Spinal cord Schistosomiasis: A child's case with an unsatisfactory outcome that mimicked an intramedullary neoplasm. A rare case report.

Neuroshcistosomiasis is a life-threatening complication of schistosomiasis. Its prevalence in endemic populations is believed to be underreported at 1-4%. We report a four-year-old child who came to our hospital relatively late since the presentation of weakness and incontinence. MRI revealed long segment (T12-L1) ill-defined intramedullary lesions with cord extension having patchy enhancements. Despite the administration of both praziquantel and pulse prednisolone treatment, there was no convincing result. We thus question the role of steroids and praziquantel in individuals with late-diagnosed spinal schistosomiasis.

Prevalence, Clinical Profile and Risk Factors of Nosocomial Infection in Ayder Pediatric Intensive Care Unit, Tigray, Ethiopia.

Background: Hospital-acquired infection (HAI) is a significant cause of increased morbidity and mortality amongst hospitalized patients and represents a considerable health and economic burden worldwide. However, evidence about HAI in pediatric ICU is limited. Objective: To identify the prevalence of hospital-acquired infection (HAI), clinical profile, and its risk factors for nosocomial infection in patients admitted to the pediatric intensive care unit (PICU). Methodology: From a two-year retrospective chart review admitted from 2019 to 2020 to the PICU, 223 patients were selected by systematic random sampling. Data were analyzed in SPSS version 23.0. P-values <0.05 were considered significant for all tests. Results: Forty-five (20.2%) patients developed nosocomial infection (NI). The median age was 4 years with 25-50th IQR of (0.6-9). About invasive procedures done, the most common was nasogastric tube (57%), followed by mechanical ventilation (17.9%) and urinary catheter (13.9%). The main focus of the infection was chest (53.3%), followed by bloodstream infection (22%) and gastrointestinal infection (9%). The odds of HAI were 3.3 times higher among under-five compared to those aged between 5 and 18 years (AOR: 3.3, 95% CI = 1.4-8.0, p = 0.008). The odds of HAI were also 4.1 times higher in those who stayed for more than two weeks compared to those who stayed in the pediatric ICU 2 to 14 days (AOR: 4.1, 95% CI = 2.0-8.6, p < 0.001). The mean duration of mechanical ventilation in those patients with and without NI was 1.65 days and 13.96 days, respectively (AOR = 3.46, 95% CI = 1.44-9.81, p = 0.02). Patients who started antibiotics at admission and patients who were on nasogastric tube feeding were also statistically significant risk factors for developing NI (AOR = 2.67, 95% CI = 1.37-9.64, p = 0.02; AOR = 2.45, 95% CI = 1.64-6.53, p = 0.03). Conclusion: The rate of infection in this study was higher compared to some developing countries. Younger age and prolonged length of hospital stay were found to be significant risk factors for HAI.

Zinc Monotherapy as an Alternative Treatment Option for Decompensated Liver Disease due to Wilson Disease?

BACKGROUND: Wilson disease is a rare metabolic disorder involving copper metabolism, and patients may present with a variable degree of hepatic, neurologic, and psychiatric manifestations. In the case of hepatic presentation, treatment is usually initiated with potentially toxic copper chelators (D-penicillamine or Trenton). Although zinc is of low toxicity and low cost for treatment of Wilson disease, it has been limited to the adjunctive as a single maintenance drug or for asymptomatic patients. The use of zinc monotherapy in patients suffering from a severe liver disease was not well studied. In our case report, we describe a pediatric patient who presented with liver failure and the use of zinc monotherapy in patients with severe hepatic manifestations. Case presentation. A 15-year-old male patient from Ethiopia presented with generalized body swelling (edema and ascites) with yellowish discoloration of his eyes and easy fatigability. He had hyperbilirubinemia, coagulopathy, hypoalbuminemia, and deranged liver enzymes. He had a Keyser-Fleischer ring visible with the naked eye, which was confirmed by slit-lamp examination. He had very low serum ceruloplasmin (<8 mg/L) and high 24-hour urine copper (150 mcg/dl). In accordance with the scoring system proposed by the 8th International Meeting on Wilson Disease and Menkes Disease, a diagnosis of Wilson disease was made. Zinc monotherapy with low copper diet was initiated for decompensated liver disease due to Wilson disease because of the inaccessibility of chelators (D-penicillamine or Trientine). After months of treatment with zinc, the patient experienced normalization of hepatic synthetic function and resolution of hypoalbuminemia and coagulopathy. The patient had also clinically stabilized (ascites, lower extremity swelling, edema, and jaundice were improved. Currently, the patient is on follow-up almost for the last four years in the gastrointestinal clinic. CONCLUSION: Our case shows that zinc has the potential for treatment in improving liver function. Though zinc has its own side effects, it is important and maybe an alternative treatment option in those with limited resources (not able to access chelators). This example hopefully will encourage future investigations and researches on zinc monotherapy for treating symptomatic decompensated hepatic Wilson disease.