Eighteen-year-old man with syncope with Helicobacter pylori as the culprit: a case report.

Helicobacter pylori (H. pylori) is amongst the most common chronic bacterial infection in humans. Pediatric patients appear to differ from their adult counterparts in terms of the prevalence, the complication rate, and the rate of antibiotic resistance. In this report, we present an 18-year-old man without any past medical history who was evaluated after an episode of syncope. Evaluation revealed a case of chronic H. pylori gastritis leading to gastrointestinal (GI) bleeding and weight loss, and his syncope was the byproduct of symptomatic anemia and physical exertion. Pediatricians should think of peptic ulcer disease (PUD) in evaluating poor weight gain/feeding in younger patients, and abdominal pain in older patients. Early diagnosis can prevent complications such as perforation, bleeding and obstruction. Endoscopy is the gold standard of diagnosis for H. pylori infection. Noninvasive testing with urease breath test and stool antigen test is reserved for post-treatment testing only. Treatment consists of a 14-day course of a proton-pump inhibitor (PPI) and amoxicillin. A third agent, either clarithromycin or metronidazole, is added depending on regional resistance patterns. Testing for eradication at least 4 weeks later is recommended. This case serves as a reminder to primary care providers to be aware of H. pylori infection, diagnosis, treatment and complications.

Bartonella endocarditis in patients with right ventricle-to-pulmonary artery conduit: 2 case reports and literature review.

Bartonella species are Gram-negative bacilli and fastidious bacteria that can cause a number of clinical syndromes, including blood culture-negative infective endocarditis (IE). The two most commonly isolated species in humans are Bartonella quintana, the agent of trench fever, and Bartonella henselae, mostly known for causing cat scratch disease (Edouard et al., 2015 [1]; Edouard and Raoult, 2010 [2]). Both species also cause bacillary angiomatosis, primarily in immunocompromised patients (Edouard et al., 2015 [1]; Fournier et al., 2001 [3]). The risk of B. henselae IE is increased in patients with cardiac valvular disease and congenital heart disease (CHD) (Edouard and Raoult, 2010 [2]; Das et al., 2009 [4]; Abandeh et al., 2012 [5]; Ouellette et al., 2016 [6]; Hoffman et al., 2007 [7]; Georgievskaya et al., 2014 [8]). In this article, we detail two cases of Bartonella IE in patients with right ventricle-to-pulmonary artery (RV-PA) conduits who presented to our institution. We also perform a literature review on Bartonella IE in patients with a history of RV-PA conduit or pulmonary valve replacement.

A meta-analysis of transcatheter device closure of perimembranous ventricular septal defect.

BACKGROUND: While transcatheter device closure of ventricular septal defects (VSDs) is gaining popularity, concerns remain about adverse events; particularly heart block in peri-membranous VSDs (pmVSDs). The aim of this study is to ascertain outcomes of transcatheter device closure of pmVSDs through a meta-analysis of current literature. METHODS: A PubMed and Scopus search for studies in English on device closure of pmVSDs published till end-February 2017 was performed. Exclusion criteria included case series already included in multi-centre studies, sample size <5, and VSD acquired following myocardial infarction. Pooled estimates of success and complications was obtained using the random effects model. RESULTS: A total of 54 publications comprising 6762 patients with pmVSDs were included. The mean age of patients ranged from 1.6 to 37.4years. The pooled estimate of successful device implantation is 97.8% (95% CI: 96.8 to 98.6). The most common complication is residual shunt (15.9%; 95% CI: 10.9 to 21.5). Other complications include arrhythmias (10.3%; 95% CI: 8.3 to 12.4) and valvular defects (4.1%; 95% CI: 2.4 to 6.1). The pooled estimate of complete atrioventricular block (cAVB) is 1.1% (95% CI: 0.5 to 1.9). CONCLUSION: Our meta-analysis suggests that device closure of pmVSDs is a safe and effective procedure. The complication of cAVB is low but significant. The risk is expected to further reduce with newer devices which are less stiff with improved profiles. Further studies validating this will be useful in formulating guidelines for device closure of pmVSDs.

Risk Factors for Mortality in Asian Children Admitted to the Paediatric Intensive Care Unit after Haematopoietic Stem Cell Transplantation.

INTRODUCTION: This study aimed to investigate the risk factors associated with mortality in haematopoietic stem cell transplant (HSCT) patients admitted to our paediatric intensive care unit (PICU) over an 8-year period. MATERIALS AND METHODS: A retrospective chart review was conducted of all HSCT patients requiring PICU admission at our centre (a tertiary care university hospital in Singapore) from January 2002 to December 2010. Chief outcome measures were survival at the time of PICU discharge and survival at 6 months after initial PICU admission. RESULTS: Ninety-eight patients underwent HSCT during this period; 18 patients (18%) required 24 PICU admissions post-HSCT. The overall survival to PICU discharge was 62.5%. Of those who survived discharge from the PICU, 33% died within 6 months of discharge. Non-survivors to PICU discharge had a higher incidence of sepsis (89% vs 33%, P = 0.013) and organ failure as compared to survivors (cardiovascular failure 100% vs 20%, P = 0.0003; respiratory failure 89% vs 20%, P = 0.002; and renal failure 44% vs 7%, P = 0.047). Mortality rates were higher in patients requiring mechanical ventilation (70% vs 14%, P = 0.010) and inotropic support (70% vs 14%, P = 0.010). Mortality in all patients with renal failure requiring haemodialysis (n = 4) was 100%. Presence of 3 or more organ failures was associated with 80% mortality (P = 0.003). CONCLUSION: Sepsis, multiple organ failure and the need for mechanical ventilation, inotropes and especially haemodialysis were associated with increased risk of mortality in our cohort of HSCT patients.