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JPMA. the Journal of the Pakistan... Jun 2022Rumination syndrome is a functional gastrointestinal disorder with effortless, non-projectile regurgitation seen mostly in paediatric population and seems to be an...
Rumination syndrome is a functional gastrointestinal disorder with effortless, non-projectile regurgitation seen mostly in paediatric population and seems to be an uncommon gastrointestinal disorder due to lack of awareness among physicians. Here we report three such cases in adult patients that were labeled "refractory vomiting". No such case has been reported from Pakistan which makes this a unique case series. All of our patients were diagnosed within six to fifteen months of initial symptoms, hence a high index of suspicion is required for early diagnosis of Rumination Syndrome to avoid excessive and repeated investigations, causing emotional trauma and financial loss to patients and their families.
Topics: Adult; Child; Gastrointestinal Diseases; Humans; Pakistan; Rumination Syndrome; Vomiting
PubMed: 35751337
DOI: 10.47391/JPMA.2244 -
BMJ Case Reports Sep 2018A 17-year-old young woman presented to Patan Hospital, Kathmandu, Nepal, with high-grade fever and headache for 4 days and non-projectile vomiting for 1 day. She...
A 17-year-old young woman presented to Patan Hospital, Kathmandu, Nepal, with high-grade fever and headache for 4 days and non-projectile vomiting for 1 day. She also had blurred vision with dizziness on and off. There was no abnormal physical finding. Enteric fever was suspected, and she was empirically started on azithromycin (20 mg/kg) for 7 days. She became afebrile after 2 days and was followed up in 7 days with diplopia since 5 days. At this time, the blood culture was positive for serovar typhi. On examination, there was isolated left lateral rectus palsy which accounted for her diplopia. Methylprednisolone (1 mg/kg) was prescribed which was tapered over 1 month and gradually her diplopia subsided. We hypothesise that vasculitic change in the blood vessel supplying the left abducens nerve could be causing the diplopia.
Topics: Abducens Nerve Diseases; Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Diplopia; Female; Humans; Methylprednisolone; Neuroprotective Agents; Typhoid Fever
PubMed: 30181402
DOI: 10.1136/bcr-2018-225746 -
JPGN Reports Nov 2023Infantile hypertrophic pyloric stenosis is a common surgical disease in infants, with an incidence of 2 to 5 cases per 1000 live births. It often presents with...
Infantile hypertrophic pyloric stenosis is a common surgical disease in infants, with an incidence of 2 to 5 cases per 1000 live births. It often presents with nonbilious projectile vomiting after feeding and a mid-epigastric mass in infants between the third and eighth weeks of life. Ramstedt pyloromyotomy remains the gold standard of treatment. Postoperative emesis is common; however, further evaluation for incomplete pyloromyotomy and recurrent pyloric stenosis should be conducted with prolonged, or new-onset postoperative emesis. While repeat pyloromyotomy is the standard of care for infants presenting with incomplete pyloric stenosis, treatment for the rare development of recurrent pyloric stenosis is not clearly outlined. Here, we report a successful balloon dilation procedure in an 8-week-old female with recurrent pyloric stenosis three and a half weeks after the initial laparoscopic pyloromyotomy.
PubMed: 38045639
DOI: 10.1097/PG9.0000000000000364 -
Case Reports in Pediatrics 2021Li-Fraumeni syndrome is an inherited, autosomal dominant disease. It is categorized as a rare disease caused by mutations of the gene, which causes increased...
Li-Fraumeni syndrome is an inherited, autosomal dominant disease. It is categorized as a rare disease caused by mutations of the gene, which causes increased susceptibility of the patients and their children to many types of cancer. Choroid plexus tumor is rare, which occurs in 0.3 cases per 1,000,000 people, of which 40% turn out to be carcinomas. We present a 12-year-old boy with a history of worsening headaches of more than one month, gait disturbance, projectile vomiting, and right hemiparesis. An intraventricular tumor was identified in the occipital of the left lateral ventricle, which turned out to be a TP53-mutant choroidal plexus carcinoma.
PubMed: 33505750
DOI: 10.1155/2021/6612802 -
The Journal of Hospital Infection Jun 2018Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal...
BACKGROUND
Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal protective equipment (PPE). Protection is acquired through the inherent safety of the PPE components, but also their safe and correct use, supported by adequate training and user familiarity. However, the evidence base for HCID PPE ensembles and any associated training is lacking, with subsequent variation between healthcare providers.
AIM
To develop an evidence-based assessment and training tool for evaluating PPE ensembles and doffing protocols, in the assessment of patients with suspected HCIDs.
