Search

A 3-year-old boy initially presented with purpura-like rashes and nephrotic syndrome, suspected to be IgA vasculitis nephritis (IgAVN). The suggestion of kidney biopsy was rejected. Although the patient responded well to glucocorticoids, they later developed recurrent proteinuria, refractory diarrhea, and subsequent metabolic acidosis. Kidney biopsy showed membranous nephropathy with positive semaphorin 3B expression, indicative of other kidney diseases rather than IgAVN. Although his kidney responded well to glucocorticoid combined with cyclosporine A treatment regimen, enteropathy and severe food allergy still progressed afterwards as evidenced by villous atrophy on gastrointestinal endoscopy examination. Whole exome sequencing identified a heterozygous missense variant in exon 11 of FOXP3: c.1121 T > G, confirming the diagnosis of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome. The case expanded the phenotypic spectrum of IPEX syndrome, suggesting high phenotypic heterogeneity despite similar genotypes. It also put emphasis on the significance of kidney biopsy to differentiate IgA vasculitis nephropathy from other immune disorders. [ABSTRACT FROM AUTHOR]

The article describes the case study of a 6-week-old male infant with persistent respiratory distress and head bobbing. Topics include the patient's complex neonatal history; symptoms observed at home, such as tachypnea, retractions, and head bobbing that fluctuated in severity; and diagnostic assessments, including normal chest radiographs, echocardiogram showing minor heart findings, and elevated bilirubin levels without definitive respiratory or cardiac diagnoses.

INTRODUCTION: Isolated oligohydramnios occurs in 1%–2% of pregnancies when amniotic fluid is reduced in otherwise normal pregnancies. The actual clinical significance and optimal management are still unclear. We investigated how isolated oligohydramnios affects birth mode and perinatal outcomes. METHODS: A retrospective case-control study compared an isolated oligohydramnios group with a low-risk pregnancy group whose gestational age was between 32 and 41 weeks between January 2017 and December 2020. We recruited 636 women, 277 isolated oligohydramnios patients, and 359 controls. The primary outcomes were birth mode and perinatal outcomes. RESULTS: Compared with that in the control group, the emergency cesarean section rate was higher with isolated oligohydramnios (43.3% vs. 14.2%, relative risk [RR] 4.62, 95% confidence interval [CI] [3.2, 6.8], p <.001). This group also had a greater incidence of an Apgar score of <7 at 5 minutes (6.5% vs. 1.9% [RR 3.49, 95% CI [1.44, 8.49], p =.003]), transient tachypnea of the newborn (5.1% vs. 0.3% [RR 19.05, 95% CI [2.49, 14.5], p <.001]), neonatal intensive care unit admission (7.9% vs. 1.7% [RR 5.08, 95% CI [2.03, 12.69], p <.001]), and perinatal mortality (2.5% vs. 0%, p =.002). Women with isolated oligohydramnios who received labor induction had a higher emergency cesarean section rate than noninduced women did (57% vs. 34.7%, p <.001), without a negative impact on perinatal outcomes. CONCLUSION: We found that isolated oligohydramnios was linked to poorer birth and composite perinatal outcomes. Delaying birth until term or even full term reduced the cesarean section rate and transient tachypnea of the newborn. Labor induction resulted in more emergency cesarean sections but had no negative impact on perinatal morbidity. [ABSTRACT FROM AUTHOR]

Aim: To investigate if tachypneic response to hypoxia is decreased in older patients. Methods: We included all patients ≥65 years of age attending 52 Spanish emergency departments (EDs) for whom peripheral arterial oxygen saturation (SatO2) measured by pulsioxymetry and respiratory rate (RR) were registered at ED arrival. We assessed the relationship between SatO2 and RR in different models, and with the best‐fitting model, we independently analyzed this relationship in four subgroups according to patient age (65–69, 70–79, 80–89, and ≥90 years). Five sensitivity analyses using different subsets of patients were carried out to check for the consistency of the results. Results: We included 7126 patients, with medians for SatO2 and RR of 97% (interquartile range [IQR]: 94–98) and 15 bpm (IQR: 15–16), respectively. We found significant associations (P < 0.001) between SatO2 and RR in every model tested (P < 0.001 for all), with the quadratic model obtaining the best fit (R2: 0.098) over those obtained with linear (R2: 0.096) and logarithmic (R2: 0.092) models. The same was observed in sensitivity analyses, with R2 for quadratic models ranging from 0.069 in patients with low comorbidity and 0.102 in patients breathing room air. The mean RR for 100% SatO2 was 15 bpm and increased as SatO2 decreased, although with a progressive slowing of the slope, with a mean RR of 27 at 50% SatO2. We detected a decreased RR response to increasing hypoxemia according to age and, while the RR curve was higher and with a progressively steepening slope in the 972 patients aged 65–69 (mean RR of 42 bpm with 50% SatO2), a progressive slowing of slope was observed in the 2693 patients aged 70–79 (mean RR of 28 with 50% SatO2), the 2582 aged 80–89 (mean RR of 25) and the 879 aged ≥90 (mean RR of 23). Sensitivity analyses provided very similar results. Conclusion: Tachypneic response to hypoxemia in older patients decreases as age advances, regardless of the reason leading to hypoxemia. Geriatr Gerontol Int 2024; 24: 1120–1129. [ABSTRACT FROM AUTHOR]

