Introduction: Encephalitis is a life-threatening neurological condition with multiple causes in the setting of Human Immunodeficiency Virus (HIV). CD8 Encephalitis (CD8E) is a newly recognised condition which can present in an acute manner, with pertinent features including classical radiological findings with an intense brain parenchymal infiltration of CD8+ T cells. This review attempted to clarify the symptomatology, distribution and determinants of this condition, as well as to examine its vast unknowns. Methods: A literature review was undertaken in July 2022, utilising the PubMed and Google Scholar databases. Papers published between 2006–2022 were reviewed. Eighteen papers, totalling 57 patients, were found and analysed. Statistical analysis was undertaken using Chi-squared and Wilcoxon rank-sum tests as appropriate, with p < 0.05 deemed significant. Results: In this review, 57 patients were identified, with a female (61%, 34/56) and Black African (70%, 40/57) preponderance. Females were more likely to present with headache (p = 0.006), and headache was more likely to be present in those who died (p = 0.02). There was no statistically significant association between baseline CD4 count (p = 0.079) and viral load (p = 0.72) with disease outcome. Overall, 77% (41/53) of patients had classical imaging findings, including bilateral gadolinium-enhancing punctate and perivascular white matter lesions. However, many patients (23/57) required a brain biopsy as part of their diagnostic workup. Corticosteroid treatment was commonly prescribed in patients (64%, 35/55) and had a mortality benefit, with an overall survival in this group of 71% (p = 0.0008). In those who died, median survival was 5.5 months. In rare instances, recurrence of the disease was noted, which responded poorly to treatment. Discussion: CD8E represents a new and complex condition with few risk factors identified for its occurrence. The presenting symptoms are broad, but headache appears to be more common in females and more significantly associated with death. Though rare, CD8E is likely under-diagnosed, possibly due to overlapping features with other illnesses and lack of physician experience in its recognition and management. Corticosteroids demonstrate a clear mortality benefit, but more studies are required to determine their optimal dosing and duration, as well as the use of steroid-sparing agents. Further reviews should help to better determine the risk factors for the condition, as well as non-invasive biomarkers, to aid in diagnosis and help to predict poor prognosis and disease recurrence.
Introduction RCPCH allergy care pathways recommend use of either RAST or skin prick testing for diagnosis only when there is clinical suspicion of allergy. Pathways further recommend use of measurements of skin prick and specific IgE test results to optimise the timing of food challenges. This audit aimed to compare our practice against national standards. Method A retrospective analysis of all notes for food challenges between May 2013–May 2014 was undertaken. Total of 29 food challenges were identified. Results More than half of our patients were males. Majority of the patients (69%) had RAST test done at time of diagnosis. 7% of patients had both skin prick and RAST done. However, 21% of allergy patients did not have any test done at time of diagnosis and diagnosis was made on history only. In regards to food challenge, more then half of patients were aged 8 years or above at time of challenge. Only 66% of patients passed food challenge. 79% of patients have either RAST or Skin prick test done prior to challenge. 21% of our patients had no form of testing prior to challenge. Of all patients who passed challenge 53% of patients have both tests done in contrast to all patients who failed challenge only 30% have both tests done. All patients who had both tests negative passed the food challenge. All the patients who failed the challenge had a positive RAST test prior to challenge. Recommendations An allergy clinic proforma was introduced as an aide–memoir to facilitate appropriate testing at diagnosis and prior to challenge. Failed food challenges bring disappointment for child, parents and unnecessary burden on NHS budget. Choosing the right patient is the key to prevent failed challenges, hence, referral process for challenges was re evaluated and now clinicians will make sure that both tests are done prior to food challenges. We aim to re audit in six months.
We aimed to retrospectively analyse emergency department records to examine the nature of paediatric dog bite incidences, demographics, management, and child safeguarding actions. Methods This was a retrospective case series review of routinely collected data, reviewing electronic notes of emergency departments attendances coded for animal bites, stings, or wounds, between 1st May 2013 and 31st of May 2014.The audit was registered with the audit department, ethics committee approval was not required.We obtained records for 193 patients between 0 and 17 years of age. 33 patients were excluded (17%), 7 due to insufficient documents, 19 due to bites from other animals, and 7 reattendances. Results 160 patients were analysed, the mean age was 9.4 years of age, with 66 female (41%) and 94 male (59%).There were 105 injuries to the limbs and 50 facial injuries. Most injuries occurred within the family home (n = 43) or in a public place (n = 43). The commonest culprit was the family's own dog (n = 47), the next commonest being a relative's dog (n = 22).135 patients received antibiotics, and 17 required referral to other specialities.There were 3 safeguarding referrals to social services within the department, and 4 referrals to health visitors by clinicians.However the trust employs paediatric liaison nurses who retrospectively review notes and take further actions if there are child protection issues. The paediatric liaison team made 32 referrals to school nurses and 21 referrals to health visitors, though no social services safeguarding referrals. Conclusion Our study suggests children attending emergency departments with dog bites are commonly attacked by the family dog within the family home. There was a low overall rate of child safeguarding actions taken though the trust paediatric liason team made more referrals than clinicians.As a result of this audit we will update our online emergency department guidelines for clinicians. Moreover, we will distributea patient information leaflet including advice regarding supervision of children around dogs. Aims Anaphylaxis Care Pathways were introduced by RCPCH in 2011 to help health services achieve adequate standards of Abstract G96(P) Figure 1 Results of retrospective review G98(P)ANAPHYLAXIS Abstracts A42Arch Dis Child 2015;100(Suppl 3):A1-A288
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.