Childhood encephalopathy comprises a wide range of etiologies with distinctive distribution in different age groups. We reviewed the pattern of encephalopathy admitted to the pediatric intensive care ...unit (PICU) of a tertiary children's hospital.
We reviewed the medical records and reported the etiologies, clinical features, and outcomes of children with encephalopathy.
Twenty-four admissions to the PICU between April 2019 and May 2020 were reviewed. The median (interquartile range) age was 10.0 (14.7) years and 62.5% were boys. Confusion (66.7%) was the most common presentation. Adverse effects related to medications (33.3%) and metabolic disease (20.8%) were predominant causes of encephalopathies in our study cohort. Methotrexate was responsible for most of the medication-associated encephalopathy (37.5%), whereas Leigh syndrome, pyruvate dehydrogenase deficiency and Wernicke's encephalopathy accounted for those with metabolic disease. The median Glasgow Coma Scale (GCS) on admission was 12.5 (9.0). Antimicrobials (95.8%) and antiepileptic drugs (60.9%) were the most frequently given treatment. Children aged 2 years or younger were all boys (P = 0.022) and had a higher proportion of primary metabolic disease (P = 0.04). Intoxication or drug reaction only occurred in older children. The mortality was 8.3%, and over half of the survivors had residual neurological disability upon PICU discharge. Primary metabolic disease (P = 0.002), mechanical ventilation (P = 0.019), failure to regain GCS back to baseline level (P = 0.009), and abnormal cognitive function on admission (P = 0.03) were associated with cerebral function impairment on PICU discharge.
Primary metabolic encephalopathy was prevalent in younger children, whereas drug-induced toxic encephalopathy was common among older oncology patients. Survivors have significant neurologic morbidity. Failure to regain baseline GCS was a poor prognostic factor for neurological outcomes.
Background
Approximately 15–20% of patients with osteosarcoma present with detectable metastatic disease and the majority of whom (85%) have pulmonary lesions as the sole site of metastasis. Previous ...studies have shown that the overall survival rate among patients with localized osteosarcoma without metastatic disease is approximately 60–70% whereas survival rate reduces to 10–30% in patients with metastatic disease.
Objective
To determine the incidence and characteristic features of pulmonary metastases in a group of osteosarcoma patients and correlate the findings with the prognostic outcome/survival.
Materials and methods
Seventy-seven cases of histologically confirmed osteosarcoma were reviewed (47 male, 30 female, mean age 10.9). The site and size of the primary tumour and degrees of chemonecrosis were recorded. Lung metastases were analyzed according to their size, number, distribution and interval from diagnosis. The Kaplan-Meier method was used to analyze the survival probability curve. Significant differences (
P
< 0.05) were evaluated with the log-rank test for univariate analyses.
Results
Seventeen patients had synchronous and 11 had metachronous lung metastases. Sixteen (57%) underwent pulmonary metastasectomy. Nine of sixteen (56%) patients with metastasectomy and 10/12 (83%) patients without metastasectomy died. Poor chemonecrosis was associated with a worse outcome. Number, distribution and timing of lung metastases, but not the size of lung metastases, were of prognostic value for survival.
Conclusion
Radiological detection of lung metastases is clinically important as it indicates a worse prognosis.
COVID-19 pandemic after Omicron Christopher KC Lai; Lam, Wilson; Tsang, KY ...
Hong Kong medical journal = Xianggang yi xue za zhi,
06/2022, Letnik:
28, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Together with a community-wide intersectoral effort to boost vaccination uptake, the COVID-naïve population in Hong Kong will decline rapidly, and so will the transmission efficiency of severe acute ...respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its emergence in late 2019, SARS-CoV-2 has mutated at an astounding rate. In 2021, the Journal published a serological response to mRNA and inactivated vaccines in healthcare workers in Hong Kong,10 and reported cases of myocarditis and pericarditis after mRNA vaccines.11 New vaccines in novel platforms or targeting new COVID-19 variants will continue to be developed, and research directed at monitoring the efficacy and adverse effects of these vaccines will remain important to guide vaccination strategies. In the earliest months of pandemic, the Journal published radiological findings of critically ill patients diagnosed with COVID-19,13 and a case series on contrasting evidence for corticosteroid treatment for COVID-19-induced cytokine storm in children.14We anticipate publications on clinical management will remain invaluable to the medical community, perhaps with a shift in focus to greater emphasis on integrative treatment strategies,15 microbiome-based therapies, and prophylactic antiviral agents and monoclonal antibody therapies targeting vulnerable populations such as the paediatric population16 17and immunocompromised hosts. Research focusing on infectious disease epidemiology, public health policies, laboratory diagnostics, vaccine development, and drug discovery will remain in high demand.
A 22 month old child with thalassaemia major received unrelated umbilical cord blood transplantation. She was born to mother of HBsAg carrier and received hepatitis B immunoglobulin at birth and ...hepatitis B vaccination. She was HBsAg negative and anti‐HBs positive before transplantation. After transplant, she was taken care by her mother and found to be HBsAg positive at 2 year post‐transplant. Genotyping of the mother's and child's HBV status confirmed to be of same genotype and demonstrated horizontal transmission in post‐transplant setting. Passive immunization of HBV may be considered in early post‐transplant phase to prevent horizontal transmission of HBV, and antiviral treatment of the carer should be offered to prevent transmission of infection to immunocompromised child.