In the study the clinical profile of 168 children diagnosed with acute bronchiolitis in the First Pediatric Department of UMBAL Burgas AD is analyzed,. The minimum age being 1 month and the maximum age being 24 months. Patients were divided into four age groups. The duration of the infection of the upper respiratory tract before the development of broncho-obstructive syndrome, the days with a clinic of acute viral infection before the appearance of broncho-obstructive syndrome, the presence of a temperature above 38.5, tachypnea, rapid heart activity, dyspnea, cyanosis, as a symptom of decreased oxygenation, etc. Conclusions were made regarding the clinical profile of the patients and the complications of the disease. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Veterinary Research / Revue Canadienne de Recherche Vétérinaire is the property of Canadian Veterinary Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: First medical contact for patients with sepsis often initiates in the prehospital setting, yet limited studies have explored the EMS sepsis recognition-mortality relationship. Racial and ethnic minority patients often have worse sepsis outcomes, yet the role of prehospital recognition in this inequity has not been explored. Our objective was to describe prehospital sepsis recognition and hospital mortality, with analysis by patient race and ethnicity. Methods: Using linked EMS and hospital records from the 2021 ESO Data Collaborative, we retrospectively analyzed 9-1-1 EMS transports for adult patients with emergency department ICD-10 sepsis diagnosis codes. EMS sepsis recognition was defined as a primary or secondary sepsis impression, use of an electronic health record specialty sepsis form, or a prehospital sepsis alert. We used multivariable logistic regression to assess the association between EMS sepsis recognition and hospital mortality, adjusting for age, sex, race and ethnicity, scene socioeconomic status, and documented clinical characteristics: altered mental status, hypotension, tachypnea, tachycardia, fever. We conducted a secondary analysis of patients who were positive for the quick sequential organ failure assessment (qSOFA) using first prehospital vital signs. Results: We analyzed 20,172 records for EMS-transported patients with diagnosed sepsis. Overall, 8% of patients were Black, 8% were Hispanic, and 72% were White. Prehospital sepsis recognition was 18%. Prehospital sepsis recognition was similar across racial and ethnic groups (Black: 17.2%, Hispanic: 17.4%, White: 18.1%) and adjusted odds of sepsis recognition did not differ between racial and ethnic groups. Overall mortality was 11% (2,186). Prehospital sepsis recognition was associated with a 18% reduction in adjusted odds of mortality (OR: 0.82, 95% CI: 0.70-0.94). Of patients who were qSOFA positive in the field (n = 2,168), EMS sepsis recognition was 32% and was similar across race and ethnicities. Adjusted odds of mortality were 0.68 (95% CI: 0.53-0.88) when sepsis was recognized in the prehospital setting. Conclusion: EMS identified sepsis in fewer than one in three patients even after limiting to those positive for qSOFA, without differences by race and ethnicity. EMS sepsis recognition was associated with reduced odds of mortality; however, Black patients remained at greater odds of death suggesting additional factors that warrant investigation. [ABSTRACT FROM AUTHOR]

Takayasu arteritis (TA) is a rare chronic granulomatous vasculitis mainly affecting the aorta and its main branches. Clinical presentations of TA are non-specific, especially in the initial phase, which likely contributes to delayed diagnosis besides the rarity of the disorder. Childhood-onset of TA is associated with significant morbidity and mortality. This case report aimed to present two rare cases of acute symptomatic severe hypertension in children due to TA. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) in children under 15 years often results in airway compression, with bronchus intermedius (BI) being the most common site. Endoscopic enucleations can be used to remove lymph nodes and establish an airway in severe cases. Both rigid and flexible bronchoscopy are suitable, with alligator forceps being preferred for its ability to extract tissue. Recent studies have also explored cryoprobe enucleation. Case Presentation: An HIV-positive boy with persistent symptoms after 9 months of TB treatment was diagnosed based on his mother's and sister's Xpert MTB/RIF positive status. He was started on 4-drug TB treatment, but the child remained clinically symptomatic with abnormal chest X-ray and unconfirmed TB. Bronchoscopy was performed, revealing complete obstruction of BI due to caseating granulomas causing collapse of the right middle and lower lobes. Cryotherapy was used to recanalize the airway, and follow-up bronchoscopy confirmed patent BI. Conclusion: While cryotherapy was effective in the restoration of airway patency in this case, there is a lack of knowledge about its use in children. [ABSTRACT FROM AUTHOR]