METHODS
VIOLET (Visualising Infection with Optimised Light for Education and Training) comprises a healthcare mannequin adapted to deliver simulated bodily fluids containing UV-fluorescent tracers. On demand and remotely operated, the mannequin projectile vomits (blue), coughs (red), has diarrhoea (yellow) and is covered in sweat (orange). Wearing PPE, healthcare staff participate in an HCID risk assessment and examination of the 'patient', thereby becoming exposed to these bodily fluids. Contamination of PPE is visualized and body-mapped under UV light before and after removal. Observational findings and participant feedback, around its use as a training exercise, is also recorded.
FINDINGS
Significant contamination from different exposure events was seen, enabling evaluation of PPE and doffing procedures used. Observational data and participant feedback demonstrated its strengths and success as a training technique.
CONCLUSION
Simulation exercises using VIOLET provide evidence-based assessment of PPE ensembles, and are a valuable resource for training of healthcare staff in wearing and safe doffing of PPE.
Topics: Cross Infection; Education, Medical; Fluorescent Dyes; Health Personnel; Humans; Infection Control; Personal Protective Equipment; Retrospective Studies; Staining and Labeling; United Kingdom; Volunteers
PubMed: 29421340
DOI: 10.1016/j.jhin.2018.01.021 -
Qatar Medical Journal 2024Cerebral venous sinus thrombosis (CVST) is a rare and life-threatening condition that may be encountered during pregnancy and puerperium. The diagnosis of CVST is a...
INTRODUCTION
Cerebral venous sinus thrombosis (CVST) is a rare and life-threatening condition that may be encountered during pregnancy and puerperium. The diagnosis of CVST is a challenge because of its varied presentation.
CASE REPORT
A 28-year-old woman presented with headache, projectile vomiting, and generalized tonic-clonic seizures 10 days after delivery by cesarean section. She had an uneventful antenatal period of 38 weeks of gestation. High clinical suspicion and the availability of magnetic resonance venography helped in making a diagnosis of CVST. She was successfully managed with a low-molecular-weight heparin (LMWH) and anti-epileptic therapy with no residual complications.
DISCUSSION
Pregnancy induces several prothrombotic changes in the coagulation system that predispose to CVST. These changes persist for six to eight weeks after birth. Infection and cesarean section are the additional risk factors for CVST during puerperium. The symptoms of CVST depend on the sinuses and veins involved, raised intracranial pressure, and the extent of brain parenchymal injury.
CONCLUSION
Greater awareness of the disease and the availability of imaging modalities have contributed to the early diagnosis and favorable outcomes in these cases. LMWH is the main stay of treatment in this disease.
PubMed: 38567103
DOI: 10.5339/qmj.2024.13 -
African Journal of Paediatric Surgery :... 2017Gastric volvulus is an uncommon entity found in the paediatric population. We are reporting a case of chronic gastric volvulus presented to us with the complaints of... (Review)
Review
Gastric volvulus is an uncommon entity found in the paediatric population. We are reporting a case of chronic gastric volvulus presented to us with the complaints of recurrent vomiting after each feed. The vomiting was projectile, nonbilious, and the content was milk. The patient was evaluated by clinical and radiological means in the form of the X-ray abdomen, ultrasound abdomen, upper gastrointestinal (GI) contrast study, and computed tomography scan of the abdomen. The upper GI contrast study was suggestive of gastric volvulus. The patient was operated and gastropexy was done. There was lax gastrocolic ligament with increased distance between stomach and transverse colon without any obvious gastric volvulus. Postsurgery, the patient was symptom-free.
Topics: Chronic Disease; Female; Humans; Infant; Recurrence; Stomach Volvulus; Vomiting
PubMed: 29487269
DOI: 10.4103/ajps.AJPS_36_16 -
Archives de Pediatrie : Organe Officiel... Sep 2017In recent years, developments in virological tools have led to the easy detection of rhinoviruses and enteroviruses (E/RV). Their detection is very frequent in cases of...
INTRODUCTION
In recent years, developments in virological tools have led to the easy detection of rhinoviruses and enteroviruses (E/RV). Their detection is very frequent in cases of airway involvement in children and their demonstrated causality. But the morbidity of E/RV in the neonatal period is unknown due to lack of epidemiological data. The objective of this study was to evaluate the incidence and clinical characteristics of these infections in hospitalized neonates.
MATERIALS AND METHODS
We retrospectively analyzed the virology specimens of all neonates hospitalized at the Caen University Hospital between 2006 and 2011. Clinical characteristics were obtained from the charts.
