Cold-induced anaphylaxis triggered by drinking cold water.

Cold urticaria is an inducible urticaria in which hives and angioedema appear after exposure to cold. The symptoms of cold urticaria often are limited to hives/angioedema. However, in up to 20% of cases, cold exposure may trigger anaphylaxis. We report the case of an 11-year-old boy previously diagnosed with chronic spontaneous urticaria who developed facial swelling, itchy hives, difficulty in breathing, vomiting and abdominal pain within 5 minutes of drinking cold water. He received a standard dose of non-sedating second-generation antihistamines at home. He was observed in the emergency room for 2 hours and discharged with an epinephrin autoinjector. During the subsequent outpatient clinic visit, an ice cube test was performed which confirmed the new diagnosis of comorbid cold-induced chronic urticaria. On further questioning, the parents reported occurrence of hives following swimming in the swimming pool. Cold-induced urticaria should be suspected in cases of anaphylaxis associated with cold exposure. Patients with chronic forms of urticaria who present with new anaphylaxis should be assessed for a potential concomitant cold-induced form.

Cold-induced anaphylaxis triggered by drinking cold water

Cold urticaria is an inducible urticaria in which hives and angioedema appear after exposure to cold. The symptoms of cold urticaria often are limited to hives/angioedema. However, in up to 20% of cases, cold exposure may trigger anaphylaxis. We report the case of an 11-year-old boy previously diagnosed with chronic spontaneous urticaria who developed facial swelling, itchy hives, difficulty in breathing, vomiting and abdominal pain within 5 minutes of drinking cold water. He received a standard dose of non-sedating second-generation antihistamines at home. He was observed in the emergency room for 2 hours and discharged with an epinephrin autoinjector. During the subsequent outpatient clinic visit, an ice cube test was performed which confirmed the new diagnosis of comorbid cold-induced chronic urticaria. On further questioning, the parents reported occurrence of hives following swimming in the swimming pool. Cold-induced urticaria should be suspected in cases of anaphylaxis associated with cold exposure. Patients with chronic forms of urticaria who present with new anaphylaxis should be assessed for a potential concomitant cold-induced form. (AU)

Acute Kidney Injury Secondary to Rhabdomyolysis: A Case of Child Physical Abuse.

Child abuse is a challenging problem that any healthcare worker might encounter. It can lead to multiple physical and psychological effects on the child. We report a case of an eight-year-old boy who presented to the emergency department with history of decreased level of consciousness and change in urine color. On examination, he was found to be jaundiced, pale, and hypertensive (160/90 mmHg) with multiple skin abrasions all over the body, suggestive of physical abuse. Laboratory investigations were consistent with acute kidney injury and significant muscle damage. The patient was admitted to intensive care unit (ICU) as a case of acute renal failure secondary to rhabdomyolysis, and subsequently required temporary hemodialysis during his stay in the ICU. The child protective team was involved in the case throughout his hospital admission. Rhabdomyolysis with acute kidney injury secondary to child abuse is an unusual presentation in children, and reporting such cases may lead to early diagnosis and initiation of prompt interventions.

Assessment of Maternal Knowledge and Practices Regarding Acute Diarrheal Illnesses in Children in Saudi Arabia: A Tertiary Care Center Survey.

Background Diarrheal illness remains one of the most common causes of death among children specifically those who live in developing countries. Appropriate mothers' knowledge and practice regarding acute diarrhea illness in children can considerably reduce diarrhea-related morbidity and mortality. So, the aim of this study was to evaluate mothers' knowledge and practice regarding acute diarrheal illness in children. Method This cross-sectional study was conducted in a tertiary hospital in Riyadh, Saudi Arabia using a newly developed questionnaire that was distributed to King Abdullah Specialist Children. The calculated sample size was 375. Results A total of 375 mothers were included in this study and the majority of them (99%) were Saudis. More than half of the participants (61%) were university graduates. The majority (96.5%) chose previous experience as the main source of information about diarrhea while (40%) chose physician. Most of the mothers (69.6%) believed that teething is the leading cause of diarrheal illness in children. Regarding the treatment, fluid was recognized to be the major treatment for diarrhea as chosen by the mothers. Around (42.7%) of the respondents thought intravenous fluid is more effective than oral rehydration solution (ORS) in treating dehydration associated with diarrheal episodes. ORS was the main type of fluid (74.1%) which was selected by the mothers to be given during the diarrheal episode. Conclusion Mothers showed good knowledge and practice overall in regard to acute diarrheal illness in children. However, this study revealed some misconceptions among the caregivers which necessitates more educational sessions to be conducted in the community and during the hospital visit.

Are the Saudi parents aware of antibiotic role in upper respiratory tract infections in children?

Upper respiratory tract infection (URTI) is considered to be the most common reason for children's visits to emergency departments or outpatient clinics. The misuse and overuse of antibiotics are currently major public health problems worldwide. This study aimed to assess Saudi parents' knowledge, attitude, and practice (KAP) regarding the use of antibiotics in URTIs in children. This cross-sectional study was conducted in Saudi Arabia using a previously validated questionnaire, which was distributed using Twitter. A total of 385 individuals completed the questionnaire. For the majority of the participants (77%), physicians were the primary source of information regarding the use of antibiotics. Forty-four percent of parents agreed that most URTIs are caused by viruses, and 81% were aware that inappropriate use of antibiotics leads to the development of antibiotic resistance. Fever was the primary symptom (27%) that led parents to ask for prescriptions for antibiotics. Although women had a higher attitude score (p=0.01), there was no difference between genders regarding knowledge and practice. Older participants (41 years or more) had a lower attitude score (p=0.02). Furthermore, participants with five children or more had lower attitude and practice scores (p=0.006, 0.04, respectively). Participants who lived in large cities had greater knowledge compared to the inhabitants of small cities (p=0.01). In conclusion, the findings of this study demonstrated that most of the participants were educated but lacked knowledge regarding antibiotic use in URTIs in children. This lack of knowledge led to inappropriate attitude and practice. Thus, launching public educational campaigns and encouraging physicians to educate parents regarding the proper use of antibiotics are recommended.