobacterium Tuberculosis mainly affects the lungs but extra-pulmonary Tuberculosis is not uncommon. However, renal involvement is very rare particularly in paediatric age group. This article is reporting a case of 14 years old Emirati boy who presented wi...
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Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report
Sam Hassan,
Farsheed Zakir,
Sameer Sajwani
Issue:
Volume 4, Issue 2, June 2018
Pages:
25-30
Received:
23 April 2018
Accepted:
16 May 2018
Published:
12 June 2018
Abstract: Despite the reduction in incidence of Group A Streptococcal (GAS) infections in the last few decades its global burden on mortality and morbidity remained significantly high and represent major concerns in many developing countries. These morbidities and mortalities can be serious in immunocompromised individuals. It has been shown for the last two decades that vitamin D plays an important role in the immune system modulation and its deficiency were associated with recurrent and sever infections. Only few literatures were written about the vitamin D deficiency and GAS infections and very scarce about its complications. One of the rarely reported complications of GAS infections is post-streptococcal systemic vasculitis. The association of this complications and the vitamin D deficiency was not reported before. We report for the first time a 5 years old boy presented with sever post-scarlet fever vasculitis with sever vitamin D deficiency, only responded to monoclonal antibody infusion. The presentation was complicated by more than one complications of GAS infection, hence difficult to diagnose initially and found to have sever vitamin D deficiency which we concluded is the causative factor for these complications. On correction of vitamin D level the deranged immunological and other factors causing the vasculitis were corrected subsequent to vitamin D correction. It is therefore recommended to check vitamin D concentration in cases of sever GAS especially in association with its complications such as the systemic vasculitis.
Abstract: Despite the reduction in incidence of Group A Streptococcal (GAS) infections in the last few decades its global burden on mortality and morbidity remained significantly high and represent major concerns in many developing countries. These morbidities and mortalities can be serious in immunocompromised individuals. It has been shown for the last two...
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High Ferritin Before Transplant Increases Cytopenia Post-transplant in HLA Mismatched Hematopoietic Stem Cell Transplantation in β-Thalassemia Major
Liao Jianyun,
Issa Moussa Mardo,
Wen Jianyun,
Zhou Xiaohui,
Peng Zhiyong,
Liu Huaying,
Chen Libai,
He Yuelin,
Pei Fuyu,
Wu Xuedong,
Feng Xiaoqin,
Bai Jing,
Su Qingxia,
Li Chunfu
Issue:
Volume 4, Issue 2, June 2018
Pages:
31-35
Received:
13 April 2018
Accepted:
24 May 2018
Published:
14 June 2018
Abstract: The objective is to find out the causes of Cytopenia post-engraftment (CPE) in hematopoietic stem cell transplantation (HSCT) for patients with β-thalassemia major (β-TM). For this, 61 consecutive β-TM patients underwent 7/8 HLA matched HSCT from January 1, 2009 to June 30, 2015 were retrospectively analyzed. Thirty-eight patients suffered from CPE and the remainder (n=23) associated without CPE. The effect of pre-transplant ferritin (PTF) and recipient and donor age on CPE were analyzed in the two groups. The CPE was defined as white blood cell counts less than 3.0×109/L for four weeks or longer without infection of cytomegalovirus, human parvovirus B19 virus and Epstein-Barr virus. As result, in univariate analysis, PTF level was a high-risk factor for CPE and significant higher in CPE group than no-CPE group (3927.9 ± 1314.9 vs 2291.0 ± 994.4 ng/ml, p=0.000). The result was also proved by multi-factor binary regression analysis (p=0.001). The optimal value of PTF level by R language (R 2.15.2) is 2500ng/ml, which is cutoff value in the two groups. The current study showed high PTF level was a high-risk factor of CPE for β-TM patients underwent 7/8 HLA-matched HSCT. PTF should be reduced below 2500ng/L if the 7/8 matched HSCT must be done.
Abstract: The objective is to find out the causes of Cytopenia post-engraftment (CPE) in hematopoietic stem cell transplantation (HSCT) for patients with β-thalassemia major (β-TM). For this, 61 consecutive β-TM patients underwent 7/8 HLA matched HSCT from January 1, 2009 to June 30, 2015 were retrospectively analyzed. Thirty-eight patients suffered from CPE...