Background: The reported outcomes of pediatric dilated cardiomyopathy (DCM) have varied across studies. There are few outcome data concerning DCM in Chinese children. Therefore, we conducted a retrospective study to describe clinical features and determine risk factors for poor outcomes in children with DCM. Methods: We enrolled 121 children with DCM in our hospital from 2003 to 2021. General information and laboratory and echocardiographic data were collected and analyzed. Cox regression analysis was performed to determine risk factors for poor outcomes. Results: This study included 121 patients (69 males and 52 females). The median age at diagnosis was 10.8 years, and the follow-up time was 10.0 months. Eighty-two patients (67.8%) exhibited cardiac function classes III–IV at the time of diagnosis. Tachypnea was the most common symptom (78.5%). In echocardiography, the mean left ventricular end-diastolic dimension z score was 7.36 ± 2.73, and the left ventricular ejection fraction z score was −6.58 ± 2.17. The 1-, 2-, and 5-year survival rates were 51.2%, 43.8%, and 32.2%, respectively. Cox analysis revealed that cardiac function classes III–IV (hazard ratio [HR] = 1.801, 95% confidence interval [95% CI] = 1.030–3.149, p = 0.039) and calcium levels (HR = 0.219, 95% CI = 0.084–0.576, p = 0.002) were predictors of poor outcomes in children with DCM. Conclusions: Children with DCM are at high risk of death. Cardiac function class III–IV and calcium levels were related to the prognosis of pediatric DCM patients. [ABSTRACT FROM AUTHOR]

An outbreak of H1N1 infection was first declared by the World Health Organization in 2009 and confirmed in the post-pandemic phase in 2010. Amid the COVID-19 pandemic, we found a confirmed case of H1N1pdm09 in Bunda Women and Children Hospital Jakarta. A 13-year-old boy was referred to our hospital after four days of hospitalization due to worsening tachypnea following a productive cough and fever. The patient had severe dyspnea with inspiratory effort and oxygen desaturation to 80%, therefore admitted to our pediatric intensive care unit. On physical examination, the patient had increased work of breathing, looked irritable, had a respiratory rate of about 40x/minute with non-rebreathing mask support, and crackles were heard in both lungs. Chest X-ray showed right bronchopneumonia. There was a history of a generalized seizure for less than 1 minute, which stopped spontaneously in previous hospital care. The patient was diagnosed with mucopolysaccharidosis at age six years old and has never received enzyme replacement therapy. Laboratory results revealed thrombocytopenia, leukopenia, neutrophilia, monocytosis, high c-reactive protein and procalcitonin, and elevated liver enzymes. The investigation of etiology was performed using the respiratory panel test and showed a positive real-time polymerase chain reaction for H1N1pdm09 and Influenza A. The patient was given oxygen therapy with a high-flow nasal cannula with an oxygen fraction of 40% and a flow of 20 liters per minute, fluid maintenance while fasting, antibiotics, inhaled b-2 agonists, and a neuraminidase inhibitor (oseltamivir). The patient's clinical and laboratory markers improved on the third day of treatment, and he was discharged two days later. [ABSTRACT FROM AUTHOR]

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease, presenting either in isolation or with other cardiac anomalies. The most common presentation is congestive heart failure in infancy, though some may remain asymptomatic till adulthood. A 5-month-old infant with congestive heart failure was diagnosed to have ALCAPA with severe Left ventricular (LV) dysfunction. Unlike the more common variants where the left coronary artery (LCA) arose from the facing sinuses, the LCA arose from the left anterior nonfacing sinus of the pulmonary artery at a considerable distance from the left aortic sinus. This made direct reimplantation of LCA to the aorta challenging. LCA was reimplanted to the aorta using an extrapulmonary baffle made of an autologous pulmonary flap. The postoperative period was uneventful. The LV contractility improved during the follow-up. Early diagnosis and intervention with a novel surgical technique prevented irreversible cardiac complications and mortality. [ABSTRACT FROM AUTHOR]

Copyright of Ümraniye Pediatri Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Elective cesarean sections (ECSs) for early-term pregnancies at 37 weeks of gestational age (GA) aim to reduce the risk of emergency cesarean sections due to the onset of labor or rupture of membranes. However, resultant increases in neonatal respiratory disorders, including transient tachypnea of the newborn (TTN) have been observed. However, few studies have elucidated the associated risk factors. Consequently, we aimed to determine whether differences existed in the clinical outcomes between neonates delivered via ECS at 37 weeks and those delivered at ≥ 38 weeks of GA. Methods: A retrospective analysis was conducted on 259 neonates born via ECS at Tottori University Hospital, between January 2013 and December 2019, with birthweights ≥ 2500 g and GAs > 37 weeks. The neonates were categorized into two cohorts: births at 37 and at ≥ 38 weeks of GA (37-week and 38-week cohorts). The principal clinical outcomes included the appearance, pulse, grimace, activity, and respiration (Apgar) scores, need for positive-pressure ventilation, incidence of TTN, and length of hospital stay. Results: No statistically significant differences were observed in the indications for ECS, sex, or birthweight between the two cohorts. The 37-week cohort exhibited a lower 1-min Apgar score than did the 38-week cohort, with no statistically significant differences between the two cohorts, at 5 min. Statistically significant differences were not observed in the need for positivepressure ventilation during initial resuscitation or length of hospital stay for patients with TTN between the two cohorts. Notably, the 37-week cohort exhibited a significantly higher incidence of TTN than did the 38-week cohort. Conclusion: ECSs at 37 weeks of GA exhibited an increased risk of TTN than ECSs at = 38 weeks of GA. Strategic neonatal care and adequate preparation can mitigate this risk without affecting the length of hospital stay. [ABSTRACT FROM AUTHOR]

