New insights into development and mortality of COVID-19-associated pulmonary aspergillosis in a homogenous cohort of 1161 intensive care patients.

BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA) has been widely reported but homogenous large cohort studies are needed to gain real-world insights about the disease. METHODS: We collected clinical and laboratory data of 1161 patients hospitalised at our Institute from March 2020 to August 2021, defined their CAPA pathology, and analysed the data of CAPA/non-CAPA and deceased/survived CAPA patients using univariable and multivariable models. RESULTS: The overall prevalence and mortality of CAPA in our homogenous cohort of 1161 patients were 6.4% and 47.3%, respectively. The mortality of CAPA was higher than that of non-CAPA patients (hazard ratio: 1.8 [95% confidence interval: 1.1-2.8]). Diabetes (odds ratio [OR] 1.92 [1.15-3.21]); persistent fever (2.54 [1.17-5.53]); hemoptysis (7.91 [4.45-14.06]); and lung lesions of cavitation (8.78 [2.27-34.03]), consolidation (9.06 [2.03-40.39]), and nodules (8.26 [2.39-28.58]) were associated with development of CAPA by multivariable analysis. Acute respiratory distress syndrome (ARDS) (2.68 [1.09-6.55]), a high computed tomography score index (OR 1.18 [1.08-1.29]; p < .001), and pulse glucocorticoid treatment (HR 4.0 [1.3-9.2]) were associated with mortality of the disease. Whereas neutrophilic leukocytosis (development: 1.09 [1.03-1.15] and mortality: 1.17 [1.08-1.28]) and lymphopenia (development: 0.68 [0.51-0.91] and mortality: 0.40 [0.20-0.83]) were associated with the development as well as mortality of CAPA. CONCLUSION: We observed a low but likely underestimated prevalence of CAPA in our study. CAPA is a disease with high mortality and diabetes is a significant factor for its development while ARDS and pulse glucocorticoid treatment are significant factors for its mortality. Cellular immune dysregulation may have a central role in CAPA from its development to mortality.

Management challenges in a child with hyperinsulinemic hypoglycemia.

Malignant insulinoma is very rare in children. Herein, we present a case of a child with malignant insulinoma along with islet cell hyperplasia. She initially presented with features of hyperinsulinemic hypoglycemia at 18 mo of age. Magnetic resonance imaging (MRI) of the abdomen showed a mass at the junction of the head and body of the pancreas. The tumor was enucleated. Five months later symptoms of hypoglycemia recurred. A subtotal pancreatectomy was performed. She continued to have hypoglycemia, although less frequently. She was put on increasing doses of diazoxide. Seven months later, MRI of the abdomen and a PET scan revealed metastatic deposits in the liver, which were confirmed by histopathology and immunostaining. To the best of our knowledge, this is the youngest child with metastatic insulinoma reported so far.

Evaluation of dilated upper renal tracts by technetium-99m ethylenedicysteine F+O diuresis renography in infants and children.

AIM: To evaluate the feasibility of modifying diuresis renography by the simultaneous administration of Tc-99m ethylenedicysteine and furosemide in the investigation of hydronephrosis and hydroureteronephrosis in infants and children. Parameters assessed were the diuretic response in normal kidneys and the ability of the F+0 study to differentiate between renal obstruction and nonobstruction. METHODS: One hundred and thirty-three children (93 males, 40 females; mean age 35.2 months) with sonographic diagnoses of hydronephrosis or hydroureteronephrosis underwent F+0 diuresis renography. Tc-99m ethylenedicysteine (3.7 MBq/kg body weight) and furosemide at an appropriate dose were administered intravenously at the start of the study. Posterior imaging of the kidneys and bladder was performed for 20 min followed by imaging after voiding. All patients were followed-up for 12 months, and the results of the initial F+0 diuresis renography were compared with the final diagnoses. Final diagnosis was based on the pediatric urologist's decision of either surgery or conservative management. RESULTS: A renal unit was defined as a kidney and its ureter. There were 262 renal units with 4 patients having a solitary kidney. 90 normal and 172 abnormal renal units on sonography were assessed by F+0 diuresis renography. The furosemide clearance half time for the 90 normal renal units was 5.8 +/- 1.4 min. Of the 172 abnormal renal units, 100 were classified as nonobstructed and 72 as obstructed on diuresis renography. All 100 nonobstructed renal units were correctly classified with no false-negative studies; of the 72 renal units classified as obstructed, there were 43 true-positive studies and 29 false-positive studies. The sensitivity was 100%, specificity was 78% and accuracy was 83%. CONCLUSION: Tc-99m ethylenedicysteine F+0 diuresis renography is a valid method for the investigation of hydronephrosis and hydroureteronephrosis in infants and children.