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Pediatrics in Review Oct 2021Hypertrophic pyloric stenosis is a common condition seen in the first 1 to 3 months after birth. Patients typically present with nonbilious projectile emesis after feeds...
Hypertrophic pyloric stenosis is a common condition seen in the first 1 to 3 months after birth. Patients typically present with nonbilious projectile emesis after feeds that may result in hypokalemic, hypochloremic metabolic alkalosis. Although inability to tolerate feeds is frequently seen with self-limited conditions such as reflux, a low threshold to obtain an ultrasonographic image is important to prevent a delay in diagnosis. Although operative intervention is the treatment, it is imperative that patients are hydrated and serum electrolyte concentrations normalized before the induction of anesthesia. Laparoscopic pyloromyotomy is safe and effective. Postoperative emesis is normal, and reassurance to parents is appropriate. There is no significant long-term physiologic impairment from pyloric stenosis after successful surgical intervention.
Topics: Alkalosis; Humans; Infant; Pyloric Stenosis, Hypertrophic; Vomiting
PubMed: 34599053
DOI: 10.1542/pir.2020-003277 -
Infectious Disorders Drug Targets 2023Idiopathic CD4+ Lymphocytopenia (ICL) is a rare entity grouped in non- HIV-related syndromes. ICL is characterized by a marked low CD4 T cell count of <300 cells/mm3...
INTRODUCTION
Idiopathic CD4+ Lymphocytopenia (ICL) is a rare entity grouped in non- HIV-related syndromes. ICL is characterized by a marked low CD4 T cell count of <300 cells/mm3 with ambiguous natural history and prognosis. In addition, cryptococcal and nontuberculous mycobacterial infections are reported as known opportunistic infections. Therefore, management turns around vigilant follow-up and treatment of the current clinical scenario of these patients.
CASE PRESENTATION
Here, a 55-year-old lady was referred with a history of diffuse headache and intermittent fever for two months, projectile vomiting, and altered mental status for five days. Nonpruritic maculopapular rashes and diffuse desquamation of the skin were noted. She had no significant previous medical history. Based on clinical findings and investigations, she was diagnosed with ICL having disseminated cryptococcosis. Unfortunately, the patient did not undergo specific treatment as she was recognized late, and unfortunately, she died.
CONCLUSION
It is of paramount importance to recognize the clinical entity as early as possible to start appropriate treatment, which may positively impact the outcome. Therefore, the clinician must be aware of disseminated cryptococcosis associated with non-HIV states.
Topics: Female; Humans; Middle Aged; T-Lymphocytopenia, Idiopathic CD4-Positive; Cryptococcosis; Lymphopenia; CD4-Positive T-Lymphocytes; CD4 Lymphocyte Count
PubMed: 35726810
DOI: 10.2174/1871526522666220621110723 -
The Journal of Hospital Infection Jul 2019Vomiting is one way in which the body rids itself of harmful gastric contents rapidly. Whilst this process is generally beneficial for the emetic individual, it can pose...
BACKGROUND
Vomiting is one way in which the body rids itself of harmful gastric contents rapidly. Whilst this process is generally beneficial for the emetic individual, it can pose significant infection control issues if they are infected with a highly communicable pathogen such as norovirus. It is not known how far norovirus could spread through vomiting while remaining viable, particularly in far-reaching droplets and splashes that might be missed during cleaning.
AIM
To identify the potential level of dissemination of viable norovirus after simulated vomiting.
METHODS
This study used a system called 'Vomiting Larry' to simulate vomiting with infection medium containing the norovirus surrogate feline calicivirus (FCV) as a worst-case scenario for distribution and survival of viruses after simulated vomiting. Air and floor samples were taken after simulated vomiting, and analysed for viable virus via plaque assay. Analysis of covariance investigated differences in FCV concentration by sample volume and location.
FINDINGS
Whilst viable virus was not isolated from any air samples taken after simulated vomiting, FCV concentrations of ≥10 plaque-forming units/mL were recovered from almost all samples taken from the floor (88/90). These included small droplets of fluid that travelled 3 m away from the vomiting system. There was evidence that FCV concentration depended on both sample volume and location.
CONCLUSION
This study suggests that norovirus can survive being ejected even within small far-reaching droplets at concentrations capable of eliciting infection. Such droplets could easily go unnoticed and be overlooked during cleaning, adding to the challenge of controlling norovirus outbreaks.
