Myocarditis in Children: Impact of Early Presentation on Disease Outcomes at a Single Tertiary Center in Saudi Arabia.

Purpose: Myocarditis is the inflammation of the heart muscle and can be caused by a variety of infections, incendiary diseases, and pollutants. It is challenging for an emergency pediatrician to have a sufficiently high degree of suspicion for myocarditis to avoid diagnostic delay given the broad overlap of myocarditis symptoms with other disease processes. The study aimed to evaluate the impact of early presentation and diagnosis on the outcomes of acute myocarditis in children. Patients and Methods: We performed a retrospective analysis of the complete records of 80 pediatric patients diagnosed with acute myocarditis between 2015 and 2019 at a single tertiary center in Saudi Arabia. Patients were two weeks to 14 years of age and were admitted to the pediatric intensive care unit (PICU) for various sequelae of myocarditis. Data from routine clinical and laboratory investigations were collected. Results: The incidence of delayed presentation at the hospital after the onset of symptoms of myocarditis was 42.5%. A total of 22 (27.5%) patients expired during their hospital stay. There was marginally significant association of earlier presentation with in-hospital survival (80.4% vs 61.8%) and delayed presentation with higher proportion of in-hospital mortality (38.2% vs 19.6%, p=0.064). The rate of mechanical ventilator was also marginally significant in delayed presentation (p=0.068). Shock and multisystem organ failure were the significantly associated manifestations of delayed acute myocarditis presentations. Length of stay in PICU was also significant in delayed presentation group. The impact of presenting symptoms, ECG findings, and use of mechanical ventilator was not significantly associated with delayed presentation. Conclusion: An earlier presentation may have a substantial impact on overall prognosis and length of PICU stay and may lead to comparatively lesser frequency of mechanical ventilation use.

Clinical profile, risk factors and outcomes of ric COVID-19: a retrospective cohort multicentre study in Saudi Arabia.

OBJECTIVE: To describe the risk factors, clinical profile and outcomes of COVID-19 in the paediatric population. DESIGN: Multicentre, retrospective observational study. SETTING: Four tertiary hospitals in Saudi Arabia. PATIENTS: We recruited 390 paediatric patients aged 0-18 years who presented from March to December 2020 and tested positive for COVID-19 on PCR. MAIN OUTCOME MEASURES: We retrospectively analysed medical records for sociodemographics, health indicators, clinical presentations, laboratory findings, clinical complications, and outcomes. RESULTS: The mean participant age was 5.66±4.90 years, and the mean hospital stay was 2.17±3.48 days. Forty patients, mostly school-aged children (16, 40.00%; p=0.005) and children with comorbidities (25, 62.50%; p<0.001), received more than just supportive care. Complications were seen in 15 (3.9%) patients, bacterial infection being the most common (6, 40.00%). Patients presented with dyspnoea (OR 6.89; 95% CI 2.89 to 20.72), abnormal chest radiographs (OR 6.11; 95% CI 1.26 to 29.38), lethargy (OR 9.04; 95% CI 2.91 to 28.06) and elevated ferritin (OR 14.21; 95% CI 4.18 to 48.37) and D-dimer (OR 48.40; 95% CI 14.32 to 163.62), with higher odds of developing complications. The odds of paediatric intensive care unit (ICU) admission were higher for patients with dyspnoea (adjusted OR 4.66; 95% CI 1.24 to 17.50) and elevated white blood cell count (adjusted OR 3.54; 95% CI 1.02 to 12.30). CONCLUSIONS: COVID-19 complications were limited among our patients. However, dyspnoea, abnormal chest radiographs, lethargy and elevated ferritin and D-dimer were associated with an increased risk of complications. Dyspnoea, leucocytosis, comorbidities and abnormal chest radiographs at presentation increased the risk of ICU admission.

Rosai-Dorfman Disease Complicated by Autoimmune Hemolytic Anemia in a Child: A Case Report and Review of the Literature.

