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  • 1
    Online Resource
    Online Resource
    Factor V11 deficiency: A rare cause of nasal bleeding
    Open Source Publications ; 2021
    In:  Journal of Clinical Images and Medical Case Reports Vol. 2, No. 3 ( 2021-06-29)
    Details
    In: Journal of Clinical Images and Medical Case Reports, Open Source Publications, Vol. 2, No. 3 ( 2021-06-29)
    Abstract: Factor VII deficiency is a rare inherited disorder. Clinically the patient presents with bleeding tendencies. Diagnosis is made by prolonged prothrombin time, normal activated partial thromboplastin time and low functions factor VII assay or factor VII antigen. Therapy involves factor VII concentrates, recombinant factor VII, fresh frozen plasma and fibrinolytic inhibitors. We present a 6 years old boy with nose bleed for six months of whom prothrombin time was prolonged with functional factor VII assay of less than 1% confirming factor VII deficiency. He was managed with fresh frozen plasma, blood transfusion, tranexamic acid. Factor VII deficiency even though rare should be sought out in children presenting with bleeding. Keywords: Factor VII deficiency; coagulation; hemorrhage.
    Type of Medium: Online Resource
    ISSN: 2766-7820
    URL: Article
    DOI: 10.52768/2766-7820/1207
    Language: Unknown
    Publisher: Open Source Publications
    Publication Date: 2021
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  • 2
    Online Resource
    Online Resource
    Recurrent obstructive uropathy secondary to pyometrocolpos in an 8-month-old infant: a case report
    Springer Science and Business Media LLC ; 2020
    In:  Journal of Medical Case Reports Vol. 14, No. 1 ( 2020-12)
    Details
    In: Journal of Medical Case Reports, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2020-12)
    Abstract: Pyometrocolpos is accumulation of infected fluid in the uterus and vagina. It is rare in children, mostly seen after menarche as a result of obstructive congenital genital malformation that impairs free drainage of the uterine secretions. In a child, it may present as an acute illness that necessitates urgent and appropriate management and treatment of the underlying cause, which can be a challenge in a resource-limited setting. Case presentation We report a case of pyometrocolpos in an 8-month-old African infant who presented with fever, vomiting, decreased urine output, and abdominal distension of 12 days’ duration. An abdominal examination revealed a subumbilical midline incision scar and a midline lower abdominal mass. She appeared to have presented at the emergency department with similar complaints 2 months earlier and had been diagnosed with pyometra, which was managed by emergency laparotomy for pus drainage, and she was kept on antibiotics. Recovery was established after 10 days of admission, and the patient was discharged to home. Her symptoms reappeared 2 months after the first presentation. Her blood work showed significant leukocytosis with neutrophilia, and abdominal ultrasound depicted bilateral hydronephrosis with hydroureters and a fluid-filled uterus. Examination under anesthesia in the operating theater revealed normal-looking female genitalia with a cribriform hymen, beneath which lied a transverse vaginal septum. Foul-smelling pus was aspirated through the septum, and septectomy was performed to allow 350 ml of pus to drain. A pus sample was sent for culture and sensitivity, and Escherichia coli sensitive to ceftriaxone and gentamicin was isolated. Conclusion Pyometrocolpos is rare in childhood but should be suspected in a girl presenting with a midline lower abdominal mass accompanied with urinary obstructive symptoms associated with fever and gastrointestinal symptoms. Escherichia coli seems to be the most probable offending organism, but pus culture is crucial for antibiotic stewardship in proper management of the infection. Definitive treatment should focus on correcting the obstructive anatomical congenital deformity that caused the obstruction in order to avoid recurrence.
    Type of Medium: Online Resource
    ISSN: 1752-1947
    URL: Article
    DOI: 10.1186/s13256-020-02543-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2269805-X
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  • 3
    Online Resource
    Online Resource
    Case Report: An Elusive Case of Septic Arthritis
    Heighten Science Publications Corporation ; 2024
    In:  Journal of Advanced Pediatrics and Child Health Vol. 7, No. 1 ( 2024-05-02), p. 045-051
    Details
    In: Journal of Advanced Pediatrics and Child Health, Heighten Science Publications Corporation, Vol. 7, No. 1 ( 2024-05-02), p. 045-051
    Abstract: Septic arthritis is a serious inflammatory infectious state of the joint secondary to microbial infection. In the pediatric population the most common route of infection is haematogenous spread. Less than fifty percent of patients with septic arthritis will yield positive culture results with a mortality rate of up to 42% in some cases. Due to the challenge in obtaining culture and identification of the causative organism the management of septic arthritis has been more of empirical in nature with the chosen antibiotic synchronized with the epidemiological data. Here is a case of a 14 months old female patient presenting at our hospital with a left knee and lower thigh swelling for three days with failure to bare weight on the limb. In addition, she had fever and diarrhea for three days. Upon evaluation clinical, laboratory and radiological findings supported septic arthritis expect for her blood, pus and synovial fluid culture of which all came back negative. She had poor response to intravenous ceftriaxone, gentamycin, metronidazole, ampicillin- cloxacillin and amoxicillin clavunate. Over the course of therapy, she developed septic shock, severe anemia and acute liver failure and was admitted to the intensive care unit. Afterwards she was initiated vancomycin and developed a hypersensitivity reaction with generalized edema which prompted cessation of the drug. Due to her critical state and poor response a triple therapy regimen composing of meropenem, ciprofloxacin and metronidazole was selected and maintained for three weeks followed by an oral clindamycin course for another three weeks of which she responded. In addition, surgical debridement arthrotomy, irrigation and drainage were done. Physiotherapy for rehabilitation is ongoing with patient recovering well.