Copyright of Respiratory Case Reports is the property of LookUs Scientific and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Respiratory Case Reports is the property of LookUs Scientific and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Bangladesh has suffered a lot corona virus disease 2019 (COVID 19), but clinical data on COVID 19 is fewer still. Objective: The purpose of the present study was to determine the patterns of clinical characteristics of confirmed COVID 19 patients in Sylhet to contribute as information resource of our country. Methodology: This cross sectional study was conducted in the inpatient Department of Medicine of Jalalabad Ragib-Rabeya Medical College Hospital, Sylhet, Bangladesh to evaluate the clinical characteristics among the COVID 19 patients from July 2020 to December 2020 by purposive sampling technique. For the purpose a total 75 RT PCR positive COVID 19 patients were included in the study and data were collected with a semi-structured questionnaire. Results: The results showed that,85.3%% patients presented with fever, 46.7% with cough and 38.7.0% with dyspnoea. On examination 85.3% had fever, 38.7% had tacypnea, 38.7% had low SpO2 at room temperature, 57.3% had vesicular breath sound. Lab investigations (biochemical) mostly needed at admission for management of the patients were complete blood count (CBC) in 93.3% case, c reactive protein (CRP) in 76.0% case, Ddimer in 68.0% case, random blood sugar (RBS) in 56.0% case, serum creatinine in 54.7%, serum ferritin in 42.7%, serum electrolytes in 42.7%, electro cardiogram (ECG) in 38.7%. According to clinical classification for case management of COVID 19 58.7%, 21.3%, 16%, 2.7%, 1.3% were successively diagnosed as mild, moderate, severe, asymptomatic and critical COVID 19 infection. Among the study population 80.0% patient was in need of antibiotic, 60.0% anti coagulant, 48.0% steroid, 38.7% oxygen, 2.7% antiviral drugs, 1.3% mechanical ventilation during their treatment. Conclusion: The results obtained from this study could urge more study on it to provide updated knowledge as well as find potential treatment strategies for this pandemic disease. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate TFC by EC versus lung ultrasound (LUS) findings for diagnosing and follow-up of TTN in late preterm and term neonates. This prospective observational study was conducted on 80 neonates with gestational age ≥ 34 weeks. TTN group included 40 neonates diagnosed with TTN, and no lung disease (NLD) group included 40 neonates without respiratory distress. LUS and EC were performed within the first 24 h of life and repeated after 72 h. There was a statistically significant increase in TFC in TTN group on D1 [48.48 ± 4.86 (1 KOhm−1)] compared to NLD group [32.95 ± 4.59 (1 KOhm−1)], and then significant decrease in TFC in D3 [34.90 ± 4.42 (1 KOhm−1)] compared to D1 in the TTN group. There was a significant positive correlation between both TFC and LUS with Downes' score, TTN score, and duration of oxygen therapy in the TTN group. Conclusion: Both LUS and TFC by EC provide good bedside tools that could help to diagnose and monitor TTN. TFC showed a good correlation with LUS score and degree of respiratory distress. What is Known: • Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns. • TTN is a diagnosis of exclusion, there are no specific clinical parameters or biomarker has been identified for TTN. What is New: • Thoracic fluid content (TFC) by electrical cardiometry is a new parameter to evaluate lung fluid volume and could help to diagnose and monitor TTN and correlates with lung ultrasound score. [ABSTRACT FROM AUTHOR]

In clinical practice, increased "work of breathing" (WOB) is used to rapidly identify the acutely ill child in need of immediate clinical care, and is commonly used to support a clinical diagnosis of pneumonia. However, this key clinical sign is poorly understood and inconsistently defined. This review discusses the physiology, measurement, and clinical assessment of WOB, highlighting its utility in the recognition of pneumonia in under-resourced settings, where access to diagnostic imaging may be limited. [ABSTRACT FROM AUTHOR]

Objectives: A hospital-based retrospective study was undertaken among the adult patients presenting to document the incidence of hypertensive urgency (HTN-U) and emergency while the secondary objectives included clinical presentations, disposition from emergency room, and inhospital mortality. Materials and Methods: All patients were evaluated by vital signs, clinical examination as well as relevant laboratory tests and radiological tests. Patients with target organ damage were grouped under the hypertensive emergency (HTN-E) group (n = 104) and patients without target organ damage were included under the HTN-U group (n = 52). The data were analyzed using GraphPad Prism (vs. 9.4.1) and MedCalc (vs. 20.118). Results: The incidence of HTN-E and HTN-U was 68.4% and 31.6%, respectively. The most common symptom observed in patients with HTN-E was breathlessness (53.8%), followed by chest pain (34.6%) and headache (27.9%). While, in HTN-U patients, most patients reported chest pain (43.8%), headache (39.6%), and epistaxis (22.9%). Majority of the patients in both the groups presented with signs of tachycardia, tachypnea, and hypoxia. The mortality in HTN-E and HTN-U patients was 15.4% and 2.1%, respectively. Among 104 patients with HTN-E, 53.8% each of the patients had acute heart failure and acute pulmonary edema. While, in HTN-U patients, acute pulmonary edema and acute coronary syndrome were observed in 2.1% each of the study subjects. Conclusion: Patients at high risk or end-organ damage should be immediately referred to the emergency department from the outpatient settings, as a rapid reduction in blood pressure is essential over minutes to hours, to prevent further organ damage. [ABSTRACT FROM AUTHOR]

