Kawasaki disease in children with Bacillus Calmette-Guérin scar reactivity: Focus on coronary outcomes.

BACKGROUND: /Purpose: Reactivity at the Bacillus Calmette-Guérin (BCG) scar is a pathognomonic feature of Kawasaki disease (KD). However, its value in predicting KD outcomes has not been emphasized. This study explored the clinical significance of BCG scar redness with respect to coronary artery outcomes. METHODS: This retrospective study collected data on children with KD from 13 hospitals in Taiwan during 2019-2021. Children with KD were categorized into four groups based on the KD type and BCG scar reactivity. Risk factors of coronary artery abnormalities (CAA) were analyzed in all groups. RESULTS: BCG scar redness occurred in 49% of 388 children with KD. BCG scar redness was associated with younger age, early intravenous immunoglobulin (IVIG) treatment, hypoalbuminemia, and CAA at the first echocardiogram (p < 0.01). BCG scar redness (RR 0.56) and pyuria (RR 2.61) were independent predictors of any CAA within 1 month (p < 0.05). Moreover, pyuria (RR 5.85, p < 0.05) in children with complete KD plus BCG scar redness was associated with CAA at 2-3 months; first IVIG resistance (RR 15.2) and neutrophil levels ≥80% (RR 8.37) in children with complete KD plus BCG scar non-redness were associated with CAA at 2-3 months (p < 0.05). We failed to detect any significant risk factors of CAA at 2-3 months in children with incomplete KD. CONCLUSION: BCG scar reactivity contributes to diverse clinical features in KD. It can be effectively applied to determine the risk factors of any CAA within 1 month and CAA at 2-3 months.

The Postnatal Risk, Resuscitation Success Rate and Outcomes of Pediatric Sudden Death in Taiwan.

BACKGROUND: The epidemiology of pediatric potentially sudden death (SD) events and the rescue rate remain unclear. METHODS: We established a birth cohort (2000-2014) from a national database 2000-2015. RESULTS: Of 3,097,277 live births, we identified 3126 children (56.1% male) with potentially SD events, including 887 who were rescued. The cumulative risk of potentially SD events for each neonate was 0.30, 0.62, 0.91, 1.05, and 1.13 per 1000 by 2 months, 0, 5, 11 and 14 years of age, respectively. Overall, 28.3% of the children were rescued from SD events, with a higher rate in neonates (69.6%) but lower rate in postneonatal infants. A cardiac diagnosis was noted in 596 (19.1%) patients, including congenital heart disease (CHD) (388), cardiac arrest (151), cardiomyopathy (23), myocarditis (12), Kawasaki disease (7) and arrhythmia (36). Coexisting severe CHD and events in postneonatal infancy were associated with a lower chance of resuscitation, whereas events within 1 week of age had a higher chance of resuscitation. Anoxic brain damage was noted in 174 (19.7%) patients and late death occurred in 348 (39.3%) patients after being rescued from SD. Late death was more common in males, those with anoxic brain damage, those with coexisting severe CHD, and postneonatal infants. CONCLUSIONS: In this birth cohort study, the postnatal cumulative risk of potentially SD events was 1 in 885 newborns by 14 years of age. Postneonatal infants and those with coexisting severe CHD had the highest risk and worst outcomes.

Ocular Sarcoidosis Masquerading as Acute Retinal Necrosis: Two Case Reports.

PURPOSE: To report two cases of ocular sarcoidosis (OS) initially presenting as unilateral acute retinitis, which mimicked acute retinal necrosis. METHODS: Retrospective descriptive case reports. RESULTS: Two middle-aged healthy Asian women experienced progressive vision loss in their left eyes over a one-month period. Anterior uveitis, vitritis, and diffuse peripheral retinal infiltration were observed. Comprehensive diagnostic evaluations were conducted, including blood work-up, viral polymerase chain reaction of anterior chamber paracentesis samples, and chest X-ray, all yielding negative results. Despite prompt initiation of antiviral therapy, retinal infiltrations remained unchanged within the first 10 days. Chest CT imaging revealed multiple lymphadenopathies consistent with sarcoidosis. Case 1 was presumed OS, and case 2 was definite OS based on lung and lymph node biopsy results in accordance with the 2017 revised international workshop on OS (IWOS) criteria. In both cases, the retinal lesions gradually resolved after several weeks of systemic corticosteroids, and the best corrected vision of the affected eye improved to 20/25 at the 12 and 6-month follow-ups, respectively. CONCLUSION: Acute unilateral retinal infiltration in the peripheral region, exhibiting rapid progression resembling acute retinal necrosis, can be a rare manifestation of OS. Chest CT imaging can provide valuable assistance in the diagnostic process, especially when systemic examinations yield no significant findings.

Nurses' perspectives on child-friendly care needs in emergency departments: A qualitative study.

