Kochomar7492

Kawasaki disease (KD) is an autoimmune disease that generally affects children under the age of five years. It has a variety of clinical manifestations which may be either specific or nonspecific. Intravenous immunoglobulin and aspirin are the mainstays of treatment. There are unusual circumstances where patients are resistant to conventional treatment. Selleck MRTX849 We report a one-year-old girl who presented with a 12-day history of fever in association with erythema at the site of Bacille Calmette-Guérin (BCG) scar. She did not respond successfully to conventional treatment although she was diagnosed to have Kawasaki disease. Eventually, she responded to intravenous methylprednisolone and was diagnosed as having refractory Kawasaki disease.Objectives The main aim is to find out the clinical feature and outcome of status epilepticus (SE) in children managed in a teaching hospital. The secondary aim is to identify the risk factors influencing the adverse outcomes. Methods In this prospective cohort, children aged 1 month to 14 years with SE as per the International League Against Epilepsy's new guideline (2016) who presented to the emergency department during the period of November 2017 to October 2019 were enrolled. Clinical profile, treatment, and outcome of cases (n = 94) were noted. Results The majority of children, 60 (63.82%), were less than five years of age. Prior history of seizures was present in 33 (35.1%) cases, whereas 61 (64.9%) cases presented with SE as the first episode of seizure. In 14 (42.4%) previous seizure cases, SE was due to drug default. No response to first-line antiepileptic drug (AED) was seen in 84 (89.37%) cases. Acute symptomatic etiology was the commonest etiology of SE in 64 (68%) cases, of which neuro-infections accounted for 44 (46.80%) cases. Longer duration (>60 minutes) of status (p less then 0.01), ventilator support (p less then 0.0001), and circulatory impairment (p less then 0.0001) were attributable risk factors for mortality. A total of 28 children died (mortality rate, 29.8%), and 11 showed the persistence of their neuro-deficit. Conclusions Neuro-infection is the most common etiology of SE in children. Longer duration of SE, more lag time for receiving the first AED, respiratory failure, and presence of shock are independent predictors for poor outcome. Hence, cessation of convulsion at the earliest leads to improved outcomes.Solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) have been combined into a single designation in the most recent World Health Organization (WHO) guidelines as solitary fibrous tumor/hemangiopericytoma (SFT/HPC). These rare intracranial tumors can present as WHO grade I, II, or III tumors, with the risk of recurrence, metastasis, and mortality worsening with higher-grade tumors. We present a case of a patient with a WHO grade III SFT/HPC with an emphasis on the imaging features that help differentiate this type of tumor from meningiomas, which are much more common and can appear similar. Being able to help differentiate these tumors by their imaging appearance is important to help triage and risk-stratify patient management decisions.We report the case of a 31-year-old male patient with underlying psychiatric illness and substance abuse who presented to the emergency department with a chief complaint of abdominal pain. CT scan of the abdomen revealed a large retroperitoneal mass wrapping around the aorta and obstructing the left ureter causing hydronephrosis. Physical examination found a painless left testicular mass. The ultrasound revealed a left scrotal mass measuring 32 x 24 x 16 mm with evidence of increased vascularity and calcifications. The patient underwent ureteral stent placement and left testicular orchiectomy with the pathology evaluation revealing seminoma. Although follow-up care plans were made, the patient relapsed IV heroin abuse causing failure to attend oncological treatment appointments. Two months later upon readmission, a repeat of the CT scan of the abdomen and pelvis showed a persistent large left retroperitoneal mass with an increase in size and significant mass effect. The patient would be ultimately considered for hospice if lack of compliance were to continue for his chemotherapy, along with his comorbid underlying substance abuse and psychiatric illness. This case highlights the effect of mental illness on medical care and treatment, demonstrating how a treatable malignancy may result in greater morbidity and mortality in psychiatric populations.Background Neonatal sepsis is one of the most common causes of neonatal mortality and morbidity, particularly in developing countries. Its causative bacteria and their respective sensitivity patterns are different in each hospital and region. The objective of this study was to determine the causative bacteria and their antibiotics sensitivity patterns at the neonatal unit. Methods This prospective study was carried out at the Neonatology Unit of Kharadar General Hospital (KGH) from January 2017 to Jun 2019. A total of 162 neonates with suspected sepsis and positive blood cultures were included in the study. Blood culture was done by standard microbiological techniques (BACTEC Method). Continuous data were presented as mean and standard deviation, while categorical data were presented in frequency and percentages. Result Out of a total of 162 neonates with blood culture positive neonatal sepsis, males were 106 (65.4%). Gram-positive and Gram-negative bacteria were found with a frequency of 83 (51.5%) and 79 (48.5%), respectively. Staphylococcus aureus and Pseudomonas were the commonest isolates in 50.5% and 25.7% of cases, respectively. The Gram-positive organism was mostly sensitive to amikacin and vancomycin whereas the Gram-negative was mostly sensitive to amikacin, imipenem, meropenem, and ciprofloxacin. Conclusion Staphylococcus aureus was the most common bacteria isolated. For the sepsis, the causative bacteria and antibiotics sensitivity pattern changes over a period of time. Continued surveillance is required to help reduce morbidity and mortality through developing institution-based guidelines.