Background
Septicemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG‐ALL‐2015 ...study was conducted in China and factors associated with septicemia and mortality were studied.
Methods
Patients participated in CCCG‐ALL‐2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected.
Results
A total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%‐13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71‐2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram‐positive bacteria accounted for 54.1%, gram‐negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug‐resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%‐4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram‐negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09‐0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%.
Conclusion
Overall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia‐related mortality rate was low. There was marked variation in the incidence of septicemia among the centers.
The incidence and pattern of septicemia in this multicenter study in China was similar to reports of western countries. The septicemia related mortality rate was low. There was marked variation in the incidence of septicemia among the centers.
In clinical settings, physicians tend to use corticosteroids only for treating critically ill patients. ...selection bias and confounders in observational studies might contribute to any observed ...increased mortality in patient groups treated with corticosteroids. Adapted from cases reported by Russell et al1 with counter comments Similar to respiratory viral diseases such as the seasonal influenza, two categories of people seem susceptible to die from COVID-19: older adults, especially those with chronic disease or other co-morbidities, and seemingly healthy adults with exacerbated autoinflammatory syndrome termed the cytokine storm syndromes.3 4 5 On the contrary, children and infants seem to survive epidemics of coronavirus infections with very mild disease.6 We acknowledge the potential risks associated with high-dose corticosteroids in treating COVID-19 pneumonia, and agree that corticosteroid usage should be avoided if there are other efficacious anti-inflammatory immunomodulating medications against the cytokine storm, such as intravenous immunoglobulin, interleukin-1 inhibitors, interleukin-6 inhibitors, and Janus kinase inhibitors.4However, on the basis of recommendations by frontline Chinese physicians and local clinical experience during the severe acute respiratory syndrome epidemic, a short course of corticosteroids at low-to-moderate dose is probably justifiable for critically ill patients with hyperinflammation.7 8Chinese researchers are running a prospective randomised controlled trial to review the efficacy and safety of corticosteroids.9 Until further evidence becomes available, whether to use corticosteroids or not remains controversial. Karen KY Leung 1; KL Hon 1; SY Qian 2; Frankie WT Cheng 1 1 Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Hong Kong 2 Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, China
The progression to disseminated intravascular coagulation (DIC) in infected very low birth weight (VLBW; <1500 g) infants is difficult to predict with precision at the onset of sepsis. We ...investigated the immunologic profiles of preterm infants with sepsis, using chemokine and cytokine measurements to predict the development of sepsis-induced DIC at the onset of infection.
We measured a panel of chemokines and cytokines at 0 and 24 h after clinical presentation in VLBW infants with suspected infection requiring full sepsis screening. The chemokines measured were interleukin (IL)-8, interferon-gamma-inducible protein-10 (IP-10), monokine induced by interferon-gamma, monocyte chemoattractant protein-1, and regulated upon activation normal T-cell expressed and secreted (RANTES), and the cytokines were IL-6, IL-10, and tumor necrosis factor-alpha.
Of 195 episodes of suspected clinical sepsis investigated, 62 were culture-confirmed septicemia or necrotizing enterocolitis (28 of these infants developed DIC), 22 were culture-negative clinical infections, and 111 involved noninfected episodes. All studied inflammatory mediators except RANTES showed significantly greater up-regulation in culture-positive infected infants than in noninfected infants at 0 and 24 h, whereas RANTES showed significant down-regulation. The model that used plasma IL-10 (>208 ng/L), IL-6 (>168 ng/L), and RANTES (<3110 ng/L) at 0 h had sensitivity, specificity, and positive and negative predictive values of 100%, 97%, 85%, and 100%, respectively, for identifying infected patients who subsequently developed DIC.
IL-10, IL-6, and RANTES measured at clinical presentation sensitively and accurately predicted the development of DIC in severely infected infants. This information could be vital for early and effective treatment of neonatal sepsis.
Severe acute respiratory syndrome (SARS) is a newly discovered infectious disease caused by a novel coronavirus. During the community outbreak in Hong Kong, 5 liveborn infants were born to pregnant ...women with SARS. A systematic search for perinatal transmission of the SARS-associated coronavirus, including serial reverse transcriptase-polymerase chain reaction assays, viral cultures, and paired serologic titers, failed to detect the virus in any of the infants. In addition, none of the infants developed clinical, radiologic, hematologic, or biochemical evidence suggestive of SARS. One preterm infant developed jejunal perforation and another developed necrotizing enterocolitis with ileal perforation shortly after birth. This case series is the first report to describe the clinical course of the first cohort of liveborn infants born to pregnant women with SARS.
Paediatric brain tumours commonly arise in the posterior cranial fossa. Early diagnosis is often challenging due to initial non-specific clinical symptoms, especially in very young children. The ...typical MR features of tumours in this region including medulloblastoma, ependymoma, juvenile pilocytic subtype of cerebellar astrocytoma, brain stem glioma and atypical teratoid-rhabdoid tumour are illustrated. Diffusion-weighted imaging and apparent diffusion coefficient values combined with signal characteristics on conventional MR sequences can usually differentiate low-grade from high-grade tumours. Prompt diagnosis is crucial as total surgical resection, which is only possible in localised disease, improves prognosis. A practical MR flow chart is introduced for differentiating different types of posterior cranial fossa tumours, which might be useful in clinical practice.
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