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[PMID]: 29506574
[Au] Autor:Dalugama C; Gawarammana IB
[Ad] Address:Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. chamaradalugama@yahoo.com.
[Ti] Title:Fever with pancytopenia: unusual presentation of extrapulmonary tuberculosis: a case report.
[So] Source:J Med Case Rep;12(1):58, 2018 Mar 06.
[Is] ISSN:1752-1947
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Tuberculosis is a major health problem in the developing world. Diagnosis of extrapulmonary tuberculosis is delayed because the presentation is nonspecific. Extrapulmonary tuberculosis can present with various hematological manifestations, including pancytopenia. Pancytopenia could be due to hypersplenism, maturation arrest, hemophagocytic lymphohistiocytosis, or infiltration of the bone marrow by caseating or noncaseating granulomas causing reversible or irreversible fibrosis. CASE PRESENTATION: We report a case of a 56-year-old Sri Lankan Sinhalese man who presented with pyrexia of known origin with significant loss of weight and loss of appetite. He had mild pallor with mild hepatosplenomegaly. He had high inflammatory markers with pancytopenia in a peripheral blood smear. His chest radiograph was unremarkable, and he had a negative Mantoux test result. A diagnosis of disseminated tuberculosis was made on the basis of caseating tuberculous granulomas in the bone marrow. CONCLUSIONS: Disseminated tuberculosis remains a diagnostic challenge because the presentation is vague and nonspecific. In case of pyrexia of unknown origin with peripheral cytopenia, the possibility of disseminated tuberculosis should be considered, particularly in endemic areas. Simultaneous culture and histopathological examination of the bone marrow is important in such instances, because results of common tests such as chest radiography or Mantoux tests can be negative.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Process
[do] DOI:10.1186/s13256-018-1596-0

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[PMID]: 29506438
[Au] Autor:Hofmeister EK; Lund M; Shearn Bochsler V
[Ad] Address:1 US Geological Survey, National Wildlife Health Center, Madison, WI, USA.
[Ti] Title:West Nile Virus Infection in American Singer Canaries: An Experimental Model in a Highly Susceptible Avian Species.
[So] Source:Vet Pathol;:300985818760377, 2018 Jan 01.
[Is] ISSN:1544-2217
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:This study investigated the susceptibility of American singer canaries ( Serinus canaria) to West Nile virus (WNV) infection. Adult canaries were inoculated with 10 , 10 , and 10 plaque forming units (PFU) of WNV. All birds became infected and mortality occurred by 5 days postinoculation. The load of viral RNA as determined by RT-qPCR was dose dependent, and was higher at all doses than the level of viral RNA detected in American crows ( Corvus brachyrhynchos) challenged with 10 PFU of WNV. In a subset of birds, viremia was detected by virus isolation; canaries inoculated with 10 PFU of WNV developed viremia exceeding 10 PFU/mL serum, a log higher than American crows inoculated with 10 PFU of virus. In canaries euthanized at 3 days postinoculation, WNV was isolated at >10 PFU of virus/100 mg of lung, liver, heart, spleen, and kidney tissues. Pallor of the liver and splenomegaly were the most common macroscopic observations and histologic lesions were most severe in liver, spleen, and kidney, particularly in canaries challenged with 10 and 10 PFU. Immunoreactivity to WNV was pronounced in the liver and spleen. IgG antibodies to WNV were detected in serum by enzyme immunoassay in 11 of 21 (52%) challenged canaries and, in 4 of 5 (20%) of these sera, neutralization antibodies were detected at a titer ≥ 1:20. American singer canaries provide a useful model as this bird species is highly susceptible to WNV infection.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.1177/0300985818760377

  3 / 2867 MEDLINE  
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[PMID]: 29497504
[Au] Autor:Ogero M; Ayieko P; Makone B; Julius T; Malla L; Oliwa J; Irimu G; English M; Clinical Information Network author group
[Ad] Address:Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya.
[Ti] Title:An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?
[So] Source:J Glob Health;8(1):010409, 2018 Jun.
[Is] ISSN:2047-2986
[Cp] Country of publication:Scotland
[La] Language:eng
[Ab] Abstract:Background: Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries. Objective: To examine documentation of vital signs by clinicians for admissions to paediatric wards in Kenyan hospitals, to describe monitoring frequency by nurses and explore factors influencing frequency. Methods: Vital signs information (temperature, respiratory and pulse rate) for the first 48 hours of admission was collected from case records of children admitted with non-surgical conditions to 13 Kenyan county hospitals between September 2013 and April 2016. A mixed effect negative binomial regression model was used to explore whether the severity of illness (indicated by danger signs or severe diagnostic episodes) is associated with increased vital signs observation frequency. Results: We examined 54 800 admission episodes with an overall mortality 6.1%. Nurse to bed ratios were very low (1:10 to 1:41 across hospitals). Admitting clinicians documented all or no vital signs in 57.0% and 8.4% cases respectively. For respiratory and pulse rates there was pronounced even end-digit preference (an indicator of incorrect information) and high frequency recording of specific values ( < 0.001) suggesting approximation. Monitoring frequency was explored in 41 738 children. Those with inpatient stays ≥48 hours were expected to have a vital signs count of 18, hospitals varied but most did not achieve this benchmark (median 9, range 2-30). There were clinically small but significant associations between vital signs count and presence of multiple severe illnesses or presence of severe pallor (adjusted relative risk ratio = 1.04, < 0.01, 95% confidence interval CI = 1.02-1.06 and 1.05, = 0.02, 95% CI = 1.01-1.09, respectively). Conclusions: Data suggest accurate admission measures are sometimes missing especially for pulse and respiratory rates, possibly linked to manual measurement. Monitoring frequency is often low in the high risk population studied probably indicating how quality of nursing care is undermined by considerable human resource shortages.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180304
[Lr] Last revision date:180304
[St] Status:In-Process
[do] DOI:10.7189/jogh.08.010409