    Type of Medium: Online Resource
    ISSN: 2689-9817
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.29328/journal.japch.v7i1
    DOI: 10.29328/journal.japch
    DOI: 10.29328/journal.japch.1001067
    Language: Unknown
    Publisher: Heighten Science Publications Corporation
    Publication Date: 2024
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  • 4
    Online Resource
    Online Resource
    Factors Associated with Elevated Transcranial Doppler Ultrasound Velocities in Children With Sickle Cell Anemia in Mwanza, Tanzania
    Heighten Science Publications Corporation ; 2023
    In:  Journal of Advanced Pediatrics and Child Health Vol. 6, No. 2 ( 2023-07-28), p. 033-038
    Details
    In: Journal of Advanced Pediatrics and Child Health, Heighten Science Publications Corporation, Vol. 6, No. 2 ( 2023-07-28), p. 033-038
    Abstract: Background: Stroke occurs in 11% of patients with SCA before 20 years of age. In Northwestern Tanzania, the prevalence of stroke among children living with SCA under the age 15 years is 16.9%, of which might be attributed to the absence of routine screening for the risk of stroke by using Transcranial Doppler Ultrasound (TCD). Screening with TCD allows preventive measures such as chronic blood transfusion to be done which has led to the reduction of stroke by 92%. Methods: This was a prospective analytical cross sectional study which enrolled 267 SCA children aged 2 to 16 years attending Bugando Medical Centre Pediatric Sickle Cell Clinic from July 2019 to June 2020. Assessment of factors associated with elevated TCD included a clinical history of stroke in sibling, death in sibling, temperature, oxygen saturation in room air, blood pressure, hemoglobin level and total white blood cell count. TCD was done by accessing transtemporal window and recording the highest time average mean of maximum velocity (TAMMV) of major vessels mainly, middle cerebral artery (MCA) and distal internal carotid artery (dICA). Results: The median age of enrolled was 6.6 (IQR: 4-9) years. The prevalence of elevated TCD ( 〉 170 cm/s) was found to be 21% (56/267). By multivariate logistic regression, low oxygen saturation in room air, p - value = 0.037, OR 1.08 [95% CI 1.00-1.17] and low hemoglobin level, p - value = 0.001, OR 1.76 [95% CI 1.26-2.45] were statistically significantly associated with elevated TCD among children living with SCA. Conclusion: The high prevalence of elevated TCD velocity, with low hemoglobin and low oxygen saturation in room air as associated factors under multivariate logistic regression, warrants routine TCD screening for children with SCA aged 2 to 16 years.
    Type of Medium: Online Resource
    ISSN: 2689-9817
    URL: Journal
    URL: Article
    DOI: 10.29328/journal.japch
    DOI: 10.29328/journal.japch.1001058
    Language: Unknown
    Publisher: Heighten Science Publications Corporation
    Publication Date: 2023
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  • 5
    Online Resource
    Online Resource
    Stroke Prevention with Hydroxyurea Enabled through Research and Education: A Phase 2 Primary Stroke Prevention Trial in Sub-Saharan Africa
    S. Karger AG ; 2023
    In:  Acta Haematologica Vol. 146, No. 2 ( 2023), p. 95-105
    Details
    In: Acta Haematologica, S. Karger AG, Vol. 146, No. 2 ( 2023), p. 95-105
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Stroke is a severe complication of sickle cell anemia (SCA), with devastating sequelae. Transcranial Doppler (TCD) ultrasonography predicts stroke risk, but implementing TCD screening with suitable treatment for primary stroke prevention in low-resource environments remains challenging. SPHERE (NCT03948867) is a prospective phase 2 open-label hydroxyurea trial for SCA in Tanzania. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 After formal training and certification, local personnel screened children 2–16 years old; those with conditional (170–199 cm/s) or abnormal (≥200 cm/s) time-averaged mean velocities (TAMVs) received hydroxyurea at 20 mg/kg/day with dose escalation to maximum tolerated dose (MTD). The primary study endpoint is change in TAMV after 12 months of hydroxyurea; secondary endpoints include SCA-related clinical events, splenic volume and function, renal function, infections, hydroxyurea pharmacokinetics, and genetic modifiers. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Between April 2019 and April 2020, 202 children (average 6.8 ± 3.5 years, 53% female) enrolled and underwent TCD screening; 196 were deemed eligible by DNA testing. Most had numerous previous hospitalizations and transfusions, with low baseline hemoglobin (7.7 ± 1.1 g/dL) and %HbF (9.3 ± 5.4%). Palpable splenomegaly was present at enrollment in 49 (25%); average sonographic splenic volume was 103 mL (range 8–1,045 mL). TCD screening identified 22% conditional and 2% abnormal velocities, with hydroxyurea treatment initiated in 96% (45/47) eligible children. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 SPHERE has built local capacity with high-quality research infrastructure and TCD screening for SCA in Tanzania. Fully enrolled participants have a high prevalence of elevated baseline TCD velocities and splenomegaly. SPHERE will prospectively determine the benefits of hydroxyurea at MTD for primary stroke prevention, anticipating expanded access to hydroxyurea treatment across Tanzania.
    Type of Medium: Online Resource
    ISSN: 0001-5792 , 1421-9662
    URL: Article
    DOI: 10.1159/000526322
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 1481888-7
    detail.hit.zdb_id: 80008-9
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