BACKGROUND: Children can become anxious when undergoing emergency medical treatment. Therefore, emergency departments should be child friendly. This study explored emergency nurses' perspectives on children's needs during emergency care. METHOD: This qualitative study employed purposive sampling to recruit 17 emergency nurses from 3 medical centers in northern and central Taiwan. Individual interviews were conducted between January and August 2021. Data were analyzed through qualitative content analysis. RESULTS: The participants had 2-23 years of experience in caring for children in emergency departments. We identified 208 unique meaning units in the interview data, 79 of which were related to child-friendly emergency care. These were classified into 42 codes across 6 categories and 27 subcategories. The six categories were timely comfort, emotional care, frontline safety, emergency response, human resources support, and treatment efficiency. CONCLUSION: Emergency nurses have professional competencies, play a crucial role as care providers for children in the emergency department, and ensure the comfort and safety of children seeking treatment. The categories related to child-friendly emergency care identified in this study can serve as a basis for developing child-friendly care emergency guidelines.

Patient Comfort with Various Local Infiltration Anesthetics for Minor Oculoplastic Surgery: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Although local anesthetics have been extensively studied, limited evidence is available regarding the optimal solution for maximizing patient comfort in minor oculoplastic procedures. OBJECTIVES: To determine the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries to maximize patient comfort. METHODS: This systematic review with network meta-analysis of prospective studies was conducted to understand the efficacy of different local anesthetics in combination to maximize patient comfort. The study was designed according to the Cochrane Handbook for Systematic Reviews of Interventions. The population comprised patients receiving local infiltration anesthesia in minor oculoplastic surgeries. Various anesthetics with adjuvants were compared with respect to injection pain, operative bleeding, and complications. Random-effects model was performed. The primary outcome of injection pain was measured using the visual analog scale (VAS) or a preference question (which intervention was the least painful). Other outcomes were operative bleeding and complications, which were evaluated with a similar preference question. RESULTS: Eleven randomized controlled trials (RCTs) of 521 patients (917 eyes) were included. The network meta-analysis revealed that "bicarbonate-buffered lidocaine with epinephrine" led to a significant decrease in injection pain (preference question) compared to "prilocaine with felypressin" and "lidocaine with epinephrine," whereas no significant differences were detected in the analysis of injection pain measured using the VAS. CONCLUSIONS: "Bicarbonate-buffered lidocaine with epinephrine" may be the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries due to reduced injection pain, operative bleeding, and postoperative swelling. However, this should be interpreted cautiously as the confidence in the evidence was very low. THE CLINICAL TRIAL REGISTRATION NUMBER: CRD42021260332 (PROSPERO).

Prophylactic antiemetic effects of dexamethasone versus 5-HT3 receptor antagonists in ear surgery: a systematic review and meta-analysis.

Background The optimal strategy for reducing the high incidence of postoperative nausea and vomiting (PONV) after otologic surgical procedures remains inconclusive. Aim of the review This study compared the prophylactic antiemetic effects of dexamethasone with 5-hydroxytryptamine 3 receptor antagonists (5-HT3-RAs) in ear surgery. Method PubMed, Embase, and Cochrane Library were searched up to October 31, 2020 for randomized controlled trials that used dexamethasone either singly or in combination with 5-HT3-RAs for PONV prophylaxis in adults undergoing ear surgery. Studies in languages other than English and those without a control group of 5-HT3-RAs were excluded. Random effects meta-analyses were performed, and risk of bias was assessed using the version 2 of the Cochrane risk-of-bias tool. Main outcome measures include incidences of early (< 6 h) and overall (0-48 h) PONV, the overall requirement for rescue antiemetics, and the occurrence of adverse events. Results Eight trials of 733 adults were included, and the overall risks of bias were generally low. Pooled risk ratios (RRs) of early and overall PONV of dexamethasone versus 5-HT3-RAs were 2.0 (95% CI 0.8-5.1, I2 = 82%), and 1.3 (95% CI 0.6-2.6, I2 = 86%). In studies comparing dexamethasone plus 5-HT3-RAs with 5-HT3-RAs alone, pooled RRs of early and overall PONV were 0.8 (95% CI 0.4-1.4, I2 = 30%), and 0.5 (95% CI 0.3-0.6, I2 = 0%), respectively. Pooled RRs of the overall need for rescue antiemetics comparing 5-HT3-RAs with dexamethasone alone and in combination with 5-HT3-RAs were 1.2 (95% CI 0.4-3.9, I2 = 73%) and 0.4 (95% CI 0.1-1.4, I2 = 61%), respectively. Common adverse events reported were headache and dizziness, and the incidences range from 0 to 10% without significant differences between the groups. Conclusion The prophylactic antiemetic effects of dexamethasone versus 5-HT3-RAs in ear surgery did not significantly differ in the early and overall postoperative phases. The combination of dexamethasone with 5-HT3-RAs showed superior overall PONV prophylactic effects to 5-HT3-RAs alone in ear surgery, but their differences in the need for rescue antiemetics remained non-significant.