Objective: To find out the spectrum of respiratory distress and outcome in neonates admitted to Neonatal Intensive care unit (NICU) of National Institute of Child Health (NICH), Karachi, Pakistan. Study Design: Cross-sectional study. Setting: NICU of NICH, Karachi, Pakistan. Period: June 2022 to May 2023. Methods: We analyzed 148 neonates of either gender presenting with respiratory distress. At the time of enrollment, demographic and clinical information was noted in all neonates along with detailed maternal history. Relevant laboratory and radiological studies were performed. Final outcomes were recorded in terms of discharged, expired or referred. Results: In a total of 148 neonates, 96 (64.9%) were boys. The mean age was 4.04±5.65 days. Tachypnea, nasal flaring, intercostal recession, subcostal recession, grunting, and cyanosis 148 (100%), 146 (98.6%), 138 (93.2%), 133 (89.9%), 97 (65.5%), and 83 (56.1%) were the most frequent clinical presentations among neonates with respiratory distress. The most frequent causes behind respiratory distress were noted to be respiratory distress syndrome, sepsis, and meconium staining of labour in 31 (20.9%), 25 (16.9%), and 24 (16.2%) neonates. Mortality was observed in 21 (14.2%) neonates. Significant association of neonates presenting with congenital pneumonia (p=0.048), or congenital anomalies (p<0.001) were found to with poor outcomes. Mechanical ventilation was found to have significant relationship with poor outcomes (p<0.001). Conclusion: Tachypnea, Nasal flaring, intercostal and subcostal recessions, grunting, and cyanosis were the primary clinical presentations among the neonates with respiratory distress. Congenital pneumonia, and congenital anomalies emerged as key predictors of poor outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

(1) Background: This study aimed to determine whether standard-dose vitamin D supplementation could provide adequate levels in exclusively breastfed infants born with different cord 25(OH)D levels and to evaluate related neonatal morbidities. (2) Methods: A prospective cross-sectional study was designed in term infants. Three groups were formed based on cord 25(OH)D levels; Group1 Deficiency:25(OH)D < 12 ng/mL, Group2 Insufficiency:25(OH)D = 12–19 ng/mL, and Group3 Optimum:25(OH)D = 20–100 ng/mL. Cord and 1st month 25(OH)D levels, after receiving standard-dose vitamin D prophylaxis, neonatal outcomes and anthropometric measurements were compared. (3) Results: The study involved 86 infants. Group1 Deficiency had also significantly lower 25(OH)D levels at 1st month compared to the others (p < 0.001). There was a significant positive correlation between cord and 1st month 25(OH)D levels (r = 0.78, p < 0.001). Despite the fact that the mother's age and clothing style were similar, Group1 Deficiency mothers had higher parity numbers and used less vitamin D during pregnancy (p = 0.03, p = 0.04). Neonatal outcomes analysis revealed that newborns in Group1 Deficiency experienced more respiratory distress, transient tachypnea, and early-onset sepsis, as well as more and longer hospital stays in the first-month of life (p < 0.05). (4) Conclusions: Infants with low cord 25(OH)D levels had also lower 25(OH)D values in the 1st month of life and experienced higher rates of neonatal morbidities. Given its numerous biological activities and impact on neonatal morbidities, determining an individualized dose of vitamin D supplementation may be more accurate than using the standard approach. [ABSTRACT FROM AUTHOR]

Copyright of Revista Científica de Enfermería (2071-5080) is the property of Colegio de Enfermeros del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We received a complaint of fever and tachypnea from a 6-year-old girl who came to our hospital. She was treated for 20 days with antibiotics and corticosteroids. She was admitted for 10 days with a diagnosis of pneumonia and was discharged after the fever subsided. Two days after her discharge, the respiratory symptoms returned, and she came to us because of the severity of her symptoms. We diagnosed her with community-acquired pneumonia (CAP), performed the necessary radiographic and laboratory procedures, and the following outcomes were obtained: the computed tomography scan revealed consolidation between the right lung’s upper and middle lobes as well as an air bronchogram, but the chest ultrasound revealed no signs of pleural effusion. D‑dimer, white blood cell, erythrocyte sedimentation rate, and C‑reactive protein were also high in the laboratory test results, indicating pulmonary inflammation. She was finally diagnosed with CAP, and although the cause of the illness is unknown, she underwent a 14-day course of common antibiotics. Two days after the medication began, the fever subsided, and the tachypnea decreased. We believe that the corticosteroid treatment during the initial hospital stay is what caused the disease agent to persist and cause the fever to recur. [ABSTRACT FROM AUTHOR]

