A rare case of acute necrotising pancreatitis in a paediatric patient
Published on: 8th December, 2020
OCLC Number/Unique Identifier: 8848126015
The diagnosis of acute necrotising pancreatitis is a rare event in the Paediatric Emergency Department (ED).
We report a case of acute pancreatitis in a paediatric patient, diagnosed in our ED, a tertiary level paediatric hospital.
This child presented with vague symptoms of constipation, abdominal pain and back pain, and on clinical examination had a distended abdomen with peritonism. She rapidly deteriorated and needed aggressive fluid resuscitation in the ED for treatment of septic shock. The diagnosis of acute pancreatitis (AP) was only considered once elevated amylase levels were apparent.
Whilst AP is an important differential diagnosis in a patient who is presenting with acute abdominal symptoms, the diagnosis in children in particular is seldom and thus easily overlooked in the previously healthy child.
Perceptions of Adolescent Mothers on Feeding and Nutrition of their Children aged 0-3 Years in Rural Bangladesh
Published on: 16th June, 2023
Proper feeding practices at an early age are the key to improving a child’s overall health and achieving developmental milestones. In Bangladesh, a large portion of rural girls become mothers before the age of 18. Past records show that most interventions are designed to improve infant and young child feeding practices targeting older mothers. That is why, this study has been designed with an aim to explore the perceptions and practices of infant and young children feeding among rural Bangladeshi mothers aged <19 years old. Data was collected through in-depth interviews and group discussions with a total of 40 adolescent mothers who have children aged 0-3 years. Data has revealed that the majority of the mothers hold very limited knowledge of nutrition and child nutrition but those who are educationally a bit ahead hold a little better knowledge. Participants are aware of breastfeeding but they all misinterpret the term ‘exclusive breastfeeding’ with other liquid food. It has also emerged that most of the mothers know the ideal timing of starting complementary feeding but very few of them actually understand what to feed children. In spite of having misconceptions and superstation rural adolescent mothers practice responsive feeding instead of force-feeding. No gender discrimination has been found regarding child feeding. The findings of the study pinpointed that mothers are unable to practice proper infant and child feeding due to a lack of knowledge and limited affordability. Educating girls & young mothers and improving financial security could be an effective way to promote improved infant feeding practices.
Dual Role of Clinician Managers in Healthcare - Challenges and Opportunities
Published on: 26th December, 2023
Background: Clinician managers can play a crucial role in healthcare organizations, including hospitals, by combining their clinical expertise with managerial responsibilities. They bring valuable insights and firsthand experience of patient care to managerial positions, contributing to improved patient outcomes and hospital performance. However, they face unique challenges that require careful attention and solutions. Aim: This review aims to critically discuss the role of clinicians as managers, the challenges that they face, and how they exercise their influence in hospital settings. Key findings: The role of clinicians as managers is critical for effective leadership and delivery of high-quality patient care. Described as a two-way window, clinician managers bridge the gap between medicine and management by combining clinical expertise with managerial skills in a hybrid leadership approach. Studies have shown a positive impact on hospital performance, including enhanced quality care, improved patient outcomes, and potentially better financial performance. In addition, they play a vital role in fostering interdisciplinary collaboration and boosting staff engagement. However, challenges such as identity conflicts, and limited formal training, are present, especially for first-time managers. Conclusion: Adapting to the dual role of clinician and manager demands a mindset shift and the development of new skills, necessitating strategic support. This includes leadership education, organizational support, mentoring, and collaborative models to empower clinician managers. Targeted training programs, formal mentoring, and peer support networks equip them with essential skills, while workload management, well-being initiatives, and a culture of balance foster success and growth.
Case – Late Presentation of Invasive Keratinizing Squamous Cell Carcinoma
Published on: 27th December, 2023
Penile cancer, a rare but highly morbid disease, primarily manifests as squamous cell carcinoma (PSCC) originating from the squamous cells of the glandular and preputial skin. Late-stage diagnosis is common due to social stigma, psychological barriers, and nonspecific initial symptoms, resulting in poor overall survival rates, especially in metastatic cases. This case report illustrates a 38-year-old man with advanced metastatic PSCC, showcasing severe systemic manifestations and delayed presentation of the disease. Despite aggressive treatment options, the patient opted for palliative care, succumbing to the disease months after his diagnosis. Risk factors for PSCC include HPV infection, phimosis, chronic inflammation, and lifestyle factors, with higher prevalence in regions of low socioeconomic status. The psychological and sexual burden of penile cancer is significant, impacting patients’ well-being, mental health, and quality of life. In conclusion, efforts to reduce the stigma associated with penile cancer are crucial to prompt early diagnosis and treatment initiation. Encouraging seeking medical attention for symptoms can enhance the chances of recovery and minimize the need for invasive treatments. Addressing the psychosocial impact of the disease is imperative for holistic patient care.