Topics: Caliciviridae Infections; Calicivirus, Feline; Disease Transmission, Infectious; Environmental Microbiology; Microbial Viability; Models, Theoretical; Vesivirus; Viral Plaque Assay; Vomiting
PubMed: 30797885
DOI: 10.1016/j.jhin.2019.02.010 -
Allergology International : Official... Apr 2024Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy presenting with delayed onset of projectile vomiting in the absence of cutaneous... (Review)
Review
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy presenting with delayed onset of projectile vomiting in the absence of cutaneous and respiratory symptoms. The pathophysiology of FPIES remains poorly characterized. The first international consensus guidelines for FPIES were published in 2017 and provided clinicians with parameters on the diagnosis and treatment of FPIES. The guidelines have served as a resource in the recognition and management of FPIES, contributing to an increased awareness of FPIES. Since then, new evidence has emerged, shedding light on adult-onset FPIES, the different phenotypes of FPIES, the recognition of new food triggers, center-specific food challenge protocols and management of acute FPIES. Emerging evidence indicates that FPIES impacts both pediatric and adult population. As a result, there is growing need to tailor the consensus guidelines to capture diagnoses in both patient groups. Furthermore, it is crucial to provide food challenge protocols that meet the needs of both pediatric and adult FPIES patients, as well as the subset of patients with atypical FPIES. This review highlights the evolving clinical evidence relating to FPIES diagnosis and management published since the 2017 International FPIES Guidelines. We will focus on areas where recent published evidence may support evolution or revision of the guidelines.
Topics: Adult; Child; Humans; Infant; Food Hypersensitivity; Vomiting; Enterocolitis; Allergens; Administration, Cutaneous; Dietary Proteins
PubMed: 38326194
DOI: 10.1016/j.alit.2024.01.006 -
Biomedical Journal Oct 2019Severe headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH)....
BACKGROUND
Severe headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH). Earlier diagnosis based on such warning symptoms theoretically would improve the clinical prognosis. However, it is still not clear whether the prognosis is correlated with early warning symptoms. Here, we reviewed warning symptoms and other predictive factors in the emergency room (ER) setting and examined their correlations with mortality.
METHODS
Ninety saccular aneurysmal SAH cases were reviewed in a single medical center between January 2011 and December 2013. We examined differences in mortality rate related to warning symptoms, SAH scales, onset-to-ER time, hydrocephalus, and aneurysm size, location, and complexity. Logistic regression analyses were performed to determine the correlations of warning symptoms and other predictive factors with mortality. Receiver operating characteristic (ROC) curve analysis was used to calculate the area the under curve (AUC) of SAH mortality prediction tools.
RESULTS
Warning headache, projectile vomiting, the Hunt and Hess scale, Fisher scale, World Federation of Neurological Surgeons (WFNS) grading scale, and modified WFNS (m-WFNS) scale, body mass index, aneurysm complexity and hydrocephalus were significantly different between the survivors and the decedents. The warning headache and WFNS grade were strongly correlated with mortality. The rate of prognostic prediction improved from 90.4% to 94.6% when warning headache was additionally evaluated.
CONCLUSIONS
With growing healthcare costs and recognition of the value of palliative care, early identification via warning headache and a detailed clinical history review is necessary for cases of aSAH.
Topics: Adult; Aged; Area Under Curve; Female; Headache; Humans; Male; Middle Aged; Prognosis; ROC Curve; Retrospective Studies; Risk Assessment; Subarachnoid Hemorrhage; Survival Rate
PubMed: 31783996
DOI: 10.1016/j.bj.2019.04.006 -
Journal of Pharmacy Practice Jun 2023Contraction alkalosis is characterized by low serum sodium and chloride and high serum carbon dioxide and bicarbonate levels. A 28-year-old Caucasian active-duty male...
Contraction alkalosis is characterized by low serum sodium and chloride and high serum carbon dioxide and bicarbonate levels. A 28-year-old Caucasian active-duty male with a history of autosomal dominant polycystic kidney disease and diarrhea-predominant Irritable Bowel Syndrome (D-IBS) presented to his primary care provider (PCP) with elevated blood pressure (136/96 mmHg), was diagnosed with stage-2 hypertension, and started oral HCTZ (25 mg/day). His medications included dicyclomine (10 mg oral three times daily). Subsequently, (Visit 1), his blood pressure was 130/91 mmHg and he was started on telmisartan (20 mg/day). At Visit 2, 4 weeks later, his blood pressure improved (121/73 mmHg); however, blood chemistry revealed elevated serum CO2 (32 mEq/L) and chloride (94 mmol/L). Four days later, the patient presented to the Emergency Department with dyspnea and swallowing difficulty. The patient returned to his PCP 3 days later complaining of cough, congestion, vomiting, and mild dyspnea, blood pressure of 124/84 mmHg. Two months later, sudden onset of projectile vomiting and abdominal pain while running was reported, resolved by rehydration and a single oral dose of prochlorperazine 25 mg. Three months later, (Visit 3), he complained of lightheadedness and cloudy judgment, suggesting contraction alkalosis. HCTZ was discontinued and telmisartan was increased to 20 mg twice daily. A follow-up blood chemistry panel 2 weeks later revealed serum chloride and CO2 levels within normal limits and blood pressure under 130/80 mmHg. This is the first known report of contraction alkalosis driven by drug-drug interaction between dicyclomine and HCTZ.