Copyright of Polish Nursing / Pielegniarstwo Polskie is the property of Poznan University of Medical Sciences Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Sepsis, a syndrome of organ dysfunction caused by an unregulated host response to infection. This study aimed to develop a novel sepsis diagnostic model of hematological parameters and evaluate its effectiveness in the early identification and prognosis of sepsis in emergency departments. Methods: A retrospective study was conducted in Emergency Department. Cell population data parameters related to monocytes and neutrophils were obtained using the Mindary BC‐6800 plus hematology analyzer. Receiver operating characteristic (ROC) curve analysis, logistic regression analysis was performed to assess the performance of the parameters and establish a diagnostic and prognostic model of sepsis, which was then verified with a validation cohort. Results: Mon_XW exhibited the best diagnostic performance (area under the ROC curve [AUC] = 0.848, 95% confidence interval [CI]: 0.810–0.885, p < 0.001), followed by Neu_Y and Neu_YW (AUC = 0.777 95% CI: 0.730–0.824, p < 0.001). Logistic regression analysis identified Mon_XW and Neu_Y as independent predictors, which were used to establish a diagnostic model named hematological parameter for sepsis (HPS). HPS demonstrated the best diagnostic performance with an AUC of 0.862 (95% CI: 0.826–0.898, p < 0.001), sensitivity of 70.0%, and specificity of 87.1%, compared to C‐reactive protein (CRP) and procalcitonin (PCT). The validation cohort also found that the positive predictive value of HPS was 70.4% and the negative predictive value was 92.2%. Conclusion: The developed HPS model showed promising diagnostic efficacy for sepsis in the emergency department, which outperformed CRP and PCT in terms of sensitivity and specificity. By enabling early identification and prognosis of sepsis, that contributes to reducing sepsis‐related mortality. [ABSTRACT FROM AUTHOR]

Venovenous extracorporeal membrane oxygenation is increasingly used as a bridging strategy in decompensating patients awaiting lung transplantation. Various approaches for continuing support intraoperatively have been previously described. A two-circuit strategy that uses the in situ venovenous extracorporeal membrane oxygenation circuit supplemented with peripheral cardiopulmonary bypass allows for diversion of native cardiac output away from the transplanted lung as well as seamless continuation of venovenous extracorporeal membrane oxygenation postoperatively. [ABSTRACT FROM AUTHOR]

The article describes the case of a six-year-old girl with schizencephaly, shunted hydrocephalus, epilepsy, global development delay, diabetes insipidus, and spastic quadriplegic cerebral palsy. Topics discussed include findings on her medical examination, major categories of the differential diagnosis for a child with acquired chest wall mass, and final diagnosis of thoraco-abdominal actinomycosis with chest wall invasion.

The article describes the case of a 13-year-old female with chronic medical history of presumed Rett syndrome (RTT) based on developmental regression and behavioral observation, microcephaly, seizure disorder, and gastrostomy tube dependence. Topics discussed include findings on medical examination of the patient, clinical characteristics of Rett syndrome, and differential diagnosis, workup, and outcomes of therapeutic interventions trialed for patient's agitation.

BACKGROUND: Cardiovascular disease has now become the leading cause of mortality in India. The primary cause of death in most of the developed nations is CHD, despite improvements in diagnostic and therapeutic procedures. The electrocardiogram's left bundle-branch block could mask the alterations caused by MI which delays the management. MAIN TEXT AIMS AND OBJECTIVES: To understand the significance of bundle branch block. To estimate the incidence of bundle branch block and its prognosis in acute coronary syndrome. PATIENTS AND METHODS: A prospective analytical study was done on 150 patients over 18 months with patients with angina chest pain admitted to the coronary care unit. Patients with known bundle branch block and previous coronary artery disease are excluded from the study results Right bundle branch block may occur normally in healthy individuals but when it is associated with acute coronary syndrome it indicates poor prognosis compared to the left bundle branch block. [ABSTRACT FROM AUTHOR]

Iatrogenic hemopneumothorax is the presence of air and hemorrhagic fluid in the pleural space. It is a complication of invasive procedures performed for diagnosis and treatment. A 75-year-old woman with a history of cerebrovascular disease and aspiration pneumonia underwent wire-guided nasogastric tube (NGT) on the first day of palliative care follow-up because of the risk of aspiration with oral feeding. Posterior-anterior chest radiography was performed after the procedure because the patient had chest pain and tachypnea. Posterior-anterior chest radiography showed that the NGT guidewire was in the right costophrenic sinus and was associated with pneumothorax. Iatrogenic hemopneumothorax may develop secondary to many invasive procedures, as well as secondary to NGT, which is a simple clinical procedure. We aim to present an unprecedented case in which a new-generation NGT with a guidewire caused a hemopneumothorax during insertion. [ABSTRACT FROM AUTHOR]

Background: Aorto‐left ventricular tunnel (ALVT) is a paravalvular communication between aorta and left ventricle. It is one of the rare congenital heart diseases which could present with heart failure. Case presentation: A case of ALVT was diagnosed in infancy. Preliminary assessment was possible using conventional echocardiography; however, functional assessment and accurate anatomy of ALVT were further verified via variable imaging modalities starting from speckle tracking and three‐dimensional echocardiography to cardiac CT angiogram. The tunnel was successfully repaired with uneventful recovery. Conclusions: Multimodality imaging can accurately assess cardiac function and demonstrate the anatomy of ALVT noninvasively to plan for successful intervention. [ABSTRACT FROM AUTHOR]