Individual Treatment Trial of PIGV-Associated Mabry Syndrome with D-Mannose in a Young Child
Published on: 27th December, 2023
We describe the first individual treatment trial with D-mannose in a young girl with PIGV-CDG. PIGV-CDG belongs to the GPI anchor deficiencies leading to intellectual disability, dysmorphic features, epilepsy, and, less frequently, organ malformations. A hallmark of the GPI anchor deficiencies is the elevated serum alkaline phosphatase (AP). Our patient carried the germline homozygous PIGV variant c.1022C>A, p. (Ala341Glu), the most commonly reported pathogenic variant leading to PIGV-CDG so far. We aimed to improve the impaired enzymatic function of PIGV through elevated substrate levels by giving D-mannose orally. We monitored the clinical status, developmental progress as well as serum AP levels. Our patient experienced no side effects. Standardized developmental testing showed better developmental progress during the 21-month treatment period with D-mannose than in the 12 months following the discontinuation of treatment. The D-Mannose treatment might have had a positive effect on the development of our patient with PIGV-CDG.
Criteria for paediatric oral liquid form
Published on: 26th March, 2021
OCLC Number/Unique Identifier: 8980371069
Paediatric hospitals frequently have to face the lack of commercially available medicines suitable or even licensed for their use in paediatrics. Thus, only one-third of all medicines approved by the European Medicines Agency over the period of 1995 to 2005 were licensed for use in children [1].
Treatment Outcome in Patients with Myofascial Orofacial Pain: A Randomized Clinical Trial
Published on: 18th January, 2024
Background: Temporomandibular Disorder (TMD) pain attributed to myalgia is a common condition and patients should get advice on the best treatment option. Objectives: The aim was to evaluate the effect of two different exercise programs, or bite splint therapy, respectively, in patients with chronic frequent primary myofascial orofacial pain. Methods: The study was a randomized clinical trial including patients fulfilling criteria of chronic frequent primary myofascial orofacial pain with a reported pain intensity of ≥ 4 on a numerical rating scale (0-10). Ninety subjects were randomized to either bite splint, home exercises, or a supervised exercise program. Two examiners blinded to the treatment modality examined the same subject at baseline and a 3-month follow-up. Non-parametric statistical methods were applied for the outcome of treatment in intended-to-treat analyses. A P-value <0.05 was considered statistically significant. Results: The pain severity index was significantly reduced (p < 0.001) in all treatment groups. Jaw opening capacity improved significantly (p < 0.05) for those randomized to bite splint and for those in the home exercise program. About 70% of the participants reported improvement in their TMD pain severity with no significant difference between treatments. Both exercise groups improved in jaw function at the 3-month follow-up compared to baseline. Those who had a bite splint reported significantly more improvement in their headaches compared to those in the exercise programs. Conclusion: Jaw exercise programs and bite splint treatments had similar positive effects on TMD pain severity attributed to myalgia after 3 months.
Tamsulosin and Dementia in old age: Is there any relationship?
Published on: 1st October, 2019
OCLC Number/Unique Identifier: 8280929913
Tamsulosin is used to treat Benign Prostatic Hyperplasia (BPH), prescribed annually to about 12.6 million patients worldwide. It is an alpha-adrenergic antagonist that reduces the tone of the prostate smooth muscle involved in the pathophysiology of BPH. By acting on alpha 1A receptors, predominant in the prostate, tamsulosin also acts on receptors present in the brain. This study consisted of a literature review aimed at disseminating scientific knowledge about the relationship between the use of tamsulosin and the onset of dementia. PubMed, Scopus, Scielo, Embase, and Web of Science studies involving dementia in patients using tamsulosin in the last five years were selected. The review showed a risk correlation and a higher incidence of dementia in treated patients. The risk ratio, when compared to other medicines, approached 1.20. In conclusion, it was identified the need for clinical trials with higher sampling power to increase relational significance due to the high prevalence of BPH and the extensive use of tamsulosin in elderly patients with the disease.
Visual evoked potentials: Normative values from healthy Senegalese adults
Published on: 11th August, 2020
OCLC Number/Unique Identifier: 8652203971
Introduction: Visual evoked potentials (VEPs) are potential differences recorded on the scalp in response to visual stimulation. They are obtained with slowly repeated stimuli. The aim of this study was to determine the normative values of the visual evoked potentials in our setting.
Methodology: We conducted a cross-sectional study from February 1 to April 30, 2019 at the Clinical Neurophysiology laboratory of the I.P. Ndiaye Clinic at CHNU Fann in Dakar (Senegal).
Results: We found that men had high averages of N75, P100 and N145 wave latencies and low averages of P100 wave amplitude (p>0.05). However, neither age nor body mass index influenced the parameters of VEPs.
Conclusion: Sex is important physiological variable in establishing laboratory normative values for VEPs. There is a marked difference between the sexes for the VEPs parameters.
Calciphylaxis in Hemodialysis
Published on: 20th July, 2023
Calciphylaxis (CP) or uremic calcific arterial disease (CUA) is a rare, potentially fatal calcific vasculopathy characterized by calcific and thrombotic occlusion of the vessels of the subcutaneous and dermis leading to extremely painful necrotic lesions. It mainly affects patients with end-stage kidney disease (ESKD) and under long time dialysis. The only therapeutic option is represented by intravenous sodium thiosulfate. Currently, clear guidelines are lacking. We have had a good therapeutic response with doses of sodium thiosulfate in association with multidisciplinary management of the patient (vulnologist, dermatologist, nephrologist, dietitian, and cardiologist). There is limited literature on the use of DOAC therapy as a successful alternative to warfarin in patients on dialysis with calciphylaxis. The left atrial appendage closure could represent an important alternative to dicumarolics in patients with atrial fibrillation with calciphylaxis. A new perspective for the treatment of this disease is SNF472 a selective inhibitor of vascular calcification.
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