  4 / 2867 MEDLINE  
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[PMID]: 29498601
[Au] Autor:Bussat A; Proisy M; Bruneau B; Bouzillé G; Chappé C; Riffaud L
[Ad] Address:Departments of 1 Ophthalmology.
[Ti] Title:Edema of the optic tract in patients with tumors of the sellar region: clinical and visual implications in the pediatric population.
[So] Source:J Neurosurg Pediatr;:1-7, 2018 Mar 02.
[Is] ISSN:1933-0715
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE Tumor-related edema of the optic tract (EOT) corresponds to a preferential posterior distribution of peritumoral edema along the white matter tract of the visual system. To date, the consequences of EOT have never been evaluated specifically in the pediatric population. In this study, the authors attempted to identify clinical and radiological features associated with the development of EOT and the specific influence of this edema on visual function. METHODS A retrospective review was performed of data collected from patients younger than 18 years who underwent surgery for a tumor in the sellar region at the authors' institution between January 2005 and January 2016. Data were collected on patient characteristics, ophthalmological evaluations, and neuroimaging findings. To evaluate and compare visual function impairment, ophthalmological data were converted to a global visual function score, which took into account visual acuity, visual field evaluations, and laterality deficiencies. The visual acuity score was defined according to the International Classification of Diseases, 10th Revision. Visual field deficiencies were converted to a score of 0-2. Two opposing groups were then distinguished according to the presence or absence of EOT. Visual acuity, visual field results, and global scores were compared between groups before and after treatment. RESULTS Twenty-six patients were included in the study: 17 patients with craniopharyngioma, 3 patients with pilocytic astrocytoma, 2 patients with ganglioglioma, 2 patients with germ cell tumor, 1 patient with macroprolactinoma, and 1 patient with Rathke's cleft cyst. There were 11 children in the group with edema and 15 children in the group without edema. None of the following criteria were statistically different between the 2 groups: age, sex, clinical symptoms at presentation (endocrine deficiency or intracranial hypertension signs), incidence of hydrocephalus, compression of the optic tracts and mass effect on the optic chiasm, tumor size and localization, presence of intratumoral cysts, treatment, type of tumor, or recurrence. The median global visual function and visual acuity scores were not significantly different between the groups either at presentation or at final evaluation. The visual field score was lower (i.e., more deficiency) in the group with edema than in the group without edema (p < 0.05); 89% of the patients with edema had severe or mild visual field impairment versus only 40% of the patients without edema. At the final examination after treatment, the visual field scores were not different between the 2 groups. Although not significant, the number of patients with optic disc pallor was greater in the group without edema both at diagnosis and at final examination. CONCLUSIONS This study confirms that EOT in the context of sellar region tumor in children is not necessarily associated with a less-favorable visual prognosis.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180302
[Lr] Last revision date:180302
[St] Status:Publisher
[do] DOI:10.3171/2017.11.PEDS17526

