Background:
Takotsubo cardiomyopathy (TCM) has some distinctive features like greater proportion of reverse-TCM and disease of central nervous system as a prevalent triggering cause. We expose the case of a child with cardiogenic shock presenting an atypical echocardiographic TCM pattern on echocardiography, after an acute neurologic trigger. We also include a systematic review of the literature of previously described cases of atypical-TCM in children.
Case Report:
A previously healthy 9 year-old boy with status epilepticus who presented abrupt cardiogenic shock. The EKG showed signs of myocardial ischemia, cardiac biomarkers NT-proBNP (2756 pg/mL ) and Troponin I (1707 pg/mL ) were raised, and echocardiography exposed a dilated LV with severely reduced systolic function (LVEF 28%) along with hypokinetic mid-basal segments (circumferential ballooning) and preserved hypercontractile apical segments, with normal origin of both coronary arterial systems. A presumptive diagnosis of “reverse”, “inverse” or atypical Takotsubo cardiomyopathy was build based on the echocardiographic findings, apart from the ACS-like EKG findings, the raised cardiac biomarkers and the neurological trigger of the hypercatecholaminergic state. Despite cardiovascular improvement with supportive treatment, the patient eventually expired on day 2 after PICU admission due to neurological complications. As shown in our systematic review, only 19 similar cases have been reported to date.
Conclusion:
With the report of this unusual case, we aim to point out the fundamental role of bedside echocardiography as diagnostic test for critically ill children presenting with ACS-like in the context of neurosurgical emergencies, where bedside echocardiography itself can accurately establish a presumptive diagnosis of TCM.
Background
Patients with paediatric Inflammatory Bowel Diseases (p-IBD) and their families widely use the Internet as a resource and tend to read the first page of 10 results. However, online content may be of questionable quality, and valuable information may be hard to find. This study aimed to (i) determine the average quality of online information on p-IBD and (ii) analyze whether it depends on the source of information.
Methods
A google search was performed on the 28 October 2019 using the keywords: ‘Crohn’s disease’, ‘ulcerative colitis’, ‘Inflammatory Bowel Disease’, ‘colonoscopy’, ‘endoscopy’, all of them combined with the terms ‘paediatric’ and ‘children’. We recorded the first 10 results for each search and excluded scientific papers, advertisements, videos and sites requiring subscription. Websites were classified according to their origin as hospital, professional society, government agency, health press or patient organisations. The quality of the information was assessed with the DISCERN instrument, a validated 16-point questionnaire (total score 16–80) to evaluate the quality of written information. DISCERN scores were graded as excellent (68–80), good (55–67), fair (42–54), poor (29–41) or very poor (16–28). In order to minimise subjectivity, four evaluators assessed the quality, and the mean total score was calculated for every selected website. The proportion of websites with excellent or good grading in each category was compared using the Fisher test.
Results
We identified 100 websites and 65 met the inclusion criteria. The type of authorship and DISCERN scores are shown in Table 1. The overall median DISCERN score was 40.8 [interquartile range, IQR 10.5]. Only 5 websites had an excellent or good score. The proportion of websites with excellent or good grading was significantly higher in those from government agencies and professional societies (33.3% and 30% vs. 2% and 0%, p < 0.05). None of the health press websites showed excellent or good grading. Surprisingly, no websites from patient organisations were identified.
Conclusion
The quality of online information on p-IBD is highly variable. Most of the easily found websites are from hospitals, but professional societies and government agencies provide a higher quality of information. Improvement of online information on p-IBD is still needed.
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