Central Corneal Thickness of Healthy Lowlanders at High Altitude: A Systematic Review and Meta-Analysis.

PURPOSE: Central corneal thickness, a marker of corneal hydration and metabolism, was reported to increase at high elevations. This study aimed to assess the effect of chronic high-altitude exposure on the central corneal thickness of healthy lowlanders with unoperated corneas, and determine if a relationship exists between exposure time and corneal edema formation. MATERIALS AND METHODS: The PubMed, Embase, Scopus, Cochrane Library, and Airiti Library databases were searched up to 2017 January 31 for prospective cohort studies performed above 2500 m in healthy lowlanders with measurements of the central corneal thickness. Subjects with prior eye surgery, contact lens, and non-hypobaric hypoxic exposure were excluded. RESULTS: Seven studies of 207 adults were included. The pooled effect of high-altitude exposure on the central corneal thickness for < 12 hours, 3-5 days, 6-7 days, and > 10 days was a mean difference of 13.4 (95% confidence interval: 5.1-21.6) µm with moderate heterogeneity (p < 0.05, I2 = 59%), 19.3 (95% confidence interval: 9.7-29) µm with low heterogeneity (p = 0.88, I2 = 0%), 20.4 (95% confidence interval: 10.3-30.5) µm with low heterogeneity (p = 0.73, I2 = 0%), and 30.8 (95% confidence interval: 20.4-41.2) µm with low heterogeneity (p = 0.69, I2 = 0%), respectively. Baseline differences between pre-exposure and post-exposure were not statistically significant. Regression analysis revealed a significant linear relation between high-altitude exposure time and corneal edema formation that exceeded 5% after 10 days. CONCLUSIONS: High-altitude exposure induces central corneal thickening with significant linear progression over time, whereas it takes over 10 days to reach clinical significance in healthy lowlanders with unoperated corneas, and changes in central corneal thickness are reversible after descent to lower elevations.

The effect of acetazolamide on sleep apnea at high altitude: a systematic review and meta-analysis.

BACKGROUND: Acetazolamide has been investigated for treating sleep apnea in newcomers ascending to high altitude. This study aimed to assess the effect of acetazolamide on sleep apnea at high altitude, determine the optimal therapeutic dose, and compare its effectiveness in healthy trekkers and obstructive sleep apnea (OSA) patients. METHODS: PubMed, Embase, Scopus, Cochrane Library, and Airiti Library databases were searched up to July 2015 for randomized controlled trials (RCTs) performed above 2500 m in lowlanders and that used acetazolamide as intervention in sleep studies. Studies including participants with medical conditions other than OSA were excluded. RESULTS: Eight studies of 190 adults were included. In healthy participants, the pooled mean effect sizes of acetazolamide on Apnea-Hypopnea Index (AHI), percentage of periodic breathing time, and nocturnal oxygenation were 34.66 [95% confidence interval (CI) 25.01-44.30] with low heterogeneity ( p = 0.7, I2 = 0%), 38.56% (95% CI 18.92-58.19%) with low heterogeneity ( p = 0.24, I2 = 28%), and 4.75% (95% CI 1.35-8.15%) with high heterogeneity ( p < 0.01, I2 = 87%), respectively. In OSA patients, the pooled mean effect sizes of acetazolamide on AHI and nocturnal oxygenation were 13.18 (95% CI 9.25-17.1) with low heterogeneity ( p = 0.33, I2 = 0%) and 1.85% (95% CI 1.08-2.62%) with low heterogeneity ( P = 0.56, I2 = 0%). CONCLUSIONS: Acetazolamide improves sleep apnea at high altitude by decreasing AHI and percentage of periodic breathing time and increasing nocturnal oxygenation. Acetazolamide is more beneficial in healthy participants than in OSA patients, and a 250 mg daily dose may be as effective as higher daily doses for healthy trekkers.

A novel 3670-base pair mitochondrial DNA deletion resulting in multi-systemic manifestations in a child.

Mitochondrial DNA (mtDNA) deletion is a rare occurrence that results in defects to oxidative phosphorylation. The common clinical presentations of mtDNA deletion vary but include mitochondrial myopathy, Pearson syndrome, Kearns-Sayre syndrome, and progressive external ophthalmoplegia. Here, we report the case of a 10-year-old boy who presented with progressive deterioration of his clinical status (which included hypoglycemia, short stature, sensorineural hearing loss, retinitis pigmentosa, and chronic gastrointestinal dysmotility) that progressed to acute deterioration with pancreatitis, Fanconi syndrome, lactic acidosis, and acute encephalopathy. Following treatment, the patient was stabilized and his neurological condition improved. Through a combination of histological examinations and biochemical and molecular analyses, mitochondrial disease was confirmed. A novel 3670-base pair deletion (deletion of mtDNA nt 7,628-11,297) was identified in the muscle tissue. A direct repeat of CTACT at the breakpoints was also detected.