Levodopa treatment of late onset extrapyramidal movements in a child after high voltage electrocution.

We present the case of a 12-year-old girl with abnormal extrapyramidal movements associated with basal ganglia lesions after electrical injury. After her injury, our patient initially did well and recovered from acute cardiovascular and hemodynamic instability, and the results of her neurological examination, head computed tomography scan, and electroencephalogram were normal on discharge from hospital. Two weeks after discharge, she developed extrapyramidal movements, and head magnetic resonance imaging showed areas of bilateral, symmetrical enhanced associated with signal intensity in the basal ganglia, hypoxic encephalopathy, and cerebral edema that may have occurred secondary to the cardiopulmonary arrest that she suffered immediately after her accident. The symptoms disappeared after low dose levodopa was instituted and have not recurred during the 15 months of treatment. Injury and death from electric current, although rare, are not uncommon and occur mostly as a result of accidental contact with a live wire. This is the first case report documenting the use of levodopa for extrapyramidal movements secondary to high-tension electrocution.

High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit: a predictive model of mortality.

OBJECTIVE: To describe the clinical characteristics and outcome of patients admitted to pediatric intensive care with influenza A (pH1N1) 2009 in Argentina. DESIGN: Retrospective observational study. SETTING: Thirteen pediatric intensive care units in Argentina. SUBJECTS: One hundred and forty-two patients with confirmed or suspected influenza A (H1N1). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 142 critically ill patients. The median age was 19 months (range, 2-110 months) with 39% of the patients <24 months of age. Ninety-nine patients (70%) had an underlying disease. Influenza A (pH1N1) 2009 infection was confirmed in 90 patients and the remaining 52 had a positive direct immunofluorescence assay for influenza A. The median length of stay in the pediatric intensive care unit was 12 days (range, 2-52 days). One hundred eighteen patients (83%) received invasive mechanical ventilation and 19 patients were treated with noninvasive ventilation; however, seven of the patients receiving noninvasive ventilation later needed mechanical ventilation. Sixty-eight patients died (47%) with the most frequent cause refractory hypoxemia. Multivariate logistic regression analysis showed that age <24 months (odds ratio, 2.87; 2.35-3.93), asthma (odds ratio, 1.34; 1.20-2.91), and respiratory coinfection with respiratory syncytial virus (odds ratio, 2.92; 1.20-4.10) were associated with higher mortality. As expected, mechanical ventilation and treatment with inotropes were also associated with increased mortality. CONCLUSIONS: The mortality of children admitted to the pediatric intensive care unit with 2009 pH1N1 influenza was high (47%) in our population. Age <24 months, asthma, respiratory coinfection, need of mechanical ventilation, and treatment with inotropes were predictors of poorer outcome.

Severe Staphylococcus aureus infection in three pediatric intensive care units: analysis of cases of necrotizing pneumonia.

Staphylococcus aureus frequently affects human beings. Among clinical manifestations, necrotizing pneumonia is associated with a high mortality rate. Our objective is to describe the progress of severe Staphylococcus aureus infections in three intensive care units and analyze cases ofnecrotizing pneumonia in the period ranging from January 2011 to March 2013. Forty-three patients were studied, 76.7% had a community-acquired infection, and 31 had community-acquired methicillin-resistant Staphylococcus aureus. The main reason for admission was respiratory failure. Bacteremia was confirmed in 55.8% of cases. Mechanical ventilation was required in 86% of admitted patients, while 27 patients developed septic shock. The length of stay in the intensive care unit was 13 (5-25) days, and the mortality rate was 14%. Necrotizing pneumonia was observed in 51% of cases. Conclusion. A high rate of community-acquired infection was identified. Necrotizing pneumonia was associated with a worse clinical course.

Infección grave por Staphylococcus aureus en tres unidades de cuidados intensivos pediátricos. Análisis de los casos de neumonía necrotizante / Severe Staphylococcus aureus infection in three pediatric intensive care units. Analysis of cases of necrotizing pneumonia

El Staphylococcus aureus afecta frecuentemente al ser humano. Dentro de las manifestaciones clínicas, la neumonía necrotizante se asocia a una alta mortalidad. Nuestro objetivo es describir la evolución de las infecciones graves por Staphylococcus aureus en tres unidades de terapia intensiva pediátricas y analizar los casos de neumonía necrotizante en el período del 01-2011 al 03-2013. Se analizaron 43 pacientes; 76,7% presentaron infección adquirida en la comunidad, y en 31 fue por Staphylococcus aureus resistente a la meticilina adquirido en la comunidad. El principal motivo de ingreso fue la claudicación respiratoria. Se documentó bacteriemia en el 55,8% de los casos. El 86% de los ingresos requirieron asistencia respiratoria mecánica y 27 pacientes desarrollaron shock séptico. La estadía en la unidad de terapia intensiva fue de 13 (5-25) días, y la mortalidad, del 14%. La neumonía necrotizante estuvo presente en el 51% de los casos. Conclusión. Se identificó una alta proporción de infección adquirida en la comunidad. La neumonía necrotizante se asociócon una peor evolución.

Staphylococcus aureus frequently affects human beings. Among clinical manifestations, necrotizing pneumonia is associated with a high mortality rate. Our objective is to describe the progress of severe Staphylococcus aureus infections in three intensive care units and analyze cases of necrotizing pneumonia in the period ranging from January 2011 to March 2013. Forty- three patients were studied, 76.7% had a community-acquired infection, and 31 had community-acquired methicillin-resistant Staphylococcus aureus. The main reason for admission was respiratory failure. Bacteremia was confirmed in 55.8% of cases. Mechanical ventilation was required in 86% of admitted patients, while 27 patients developed septic shock. The length of stay in the intensive care unit was 13 (5-25) days, and the mortality rate was 14%. Necrotizing pneumonia was observed in 51% of cases. Conclusion. A high rate of community-acquired infection was identified. Necrotizing pneumonia was associated with a worse clinical course.