Multisystem inflammatory syndrome in children (MIS-C) has been observed in temporal association with coronavirus disease 2019 (COVID-19), typically within 2 to 6 weeks of illness or exposure. We present a case of MIS-C occurring 16 weeks after initial COVID-19 illness to highlight the prolonged period of risk for developing MIS-C.
Because pediatric cardiologists can accurately diagnose innocent murmurs by physical exam alone, the authors developed a system for remote cardiac auscultation. They hypothesized that their system could accurately classify auscultatory findings as normal/innocent or pathologic. Patients undergoing evaluation underwent examination, echocardiography, and heart sound recording. Pediatric cardiologists evaluated the heart sounds and classified the case as either normal/innocent or pathologic. They reviewed103 heart sound data sets; 85% of the cases were accurately classified as either normal/innocent or pathologic, with a sensitivity of 82% and specificity of 86%. However, when accounting for clinical diagnosis, reviewer uncertainty, and ECG abnormalities, the sensitivity and specificity improved to 91% and 88% (accuracy 89%), respectively. Degree of certainty with the telecardiology diagnosis correlated with correct interpretation (P < .005). Digital heart sound recordings evaluated via telemedicine can distinguish normal/innocent murmurs from pathologic ones. Such a system could improve the use of pediatric cardiology services.
Generalized arterial calcification of infancy (GACI) is a rare genetic disorder consisting of diffuse arterial calcification and intimal proliferation. The disease typically results in progressive arterial stenosis and frequently leads to death from myocardial ischemia by 6 months of life. Affected infants are usually diagnosed before birth or in the neonatal period with symptoms of congestive heart failure. Therapy with bisphosphonate has been used to treat the condition, but with inconsistent results. The disease is associated with mutations in ENPP1 in the majority of the cases. Here we report a unique case of GACI associated with in utero meconium peritonitis and without coding region mutations of the ENPP1 gene. GACI should be considered in the differential diagnosis in infants presenting with arterial calcifications and congenital anomalies of the gastrointestinal tract.
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