Stridor is an important symptom which should not be missed, especially in a child. The etiology could be multifactorial and will require a comprehensive investigation into its management. In this case, we discuss the clinician's dilemma in reaching a diagnosis due to various factors which were present in a single patient. This rare benign laryngeal squamous polyp was eventually diagnosed in an 11-week-old boy who presented with acute stridor. The diagnostic dilemma we discuss in this case was due to multiple maternal and fetal factors. He was a premature baby, intubated at birth, there was a maternal tuberculosis infection and he also had a cutaneous hemangioma which were all part of the diagnostic dilemma faced in his management which eventually led to an acquired subglottic stenosis. Our discussion will focus on how a thorough and proper evaluation is needed especially when there are many deceptive clues or signs present in a patient. [ABSTRACT FROM AUTHOR]

Sepsis is increasing in incidence in the United States and is one of the most common causes of death in hospitalized patients. Sepsis affects different biochemical and immunologic pathways and can present variably. Despite efforts to unify definitions of sepsis, increase awareness, and improve treatment, mortality remains high. Because of sepsis's complex pathophysiology, diagnosis can be challenging. No diagnostic test is sensitive or specific enough to diagnose sepsis in isolation. However, three biomarkers--lactate, C-reactive protein, and procalcitonin--in combination with other diagnostics may help clinicians diagnose sepsis earlier, leading to better patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Twin pregnancies are associated with a high risk of perinatal mortality and morbidity. Late preterm or early term delivery is frequently performed to avoid unexpected fetal death in uncomplicated twin pregnancies. Nonetheless, delivery before full term is associated with neonatal respiratory complications. This study aimed to evaluate perinatal respiratory complications in twins delivered between 36 and 38 weeks of gestation. Methods: A retrospective cohort study was conducted on twins delivered between 36 and 38 weeks of gestation from January 2008 to June 2020. The primary outcomes were the incidence of composite neonatal respiratory morbidity, which included respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, mechanical ventilation or continuous positive airway pressure according to gestational age at delivery, and chorionicity. The relationship between gestational age at delivery and composite neonatal respiratory morbidity was evaluated using multivariate logistic regression analysis adjusted for potential confounders. Results: This study included 1608 twins (614 monochorionic diamniotic twins, 994 dichorionic diamniotic twins). At 36, 37, and 38 weeks of gestation, the frequencies of composite neonatal respiratory morbidity were 19.4%, 10.7%, and 9.2% in dichorionic diamniotic twins and 13.6%, 8.7%, and 9.4% in monochorionic diamniotic twins, respectively. In dichorionic diamniotic twins, the composite neonatal respiratory morbidity rate was higher for twins delivered at 36 weeks of gestation than for those delivered at 37 weeks. No significant differences between monochorionic diamniotic twins were detected. Conclusions: In uncomplicated dichorionic diamniotic twin pregnancies, delivery should be considered after 37 weeks of gestation to reduce neonatal respiratory complications. [ABSTRACT FROM AUTHOR]

Diabetic Ketoacidosis (DKA) presents as an acute emergency in children with type 1 diabetes mellitus. The mortality associated with DKA is more in developing countries and in children less than 5 years of age. Cerebral edema, sepsis, shock and renal failure are the identified causes for mortality. Severe hyperlipidemia and pancreatitis are less recognised causes for mortality in children with DKA. We report a 6-year-old female child who presented with lipemic serum due to severe hyperlipidemia associated with DKA. With adequate management of DKA as per the guidelines, hyperlipidemia also resolved and no further episodes were noted on follow up. Knowledge about this rare entity could help the clinicians regarding the prompt recognition, evaluation and management of hyperlipidemia and thus help in reduction of mortality associated with the same. [ABSTRACT FROM AUTHOR]

The article focuses on a case of a 9-day-old infant who initially presented with fast breathing and cough, but later developed severe symptoms, including fever and worsening cough. Topics include the infant's medical history, diagnostic workup, and the identification of an underlying primary immunodeficiency, chronic granulomatous disease (CGD), which was associated with invasive pulmonary Aspergillus infection.

Introduction: Respiratory distress is the leading cause of admission to neonatal units and is a common indication for medical retrieval. Whilst approximately 25% of births in NSW occur in regional centres, there is a paucity of neonatal research in these settings. Objective: To describe the characteristics and outcomes of term neonates admitted with respiratory distress to two regional special care nurseries (SCNs) and identify variables associated with the need for medical retrieval. Design: We describe a cohort of 629 term infants admitted to the SCN in two regional hospitals, 2015–2019. We describe the admission characteristics, level of respiratory support, biochemical investigations, diagnosis and outcomes. Findings: During the study period, 629 eligible term infants were admitted, retrieval occurred in 29 (4.6%). Those admitted were more often male (66.5%), with a mean gestational age of 39 + 1 weeks (±9 days) and birth weight of 3470 g (±500 g). Infants requiring medical retrieval had higher PaCO2 on blood gas analysis (59.8 mmHg vs. 53.3 mmHg, OR 1.03, p = 0.02). There was no association between maternal GBS status, meconium‐stained liquor, gestational age, or raised inflammatory markers and medical retrieval. Transient tachypnoea of the newborn was the most common diagnosis of neonates admitted to SCN with respiratory distress. Discussion: Among term infants admitted to a SCN for respiratory distress most were male, of a normal birthweight and born in good condition. Within our cohort there was no association between retrieval and maternal GBS colonisation, meconium‐stained liquor or raised infectious biomarkers. Medical retrieval was infrequent and was associated with higher PaCO2 on initial blood gas analysis. Conclusion: We present a large cohort of term newborn infants managed for respiratory distress in a regional setting over a five‐year period. Retrieval was infrequent, and outcomes for the cohort were excellent with no deaths during the study period. [ABSTRACT FROM AUTHOR]