RESULTS
During the study period, 4544 infants aged less than 28 days were hospitalized: 4159 in the neonatal ward and 385 in the pediatric ward. Among these, 711 virology specimens were available, 31 % of which identified at least one virus. An E/RV was identified in 87 patients (1.9 % of the neonates admitted during the study period): 52 in the pediatric ward (13.5 % of 385), and 35 in the neonatal ward (0.8 % of 4159). The mean gestational age was 39 weeks in the pediatric cohort and 35 weeks in the neonatal cohort. The main indication for virological analysis was persistent drowsiness (28 %), temperature above 38°C (25 %), an apparently life-threatening event (23 %), bradycardia (20.5 %), and pallor (20.5 %). Respiratory symptoms associated with E/RV infection were coryza (74 %), cough (35 %), hypoxemia (32 %), accessory muscle use, and recession (31 %). Digestive symptoms were poor feeding (59 %), regurgitation (38 %), abdominal distension (24 %), and projectile vomiting (17 %). Twenty-three percent of the patients required admission to the neonatal ICU or pediatric ICU. Respiratory treatments included oxygen (24 % of 87 patients), continuous positive airway pressure (11 %), and ventilation (5 %). Antibiotics were prescribed in 41 % of the patients (46), but only 10 % (9) had an identified concomitant bacterial infection. In the neonatal department, nosocomial acquisition was suspected in 50 % of E/RV infections.
CONCLUSION
E/RV infections have a significant morbidity in neonates, and nosocomial transmission of the virus is underestimated. We recommend that respiratory viruses, including E/RV, be tested for in any unexplained signs in a neonate. Better identification of viruses might shorten the duration of unnecessary antibiotics.
Topics: Enterovirus Infections; Female; Humans; Infant; Infant, Newborn; Male; Picornaviridae Infections; Retrospective Studies; Rhinovirus
PubMed: 28822736
DOI: 10.1016/j.arcped.2017.06.012 -
Journal of Clinical Medicine Sep 2023Taliglucerase alfa is an enzyme replacement therapy approved for Gaucher disease. We assessed the duration/compliance/safety of such home infusions in commercial use in...
Taliglucerase alfa is an enzyme replacement therapy approved for Gaucher disease. We assessed the duration/compliance/safety of such home infusions in commercial use in four countries where home infusion programs are available. The treatment duration/compliance study included 173 patients (Israel, 58; US, 61; Brazil, 48; Australia, 6) who received ≥1 taliglucerase alfa home infusion through 6/2021. The median age at home therapy initiation was 38 (range, 2-87) years; 58% were females. The median treatment duration (at home) was 2.7 (range, 0.04-9.0) years. The annual compliance rate was stable (≥95%) throughout the study period. A search of the Pfizer global safety database (through 6/2021), identified 19 adverse events (AEs) as related to "definite home use" and 14 to "possible home use" of taliglucerase alfa; 42.4% of these AEs were serious; none were fatal. Twelve serious AEs in five separate case reports were considered treatment related: one case of chest discomfort/pain and hypertension and one case of erythema associated with a toe blister, for which causality could not be excluded; pain in extremity; projectile vomiting and chills, alongside excessive eye blinking; and an infusion-related AE (pruritus). In conclusion, this real-life global study demonstrated that taliglucerase alfa home infusions are safe with high compliance rates.
PubMed: 37762854
DOI: 10.3390/jcm12185913 -
Cureus Feb 2023Acute appendicitis due to a foreign body is a very rare condition with an incidence of 0.0005% of all appendicitis cases and among all age groups. It is one of the...
Acute appendicitis due to a foreign body is a very rare condition with an incidence of 0.0005% of all appendicitis cases and among all age groups. It is one of the atypical cases of appendicitis, and it is a rare condition commonly asymptomatic; there is a period of time between ingestion of the body and appendicitis. A 14-year-old female patient presented to the emergency room with right lower quadrant colicky pain. Moreover, it was progressive with six hours duration, preceded by loss of appetite. It was associated with nausea, non-projectile vomiting, and diarrhea. By taking the past medical history, the patient had a history of multiple times of foreign ingestions when she was younger. On examination, the patient appeared ill, and was vitally stable. On palpation, the patient had a right lower quadrant tenderness. The patient had positive pointing, rebound, Rovsing, and psoas signs. Full labs were done. Abdominal x-ray revealed a radiopaque metallic body in the right lower quadrant. By ultrasound, there was a minimal free fluid collection in the pelvis. Intraoperatively, the appendix looked hyperemic. Appendectomy was performed, and a needle was extracted from the appendix. Furthermore, the histopathology revealed an early inflamed appendix. Foreign body-causing appendicitis is a rare condition. We need to investigate suspected cases carefully because the presentation is atypical, and sometimes the patients are asymptomatic.
PubMed: 36938180
DOI: 10.7759/cureus.34948