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[PMID]: 29303456
[Au] Autor:Renne B; Rueckriegel S; Ramachandran S; Radic J; Steinbok P; Singhal A
[Ad] Address:Faculty of Medicine and the Division of Neurosurgery, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada; and.
[Ti] Title:Bobble-head doll syndrome: report of 2 cases and a review of the literature, with video documentation of the clinical phenomenon.
[So] Source:J Neurosurg Pediatr;21(3):236-246, 2018 Mar.
[Is] ISSN:1933-0715
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Bobble-head doll syndrome (BHDS) is a rare pediatric movement disorder presenting with involuntary 2- to 3-Hz head movements. Common signs and symptoms also found on presentation include macrocephaly, ataxia, developmental delay, optic disc pallor or atrophy, hyperreflexia, tremor, obesity, endocrinopathy, visual disturbance or impairment, headache, and vomiting, among others. The syndrome is associated with suprasellar cysts, third ventricular cysts, or aqueductal obstruction, along with a few other less common conditions. The cause of involuntary head motions is not understood. Treatment is surgical. The authors present 2 cases of BHDS. The first is a 14-year-old boy with BHDS associated with aqueductal obstruction and triventricular hydrocephalus secondary to a tectal tumor. He was successfully treated by endoscopic third ventriculostomy, and all symptoms resolved immediately in the recovery room. This case is unusual in its late age of symptom onset, the primacy of lateral ("no-no") involuntary head rotations, and the associated tectal tumor. The second case is a 7.5-year-old girl with BHDS associated with a suprasellar cyst. She was successfully treated with an endoscopic fenestration but preexisting endocrinopathy persisted, and the patient was diagnosed with autism spectrum disorder at age 12 years. This second case is more typical of BHDS. A comprehensive and up-to-date review of the literature of BHDS and video documentation of the phenomenon are presented.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180301
[Lr] Last revision date:180301
[St] Status:In-Data-Review
[do] DOI:10.3171/2017.9.PEDS16704

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[PMID]: 29241618
[Au] Autor:Agweyu A; Lilford RJ; English M; Clinical Information Network Author Group
[Ad] Address:Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Nuffield Department of Medicine, University of Oxford, Oxford, UK. Electronic address: aagweyu@kemri-wellcome.org.
[Ti] Title:Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study.
[So] Source:Lancet Glob Health;6(1):e74-e83, 2018 Jan.
[Is] ISSN:2214-109X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. METHODS: We did a retrospective cohort study of children aged 2-59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). FINDINGS: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1-6·8), mild to moderate pallor (3·4, 3·0-3·8), and weight-for-age Z score (WAZ) less than -3 SD (3·8, 3·4-4·3). Additional factors that were independently associated with death were: WAZ less than -2 to -3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. INTERPRETATION: In settings of high mortality, WAZ less than -3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. FUNDING: Wellcome Trust.
[Mh] MeSH terms primary: Pneumonia/classification
Pneumonia/therapy
Practice Guidelines as Topic
Severity of Illness Index
[Mh] MeSH terms secundary: Ambulatory Care
Child, Preschool
Female
Hospitalization
Humans
Infant
Kenya/epidemiology
Male
Pneumonia/mortality
Retrospective Studies
Risk Assessment/methods
Treatment Outcome
World Health Organization
[Pt] Publication type:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Entry month:1802
[Cu] Class update date: 180221
[Lr] Last revision date:180221
[Js] Journal subset:IM
[Da] Date of entry for processing:171216
[St] Status:MEDLINE

  7 / 2867 MEDLINE  
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[PMID]: 29433507
[Au] Autor:Elizalde-Torrent A; Val F; Azevedo ICC; Monteiro WM; Ferreira LCL; Fernández-Becerra C; Del Portillo HA; Lacerda MVG
[Ad] Address:ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
[Ti] Title:Sudden spleen rupture in a Plasmodium vivax-infected patient undergoing malaria treatment.
[So] Source:Malar J;17(1):79, 2018 Feb 13.
[Is] ISSN:1475-2875
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Splenomegaly is one of the most common features of malaria. However, spontaneous splenic rupture, although unusual, represents a severe complication often leading to death. It is mostly seen in acute infection and primary attack, and it is most commonly associated with Plasmodium vivax. Here, a case of spontaneous splenic rupture diagnosed with a portable ultrasound apparatus shortly after starting treatment and with recurrent parasitaemia after splenectomy, is reported. CASE DESCRIPTION: In November 2015, a 45-year-old Brazilian man presented to the hospital in Manaus with fever, headache and myalgia. He was diagnosed with P. vivax malaria and, after a normal G6PD test, he started treatment with chloroquine and primaquine and was discharged. Two days later, he went back to the hospital with abdominal pain, dyspnea, dry cough, pallor, oliguria and fever. Using a portable ultrasound, he was diagnosed of rupture of the spleen, which was removed by emergency surgery. After this episode, he suffered two more malaria episodes with high parasitaemia at approximately 2-month intervals. DNA from different portions of the spleen was extracted and a qualitative PCR was performed to detect P. vivax. CONCLUSIONS: The splenic rupture suffered by this patient occurred 2 days after starting the treatment. Having a portable ultrasound apparatus may have saved the patient's life, as it revealed a haemorrhage needing an urgent surgery. Parasites were detected by PCR in the extracted spleen. This patient suffered two more vivax malaria diagnosed episodes in spite of receiving and completing treatment with chloroquine and primaquine for each clinical attack. Splenic rupture during acute malaria is uncommon, but it is likely underdiagnosed and underreported, because the lack of means and equipment hinders diagnostic confirmation, especially in endemic areas.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180218
[Lr] Last revision date:180218
[St] Status:In-Data-Review
[do] DOI:10.1186/s12936-018-2228-2

