<b><i>Introduction:</i></b> COVID-19 has caused approximately one million deaths worldwide as of November 24, 2020. Markers of disease activity like ferritin, C-reactive protein (CRP), and D-dimers are frequently monitored to detect the best opportunity for intensive treatment. <b><i>Methods:</i></b> All patients of >18 years of age were included. The primary variables of interest, ferritin, CRP, and D-dimers, for each patient throughout hospitalization were recorded. Primary clinical outcomes of length of stay in ICU and survival were recorded. <b><i>Demographics:</i></b> age, gender, BMI, and nationality. Ferritin, CRP, and D-dimers were recorded daily if available for the whole ICU stay, and all other variables were recorded on admission day to ICU. <b><i>Results:</i></b> The sample includes 235 records. More than 95% of patients have all markers on the day of admission to ICU were ferritin (median 1,278; IQR 1,424), D-dimer 1.21 (3.4), and CRP 129.5 (121). Daily average levels of markers were different from their admission day level: ferritin 1,395 (1,331), D-dimer 3.11 (5.52), and CRP 107 (75.8). Multiple logistic regression analysis determined that average CRP during the stay was the only predictor of survival. <b><i>Discussion:</i></b> Data on markers utilization to detect the acute phase of inflammation help clinicians focus on the opportunity window for intensive treatment. <b><i>Conclusion:</i></b> Average CRP during the stay in ICU is higher than CRP on admission. Average CRP is the only factor that predicts survival.
Staphylococci are gram-positive bacteria divided into coagulase positive and coagulase negative classes, Staphylococcus aureus is the most important bacterium of this class. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) has changed a lot. It is no more the problem of only hospitalised patients. Children coming from community has also been increasingly affected by MRSA-called community acquired methicillin-resistant (CA-MRSA) infection. The higher severity of CA-MRSA is due to its ability to produce the toxin Panton-Valentine Leukocidin (PVL) associated with staphylococcal cassette chromosome mec (SCCmec) type IV gene. Here, we are presenting five cases of CA-MRSA infection in children having age range 0.5 months to 11 years. All of them had invasive MRSA infection finally diagnosed as causing empyema thoracis, infective endocarditis, psoas abscess and necrotising fasciitis. Early surgical intervention, quick microbiological recognition of the pathogen, and appropriate antimicrobial therapy helped save their lives.
A 4-month-old, previously healthy boy presented with acute onset of prolonged, recurrent seizure activity followed by neurodevelopmental deterioration and concurrent hair shaft hypopigmentation with fragility. Initial evaluation revealed significant low serum copper and ceruloplasmin, electrical status epilepticus on electroencephalography, and generalized subcortical white matter changes with diffuse tortuosity of intracranial vessels on MRI brain. In addition, a genetic study with whole-genome sequencing demonstrated a hemizygous pathogenic variant at c.2179G>A p(Gly727Arg) on ATP7A, thereby confirming the diagnosis of Menkes disease. Symptomatic treatment with antiepileptic medications was provided along with an urgent referral to an advanced center for multidisciplinary care and copper histidine replacement therapy.
Several studies have linked the presence of anti-NMDA receptor autoimmune encephalitis to the development of new-onset psychiatric symptoms. As psychiatric symptoms may predominate at the onset or over the course of the disease, the diagnosis is frequently delayed. Patient prognosis depends on the speed of disease detection, identification, and management. The case presented in this report shows a patient with psychiatric manifestation discovered to have anti-NMDA receptor encephalitis. Late diagnosis of anti-NMDA receptor encephalitis caused her condition to deteriorate. Therefore, we underline the importance of consid ering anti-NMDA receptor encephalitis as part of the differential diagnosis in any case presenting with first-time emotional lability or any other psychiatric finding.
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