Topics: Humans; Male; Adult; Telmisartan; Hydrochlorothiazide; Dicyclomine; Chlorides; Carbon Dioxide; Hypertension; Blood Pressure; Alkalosis; Antihypertensive Agents; Drug Therapy, Combination
PubMed: 34670427
DOI: 10.1177/08971900211052829 -
Taiwanese Journal of Obstetrics &... Nov 2022To report a case and review literature of bowel metastases from cervical squamous cell carcinoma.
OBJECTIVE
To report a case and review literature of bowel metastases from cervical squamous cell carcinoma.
CASE REPORT
A 49-year-old woman with a history of FIGO 2013 stage IVB cervical squamous cell carcinoma presented with refractory nausea, projectile vomiting, anorexia, postprandial abdominal pain, and significant weight loss for six months. Restaging images didn't reveal viable tumors but thickened duodenal wall indicating gastric outlet obstruction. Initially, the etiology was masked by chronic erosive duodenitis and mistreated as a duodenal ulcer. After repeated gastrointestinal endoscopic biopsy confirming intramural duodenal metastasis from cervical squamous cell carcinoma, the patient was treated successfully by gastrojejunostomy and adjuvant chemotherapy. She has remained asymptomatic and disease-free for more than 12 months since the surgical metastasectomy.
CONCLUSION
Intestine metastasis from cervical cancer is a rare cause that may present as projectile vomiting due to gastric outlet obstruction. Prompt recognition and surgical intervention may provide good outcomes despite the metastatic nature.
Topics: Female; Humans; Middle Aged; Uterine Cervical Neoplasms; Stomach Diseases; Gastric Outlet Obstruction; Vomiting; Carcinoma, Squamous Cell
PubMed: 36427973
DOI: 10.1016/j.tjog.2021.10.011 -
Journal of Electrocardiology 2021Paroxysmal supraventricular tachycardia (PSVT) is a prevalent pediatric arrhythmia. Neonatal and infantile-onset presentation is unspecific, thus making differential...
Paroxysmal supraventricular tachycardia (PSVT) is a prevalent pediatric arrhythmia. Neonatal and infantile-onset presentation is unspecific, thus making differential diagnosis essential in not delaying crucial intervention. We here describe the case of an undetected PSVT in an infant performing repeated abdominal contractions, thus presenting with projectile vomiting. At an early stage of tachycardia, infants are probably able to unconsciously attempt and succeed to terminate acute episodes by strengthening vagal stimulation in the form of Valsalva-like abdominal contractions, but only up to a point. As PSVT progresses, heart failure may develop. Early recognition and treatment are therefore required to minimize negative outcomes.
Topics: Child; Electrocardiography; Humans; Infant; Infant, Newborn; Tachycardia, Paroxysmal; Tachycardia, Supraventricular; Tachycardia, Ventricular; Vomiting
PubMed: 33957501
DOI: 10.1016/j.jelectrocard.2021.04.010 -
Veterinary Clinical Pathology Dec 2022A 7-year-old mixed-breed neutered male cat was presented with a history of chronic vomiting with increased frequency in the last month, progressing to depression and...
A 7-year-old mixed-breed neutered male cat was presented with a history of chronic vomiting with increased frequency in the last month, progressing to depression and profuse projectile vomiting. Abdominal ultrasonography revealed an area of marked segmental duodenal thickening associated with a nodule, and euthanasia was performed due to a poor prognosis. Grossly, at the postmortem examination, the wall of a duodenal segment was severely expanded by a nodule measuring 5.0 cm in diameter, resulting in marked luminal narrowing and obstruction. Smears were made by scraping the cut surface of the tumor during the postmortem examination. The smears were highly cellular and contained mesenchymal cells arranged individually or in large non-cohesive aggregates. Cells varied in morphology from spindle to round to stellate-shaped with marked anisocytosis and anisokaryosis. Numerous bi- and multinucleated neoplastic cells were observed. Histologic examination revealed a densely cellular neoplastic proliferation of mesenchymal cells that effaced the duodenal submucosa, muscularis externa, and serosa layers. Most cells were spindle-shaped; however, some tumor areas had numerous round cells and bi- and multinucleated neoplastic cells. Spindle cells showed variable cytoplasmic immunoreactivity for vimentin, smooth muscle actin, and desmin. Round, bi-, and multinucleated giant cells only had marked multifocal cytoplasmic immunoreactivity for vimentin. Neoplastic cells did not have immunoreactivity for cytokeratin, GFAP, S100, and CD117. A final diagnosis of duodenal leiomyosarcoma was made. This article reports the pathologic, cytologic, and immunohistochemical findings of this case and discusses the main differential diagnoses in cases of intestinal sarcomas in domestic animals.
Topics: Cats; Male; Animals; Leiomyosarcoma; Vimentin; Sarcoma; Diagnosis, Differential; Vomiting; Cat Diseases
PubMed: 35466406
DOI: 10.1111/vcp.13124