The article describes a case of respiratory distress and hypocalcemia in a 2-week-old boy, leading to the diagnosis of DiGeorge syndrome, emphasizing the importance of considering a wide range of differentials for electrolyte imbalances in infants. Topics include differential diagnosis of hypocalcemia in newborns, phenotypic features and diagnostic workup of DiGeorge syndrome, and the necessity of a multidisciplinary approach in managing associated abnormalities.

Cystic hygroma of the neck, a congenital benign tumor of the lymphatic system, is a potential cause of neonatal airway obstruction leading to stridor. Meticulous airway evaluation, case appropriate preparation, and use of advanced technology, including videolaryngoscope and ultrasonography, can facilitate the safe management of the difficult airway. [ABSTRACT FROM AUTHOR]

The article focuses on presenting metronome-paced tachypnea (MPT) as a simple, standardized method for inducing dynamic hyperinflation (DH) in obstructive lung diseases, offering insights into the pathophysiological mechanisms and potential clinical applications of DH. It mentions by employing MPT, researchers aim to elucidate the relationship between DH and dyspnea in conditions like chronic obstructive pulmonary disease (COPD).

The article offers information on the persistent perinatal complications associated with maternal diabetes, focusing on the risks for offspring of women with gestational diabetes mellitus (GDM). Topics include the global prevalence of GDM and type 2 diabetes, the importance of screening and managing these conditions, and a case report illustrating the consequences of inadequate diabetes screening in a pregnant woman, leading to neonatal complications.

This discussion reviews gastrointestinal (GI) features of coronavirus disease 2019 (COVID-19) that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that erupted into a global pandemic after being identified in Wuhan, China in December of 2019. Along with cardiopulmonary manifestations, gastrointestinal (GI) manifestations are among the most common. The mechanism of action of this virus in the GI tract are considered followed by current concepts of clinical manifestations of COVID-19 in the GI tract. Also covered are concepts of COVID-19 and the liver as well as the multisystem inflammatory syndrome in children (MIS-C). In children the mortality for SARS-CoV-2 infection including that for MIS-C is low although the long-term effects are not fully known yet. [ABSTRACT FROM AUTHOR]

In this cohort study of 800 children attending a pediatric emergency department at Oulu University Hospital, Finland with fever or respiratory symptoms, the cycle threshold values of point-of-care multiplex polymerase chain reaction testing for respiratory viruses were not associated with hospitalization, respiratory support, or need for intensive care. [ABSTRACT FROM AUTHOR]

Nasal continuous positive airway pressure (nCPAP) is one of the most commonly used non-invasive respiratory support modes in neonates with transient tachypnea of the newborn (TTN). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a non-invasive respiratory support mode that has been increasingly used in neonatal respiratory disorders. This prospective randomized controlled study compared the efficacy of nHFOV and nCPAP in reducing the duration of non-invasive respiratory support. Late preterm and term infants > 34 weeks' gestation were included in the study. The infants were randomly assigned to receive either nHFOV or nCPAP. Treatment was started with standard settings in both groups. Infants who met treatment failure criteria were switched to nasal intermittent mandatory ventilation for further positive-pressure support. A total of 60 infants were included in the study. Thirty of these infants were included in the nHFOV group and 30 were included in the nCPAP group. The median duration of non-invasive respiratory support was not significantly different between the two groups (21 h [IQR: 16–68] for nHFOV vs 15 h [IQR: 11–33] for nCPAP; p = 0.09). However, after adjusting for potential confounders, nHFOV was associated with a shorter duration of non-invasive respiratory support than nCPAP (adjusted mean difference: 16.3 h; 95% CI: 0.7 to 31.9; p = 0.04). nHFOV was well tolerated and did not increase the risk of complications. Conclusion: Our findings suggest that nHFOV is an effective and safe ventilation mode for late preterm and term neonates with TTN. Trial registry: Clinicaltrials.gov (NCT03006354). Date of registration: December 30, 2016. What is Known: • nHFOV is a ventilation model that has been increasingly used for the management of RDS. • TTN is one of the most common causes of neonatal respiratory distress. What is New: • nHFOV is associated with shorter duration of non-invasive respiratory support and duration of oxygen support. • nHFOV may be a safe and effective alternative to nCPAP for neonates with TTN. [ABSTRACT FROM AUTHOR]