Cases of infection with hypervirulent Klebsiella pneumoniae are gradually increasing in number, and cause life-threatening community-acquired infection even in immunocompetent patients. A 14-year-old boy developed septic hip arthritis due to hypervirulent K. pneumoniae (sequence type 23, serotype K1, magA positive). The patient initially seemed to have been successfully treated with antibiotics and surgical intervention, but septic arthritis developed into osteomyelitis of the femoral head and myositis, which required long-term antibiotic therapy and additional surgical intervention. This is the first pediatric case of hypervirulent K. pneumoniae septic hip arthritis. Treatment plans should mainly consist of antibiotic therapy and surgical intervention. Clinicians, even pediatricians, in developed countries should be aware of the increasing incidence of hypervirulent Klebsiella pneumoniae infection.
Objective: This study was undertaken to evaluate the efficacy, safety, and economic impact of diazepam suppositories with as-needed acetaminophen in comparison with as-needed acetaminophen alone for prevention of seizure recurrence during the same fever episode in suspected pediatric simple febrile seizures (SFS).Methods: This single-center, prospective, observational study was conducted from July 29, 2019 to February 15, 2021 at a children's hospital. Children aged 6 months to 60 months presenting to the emergency department with suspected SFS were included. Participants receiving both diazepam suppositories and asneeded acetaminophen were compared with those receiving as-needed acetaminophen alone. The primary outcome was seizure recurrence during the same fever episode. The secondary outcomes included the incidence of central nervous system (CNS) pathologies, adverse events, and medical costs. Results: Of the 316 participants, 228 (72.2%) had their first febrile seizure. Diazepam (.3-.5 mg/kg for up to two doses) was administered to 88 of 316 patients (27.8%). The outcomes were available for 306 patients. The recurrence rate was 3.5% (3/85) in the patients receiving diazepam with as-needed acetaminophen and 12.2% (27/221) in the patients receiving as-needed acetaminophen alone (relative risk = .29, 95% confidence interval [CI] = .09-.93, p = .03). The adjusted odds ratio of diazepam administration against recurrence was .23 (95% CI = .07-.78, p = .02). None of the patients had a CNS pathology. No severe adverse events occurred, although mild ataxia was observed significantly more often in
| 1705TANAKA et al.
BackgroundPediatric emergency physicians in Japan commonly experience cases of trauma resulting from the infant falling from the arms or the back of the parent while the latter is operating a bicycle. However, the clinical features and dynamic mechanisms of these injuries are unclear.Methods1. We conducted a retrospective case-series enrolling children younger than 1 year of age who received head injuries. We reviewed the charts of such patients who visited Tokyo Metropolitan Children’s Medical Center between April 2014 and March 2016. We then extracted patients injured by falling from the arms or the back of the parent while the latter was operating a bicycle. 2. We conducted dynamics experiment by recreating the circumstances of the accident using dummies representing a 6-month-old infant being carried on the back of the mother. We assessed the Head Injury Criterion (HIC) score and the maximum impact load on the head of the dummy infant at the time of the fall. In addition, we videotaped the moment of impact on the head using a high-speed camera.Findings1. We found eight patients with an injury due to this mechanism, six of whom were sent home with the diagnosis of minor head injury. However, two patients required intensive care, one of whom experienced neurological sequelae. 2. The HIC scores varied 2998 to 6019 or 7.7 to 17.0 times the reference values for 6-month-old infants. The maximum impact load varied from 6984 to 8920N or 2.26 to 3.47 times the estimated reference value (2569N)ConclusionsOur study revealed that the impact on the head of infants due to this accident mechanism far exceeded the reference value for skull fractures and could result in severe head injuries. Preventive strategies including legislation and the development of baby child seats for the safe transport of infants are needed.
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.