Transport-related Adverse Events in Critically-ill Children: The Role of a Dedicated Transport Team.

OBJECTIVE: To compare the frequency of transport-related adverse events in children during specialized, non-specialized or unassisted transports. METHODS: Patients were grouped based on transport team involved - specialized (Group-1); non-specialized (Group-2); unassisted transport (Group-3). Demographics, events during transport and condition on arrival were recorded. RESULTS: Group-1 children had a lower incidence of adverse events compared to Group-2 and Group-3 (4.3%, 82.6% and 85.4% respectively; P<0.001). At arrival, children in Group-1 had a lower incidence of respiratory distress and airway compromise (P< 0.001). CONCLUSION: Transport of critically ill children by a specialized transport team is associated with fewer transport-related adverse events.

Acquired Toxoplasmosis Presenting with a Brainstem Granuloma in an Immunocompetent Adolescent.

BACKGROUND: Toxoplasmosis is an uncommon disease in immunocompetent people. CASE CHARACTERISTICS: We report an adolescent boy with central nervous system toxoplasmosis who presented with progressive lower cranial nerve palsies and a ring-enhancing lesion on neuroimaging. INTERVENTION: Diagnosis of toxoplasmosis was confirmed on histopathology of the excised lesion. MESSAGE: Toxoplasmosis should be considered in the differential diagnosis of focal brain lesions irrespective of immune status.

Profile of hemophagocytic lymphohistiocytosis; efficacy of intravenous immunoglobulin therapy.

OBJECTIVE: To study the profile of children with Hemophagocytic lymphohistiocytosis (HLH) and compare the outcome of treatment with intravenous immunoglobulin therapy and Dexamethasone vs. HLH-2004 protocol. METHODS: The present retrospective cohort study was conducted in a tertiary care pediatric hospital in Chennai. Children with a diagnosis of HLH admitted to the hospital from June 2008 through June 2011 were included. Medical records of the subjects were reviewed and their clinical and demographic profile studied. Difference in outcome between treatment modalities was analysed. RESULTS: Of the 40 children studied, all had fever of 38.5 °C for more than 7 d. Splenomegaly was noted in 25 children at admission, but eventually occurred in all the patients. All children had bicytopenia. Mean laboratory values were as follows- neutrophil count 3,400/cu.mm, hemoglobin 8.75 g/dl, platelet count 84,000/cu.mm, fasting triglycerides 358 mg/dl, ferritin 8,139 mg/dl and fibrinogen 137 mg/dl. All children had evidence of hemophagocytosis in bone marrow smear. Good outcome was seen in 19/22 children treated with IVIG therapy (Group 1) vs. 10/12 children treated with HLH-2004 protocol with etoposide, cyclosporine and Dexamethasone (Group 2), P = 1.00. Good outcome was seen in 4/6 children treated with IVIG therapy followed by HLH-2004 protocol (Group 3). Serum ferritin levels of more than 3,000 mg/dl were present in 13 children. In this group, good outcome was seen in 7/8 patients treated with IVIG vs. 4/5 treated with the HLH-2004 protocol (P = 1.00). CONCLUSIONS: IVIG and HLH-2004 protocol may be equally effective in the management of HLH. IVIG may be a preferable initial regimen, to avoid the risk of secondary malignancy associated with etoposide.

Stevens Johnson syndrome in association with Mycoplasma pneumonia.

Infections particularly Mycoplasma pneumoniae and HSV have been reported to be the commonest precipitating cause for Stevens Johnson syndrome (SJS) in children in developed countries and drugs are the commonest triggers reported in the Indian context. Intravenous immunoglobulin (IvIg) is emerging as a therapeutic option instead of glucocorticoids. The authors report a case of Stevens Johnson syndrome in association with Mycoplasma pneumoniae in a 5-y- old girl who recovered with IvIg therapy.