Journal of tropical pediatrics
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Comparative Study
The Comparison of PRISM and PIM scoring systems for mortality risk in infantile intensive care.
Scoring systems that predict the risk of mortality for children in an intensive care unit (ICU) are needed for the evaluation of the effectiveness of pediatric intensive care. The Pediatric Risk of Mortality (PRISM) and the Pediatric Index of Mortality (PIM) scores have been developed to predict mortality among children in the ICU. The purpose of this study was to evaluate whether these systems are effective and population-independent. ⋯ Although ROC analysis showed a poor discriminatory function of both scores, a marginally acceptable performance for PIM was observed. The ROC curve also showed an acceptable performance for PIM, for patients with pre-existent chronic disorder. Although care must be taken not to overstate the importance of our results, we believe that when revised according to the characteristics of the population, PIM may perform well in predicting the mortality risk for infants in the ICU, especially in countries where the mortality rate is relatively high and pre-existent chronic disorders are more common.
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Comparative Study
Evaluation of early detection and management of disseminated intravascular coagulation among Alexandria University pediatric intensive care patients.
This prospective study over 24 months aimed to evaluate the outcome of early management of disseminated intravascular coagulation (DIC) among high-risk patients (n = 50) admitted to a pediatric intensive care unit (PICU). It also included all cases presenting with overt DIC (OD) concomitantly (n = 30). The high-risk group (pre-DIC) was subdivided, according to their D-dimer assay, into negative (n = 14) and positive (n = 36) D-dimer groups. ⋯ Among the positive D-dimer group the lowest mortality was encountered in the subgroup treated with plasma, heparin and tranexamic acid (33 per cent) while those treated with non-specific therapy, plasma only, or plasma and heparin showed higher mortality (100 per cent, 80 per cent, and 100 per cent, respectively). The deceased subgroup, among positive D-dimer cases showed a significantly higher number of patients presenting with multiple organ failure on admission compared with the discharged group. In summary, early diagnosis and proper management of pre-DIC, before overt bleeding, in high-risk patients admitted to a PICU using combined D-dimer and FDP assays had a positive impact on their prognosis.
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Comparative Study
Bacterial isolates in the sick young infant in Ile-Ife, Nigeria.
This prospective study was carried out to determine the bacterial pathogens and their antibiotic sensitivity profile in the sick young infant. All consecutive young infants with features suggestive of infection seen over 5 months at a Comprehensive Health Centre in Ile-Ife, were screened for septicaemia and local bacterial infections. Of the 121 sick young infants screened for infection, 94 (77.7 per cent) had confirmed bacterial infection and 54 (57.4 per cent) of the 94 had confirmed septicaemia. ⋯ The study highlights the high prevalence of bacterial infections (localized or systemic) among young infants. It also shows that Gram-positive organisms, the principal aetiologic agents, were sensitive to commonly used antibiotics. It is recommended that genticin and cloxacillin or erythromycin should be used as the first-line antibiotics in the treatment of young infants with bacterial infections in Ile-Ife, Nigeria.
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The cerebral hydatid cysts caused by Echinococcus granulosus are rare and occur mostly during childhood in endemic areas. A 2-year-old boy was admitted with focal neurological signs in the left extremities. ⋯ The cerebral hydatid cyst was surgically extracted without complications. We suggest that a differential diagnosis of hydatid cyst should be considered when a brain mass is found in a patient, even 2 years old, from an endemic area of echinococcosis.
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Case Reports
An uncommon presentation: chronic meningococcaemia associated with cholestatic hepatitis in a Turkish child.
Chronic meningococcaemia is a very rare clinical manifestation of invasive infection by Neisseria meningitidis. A 9-year-old girl was admitted to our clinic with complaints of fever, headache, arthralgia, and maculopapular rash. The diagnosis was made by the growth of Neisseria meningitidis in the blood cultures. ⋯ Thereafter, the patient was successfully treated and symptoms were completely resolved. To our knowledge, there have been no previous reports of Neisseria meningitidis causing cholestatic hepatitis. Herein, we present an unusual child patient with chronic meningococcaemia associated with cholestatic hepatitis.