Rosai-Dorfman disease is a rare histiocytic proliferative disorder that commonly presents with a massive lymphadenopathy and a variety of constitutional symptoms. Severe hemolytic anemia is an infrequent complication of this disease. Although the etiology of the condition is unknown, infectious agents including viruses have been implicated. We describe a 2-year-old female child who presented with fever, pallor, and generalized lymphadenopathy complicated by the development of autoimmune hemolytic anemia. A review of the literature of this condition is also provided.

The use of laryngeal mask airway during transesophageal echocardiography in pediatric patients.

BACKGROUND: Transesophageal echocardiography (TEE) in the cardiac lab is usually performed in pediatric patients under general anesthesia with an endotracheal intubation (ET). This study was performed to investigate the safety and efficacy of using the laryngeal mask airway (LMA) as an alternative to ET to maintain pediatric airway during the general anesthesia for TEE. MATERIALS AND METHODS: A total of 50 pediatric patients undergoing TEE in the cardiac lab were randomized to have their airway maintained during the procedure with either LMA (LMA group) or ET (ET group). Hemodynamic, respiratory parameters, time to extubation, recovery time, the incidence of complication and operator satisfaction were compared between the two groups. RESULTS: There were no differences between both groups in hemodynamic and respiratory parameters. Laryngeal spasm was reported in one patient in the LMA group and two patients in the ET group. TEE operators were equally satisfied with the procedure in groups. The time to extubation was shorter in the LMA group (P < 0.01). The mean recovery time was also significantly shorter in the LMA than in the ET group (44 ± 8 min and 59 ± 11 min, respectively; P < 0.001). CONCLUSION: The LMA is safe and effective in securing the airway of children undergoing diagnostic TEE.

Sydenham chorea in a 5-year-old Saudi patient.

Despite improvements in socio-economic status and the standard of health care services, rheumatic fever continuous to occur in Saudi Arabia, although with decreasing frequency. The disease is most commonly observed in school-aged children, but can also occur in a younger age group. Carditis and arthritis are the major clinical symptoms on presentation of acute rheumatic fever in young children. Rheumatic chorea is infrequently reported in young children. Here, a case of Sydenham chorea, in a 5-year-old boy, is presented. Although rare, the diagnosis of Sydenham chorea should always be considered in young children with choreiform movements.

Henoch-Schonlein purpura in children from the eastern province of Saudi Arabia.

OBJECTIVE: To evaluate the epidemiological and clinical profile of children with Henoch-Schonlein purpura (HSP) in eastern Saudi Arabia during a 15-year period. METHODS: The medical records of children discharged with a diagnosis of HSP from King Fahad Hospital of the University, Al-Khobar, Saudi Arabia, between January 1996, and December 2010, were reviewed retrospectively. RESULTS: Of 78 patients, 46 (59%) were boys, with a male to female ratio of 1.4:1. The patients' ages ranged from 22 months to 12 years, with a mean of 6.3 years. Approximately 60% of cases were presented during autumn and winter. Upper respiratory tract infection preceded HSP in over half of the patients and antistreptolyzin O (ASO) titer was positive in 11 of the 24 (46%) children tested at presentation. The main clinical features included skin purpura (100%), arthritis or arthralgia (66%), gastrointestinal manifestation (47%), orchitis (15%) of boys, and nephritis (24%). One patient with severe nephritis developed pulmonary hemorrhage and acute respiratory distress syndrome. Eleven (14%) patients received corticosteroid therapy. All children made a full recovery, only one patient with nephritis continued to have hypertension at 2 years follow up. Symptoms recurred in 6 (7.7%) patients over a period ranging from one month to 2 years. CONCLUSION: Henoch-Schonlein purpura is a mild disease in the eastern province of Saudi Arabia and with no significant differences in the epidemic and clinical profile than that reported elsewhere.

A dramatic decline in university hospital admissions of acute rheumatic fever in the eastern region of Saudi Arabia.