  8 / 2867 MEDLINE  
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[PMID]: 29402235
[Au] Autor:Turnbull S; Lucas PJ; Redmond NM; Christensen H; Thornton H; Cabral C; Blair PS; Delaney BC; Thompson M; Little P; Peters TJ; Hay AD
[Ad] Address:Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. Sophie.turnbull@bristol.ac.uk.
[Ti] Title:What gives rise to clinician gut feeling, its influence on management decisions and its prognostic value for children with RTI in primary care: a prospective cohort study.
[So] Source:BMC Fam Pract;19(1):25, 2018 Feb 05.
[Is] ISSN:1471-2296
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The objectives were to identify 1) the clinician and child characteristics associated with; 2) clinical management decisions following from, and; 3) the prognostic value of; a clinician's 'gut feeling something is wrong' for children presenting to primary care with acute cough and respiratory tract infection (RTI). METHODS: Multicentre prospective cohort study where 518 primary care clinicians across 244 general practices in England assessed 8394 children aged ≥3 months and < 16 years for acute cough and RTI. The main outcome measures were: Self-reported clinician 'gut feeling'; clinician management decisions (antibiotic prescribing, referral for acute admission); and child's prognosis (reconsultation with evidence of illness deterioration, hospital admission in the 30 days following recruitment). RESULTS: Clinician years since qualification, parent reported symptoms (illness severity score ≥ 7/10, severe fever < 24 h, low energy, shortness of breath) and clinical examination findings (crackles/ crepitations on chest auscultation, recession, pallor, bronchial breathing, wheeze, temperature ≥ 37.8 °C, tachypnoea and inflamed pharynx) independently contributed towards a clinician 'gut feeling that something was wrong'. 'Gut feeling' was independently associated with increased antibiotic prescribing and referral for secondary care assessment. After adjustment for other associated factors, gut feeling was not associated with reconsultations or hospital admissions. CONCLUSIONS: Clinicians were more likely to report a gut feeling something is wrong, when they were more experienced or when children were more unwell. Gut feeling is independently and strongly associated with antibiotic prescribing and referral to secondary care, but not with two indicators of poor child health.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180214
[Lr] Last revision date:180214
[St] Status:In-Data-Review
[do] DOI:10.1186/s12875-018-0716-7

  9 / 2867 MEDLINE  
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[PMID]: 29437133
[Au] Autor:Riney LC; Treasure JD; Varnell CD; Depinet H
[Ad] Address:Division of Emergency Medicine and.
[Ti] Title:Case 6: An Infant Presenting with Hematuria and Pallor.
[So] Source:Pediatr Rev;39(2):98-99, 2018 Feb.
[Is] ISSN:1526-3347
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180213
[Lr] Last revision date:180213
[St] Status:In-Data-Review
[do] DOI:10.1542/pir.2016-0112

  10 / 2867 MEDLINE  
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[PMID]: 29436798
[Au] Autor:Heidari A; Dabiri S; Sabzi F
[Ad] Address:Department of Anesthesiology, Kermanshah University of Sciences, Imam Ali Hospital, Kermanshah, Iran.
[Ti] Title:A Road to the Heart From Uterine Closet: A Case Report.
[So] Source:Acta Med Iran;56(1):67-70, 2018 Jan.
[Is] ISSN:1735-9694
[Cp] Country of publication:Iran
[La] Language:eng
[Ab] Abstract:Angiosarcomas of the uterine is a malignant and poor prognostic tumor and can either be a primary sarcoma or arising secondary to radiotherapy of a more complex tumor. Primary uterine angiosarcomas are exceptional and probably arise from embryonic vascular remnants, teratoma or from the rich uterine vasculature. We reported a rare case of primary angiosarcoma of uterine that at the time of diagnosis presented with sign and symptom of local and distant metastasis. The patient presented with dyspnea, chest pain, and history of vaginal bleeding and pelvic pain. The physical exam revealed pallor, prominent jugular pulse pressure, a palpable fixed mass in the pelvic however vaginal exam was unremarkable. Transthoracic echocardiography (TTE) revealed massive pericardial effusion and also a large mass in the right atrium. The abdominal ultrasound showed echogenic and poor echogenic segments in uterine mass combined with central necrosis. The patient underwent total hysterectomy and Bilateral salpingo-oophorectomy followed by radiotherapy and adjuvant chemotherapy. The patient underwent open heart surgery with resection of cardiac mass and further received a four cycle of radiotherapy (50 MG) to the mediastinum. The further follow-up (6 month) revealed no recurrence of tumor in a mediastinum. However, patient died from metastasis to the liver and its hepatic failure sequels.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180213
[Lr] Last revision date:180213
[St] Status:In-Process


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