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The Clinical Characteristics and Magnetic Resonance Analysis of Children with Mild Encephalitis with Reversible Isolated Corpus Callosum
Li Chaoyang,
Yang Jie,
Guan Xiaoli,
Li Chunhua,
Jing Xiaowei,
Li Wenling
Issue:
Volume 4, Issue 2, June 2018
Pages:
36-40
Received:
4 May 2018
Accepted:
7 June 2018
Published:
16 July 2018
Abstract: Objective: To summarize the Magnetic Resonance Imaging (MRI) performance and clinical characteristics of children mild encephalitis with reversible isolated corpus callosum pressure (MERS), and analyze the possible etiology. Methods: The clinical data and MRI findings of 11 children with MERS in children's hospital of Shanxi Province from January 2012 to January 2015 were summarized, and then their clinical manifestations and characteristics were analyzed. Results: Among the 11 patients, 5 were male and 6 were female. The age range was 2- 14 years. Clinical manifestations include fever (7 cases, 63.6%), gastrointestinal symptoms (9 cases, 81.8%), drowsiness (5 cases, 45.5%), convulsions (6 cases, 54.5%), dizziness (2 cases, 18.2%), cervical positive resistance (1 case, 9.1%), carotid resistance suspicious (3 patients [27.3%]). The appearance of cerebrospinal fluid, white blood cell count, leukocyte classification, protein, glucose and chloride are all normal. MRI showed only abnormal signal in the corpus callosum pressure: a slightly longer T1 signal, a longer T2 signal, a high Diffusion Weighted Imaging (DWI) signal, and a low signal of Apparent Diffusion Coefficient (ADC). Has 4 cases of nuclear magnetic head of abnormal signal in the middle of corpus callosum and ovoid, 6 cases, in the middle and a wide belt of corpus callosum, 1 case was located in the corpus callosum and diffuse wide strip. Eleven children were treated with anti-infective agents and other symptomatic treatment. All of the 11 children were recovered and discharged. The duration of the course is 8 d and the longest is 21 d. The results of MRI follow - up showed that the callosal pressure lesion disappeared. Conclusion: The clinical manifestations of children's MERS include fever, gastrointestinal symptoms, drowsiness and convulsions, and their characteristic head MRI is a reversible cytotoxic edema with good prognosis.
Abstract: Objective: To summarize the Magnetic Resonance Imaging (MRI) performance and clinical characteristics of children mild encephalitis with reversible isolated corpus callosum pressure (MERS), and analyze the possible etiology. Methods: The clinical data and MRI findings of 11 children with MERS in children's hospital of Shanxi Province from January 2...
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Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children
Xie Youjun,
Mo Wugui,
Wei Yue,
Wei Rong,
Tang Yupeng,
Fu Jun,
Lu Gongzhi
Issue:
Volume 4, Issue 2, June 2018
Pages:
41-45
Received:
31 May 2018
Accepted:
21 June 2018
Published:
24 July 2018
Abstract: To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health Hospital were randomly divided into two groups (n=15). PEEP was set in the control group according to the PEEP/ fraction of inspired oxygen (FiO2) in American ARDS collaboration network while the optimal Cdyn strategy was employed for the treatment group. We used the pressure control ventilation (PCV) mode and small tidal volume (7mL/Kg). Respiratory mechanics, hemodynamics, and inflammatory cytokines were monitored in each group before and after the experiment. The time of mechanical ventilation, hospital stay in the PICU, and 28-day mortality were compared. There were no significant differences in terms of sex, age, and severity of disease between the two groups. The optimal PEEP of the control group was significant lower than that of the treatment group [(6.4±1.4) cmH2O vs. (9.9±1.6) cmH2O, P<0.01]. Cdyn and oxygenation index (OI) in the two groups were improved, and the degree of improvement in the treatment group was significantly higher than that in the control group [Cdyn after the experiment at 2 h: (0.39±0.03) mL/(cmH2O.kg) vs (0.36±0.03) mL/(cmH2O.kg), P<0.05; 24h: (0.40±0.03) mL/(cmH2O.kg) vs (0.38±0.03) mL/(cmH2O.kg), P<0.05; 48 h: (0.43±0.02) mL/(cmH2O.kg) vs. (0.40±0.02) mL/(cmH2O.kg), P<0.01; OI after the experiment at 24 h: (20.07±2.12) cmH2O/mmHg vs (21.94±2.05) cmH2O/mmHg, P<0.05; 48 h: (17.51±1.64) cmH2O/mmHg vs (19.82±2.07) cmH2O/mmHg, P<0.01]. There were no significant differences in heart rate, mean arterial pressure, and cardiac index before and after the experiment (all P>0.05). Interleukin-6 (IL-6) in two groups gradually decreased, and the decrease was greater in the treatment group than in the control group [IL-6 after the experiment at 24 h: (84.58±9.11) ng/L vs (93.18±9.27) ng/L, P<0.05; 48 h: (76.67±9.23) ng/L vs (90.10±9.42) ng/L, P<0.01]. The length of mechanical ventilation and hospital stay in the PICU was significantly shorter in the treatment than in the control group [length of mechanical ventilation: (6.62±1.26) days vs (8.06±1.44) days; hospital stay in the PICU: (8.12±1.31) days vs (9.53±1.42) days, all P<0.05). There was no barotrauma and no difference in mortality between the two groups (P>0.05). The optimal Cdyn method for titrating PEEP improved respiratory mechanics in ARDS, shortened the time of mechanical ventilation, and had no serious adverse effect on hemodynamics.
Abstract: To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health H...
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