BACKGROUNDS: Acute rheumatic fever (ARF) and its sequel, chronic valvular heart disease are the most important causes for cardiovascular morbidity and mortality worldwide and mainly in developing countries. However, the incidence of ARF has declined in developed countries during the second half of 20th century. MATERIAL AND METHODS: The case files of all patients admitted as new cases of ARF over ∼11 years and 8 months, both in pediatric and medical departments of a university hospital located in the eastern region of Saudi Arabia were reviewed. The demographic and clinical data and the frequency of the new cases were compared with the data that have been published by us 10 years ago from the same hospital during a similar period of time (11 years and 8 months). RESULTS: In the current study there was a significant decline in the frequency of admission of cases of ARF as compared to our previous study during a similar period of time, with a frequency rate of 12 cases per 100.000 hospitalizations versus 45 cases per 100.000 hospitalizations, respectively, P < 0.001. Dyspnea and chest pain as clinical features of acute rheumatic carditis (ARC) were less frequent in the current study as compared to the previous study (35% versus 44%, P = 0.02 and 10% versus 28.6%, P = 0.031). The subgroup analysis revealed also a decreased frequency of the clinical features of ARC in pediatric age group in the current study as compared to our previous study. CONCLUSION: There is a significant decline in the frequency of new hospital admissions due to ARF. This decline was associated with similar decline in the frequency of the manifestations of ARC especially in pediatric age group (1-12 years).

Anomalous origin of left coronary artery from pulmonary artery: A rare cause of myocardial infarction in children.

Anomalous origin of the left coronary artery from pulmonary artery is a rare congenital heart anomaly. It presents predominantly in infancy with clinical features of myocardial ischemia and/or congestive heart failure. It poses a clinical diagnostic challenge to family physicians and pediatricians as it may present in a way similar to common pediatric conditions such as infantile colic, food intolerance, gastroesophageal reflux, and bronchiolitis. Awareness of this condition is essential for prompt diagnosis and referral to a cardiac center for early surgical intervention and improved prognosis. This article reviews this rare but serious disease in children.

Neonatal group A streptococcal meningitis: a case report and review of the literature.

INTRODUCTION: Group A streptococcus is a rare cause of neonatal meningitis. A review of MEDLINE database since1966 revealed only 15 documented cases of group A streptococcal meningitis in neonates. CASE REPORT: A previously healthy 28 days old male neonate presented with a history of irritability, fever, and focal seizures. Cerebrospinal fluid analysis and culture confirmed the diagnosis of group A streptococcal meningitis. The clinical course was complicated by the development of brain abscess. The patient made full recovery following a surgical drainage of the abscess and a 6-week total course of antibiotics. CONCLUSION: Although it is an uncommon organism, clinician should always consider group A streptococcal infection and its potential complications in the differential diagnosis and management of neonatal meningitis.

Endocarditis prophylaxis in children with congenital heart disease. A parent's awareness.

OBJECTIVE: The aim of this study is to determine the parental knowledge of bacterial endocarditis prophylaxis (BEP). METHODS: Parents of 205 patients attending the Pediatric Cardiology Clinics at King Khalid University Hospital, Riyadh, King Fahad University Hospital, Al-Khobar and Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia from July 1999 to June 2000, were interviewed by a standard questionnaire pertaining to their knowledge of their child's cardiac disease, medications, and BEP. The patients' cardiac lesions and current medications were verified by a review of medical records. Each patient's need for BEP was determined according to American Heart Association recommendations. RESULTS: All parents answered the interview questions. The patients' mean age was 5 years and 8 months with a range of one month to 15 years. One hundred and two (50%) parents were high school graduates. Fifty-two (25%) parents correctly defined endocarditis. Two hundred and one (98%) parents knew the correct name of their child's cardiac condition, and 46/50 (92%) of those on medication knew the names of their child's current medications. Only 113/176 (64%) parents with at risk children were aware of measures to prevent endocarditis. CONCLUSION: While most parents know the name of their child's heart lesion and current medications, parental knowledge of endocarditis and BEP was limited. Intensified education and awareness programs are needed in order to prevent potential major morbidity and mortality for pediatric patients with congenital heart disease.

Mesenteric cystic teratoma in children.

Mesenteric teratoma is an extremely rare tumor, arising, akin all other teratomas, from totipotent primordial cells and displays a mixture of tissues of tridermal or bidermal origin. Two cases of mature mesenteric teratoma in a 5-month-old girl and a 4-month-old boy, the youngest reported in the literature, excluding a case recently diagnosed prenatally, are described. Diagnostic tools, differential diagnosis and management are also discussed.