Presenting Complaint In Children Research Articles

Aphasia as the initial manifestation of herpes encephalitis

Pediatric acquired aphasia is an uncommon presenting complaint in children. Because of many etiologies that may prove fatal, it is essential to take immediate essential steps for diagnoses and treatment. We are presenting a 9-year-old child who was conscious, alert and did not have any other systemic findings at presentation. After initial and then more extensive workup, he was diagnosed with herpes encephalitis. Acyclovir has been started as empirical antiviral therapy. In the course of disease, he developed status epilepticus that was controlled with multi anti-epileptic drugs. Intravenous acyclovir continued for 21 days, and anti-epilepticus medicines were given at discharge.

Investigating the correlation between serum folic acid level and febrile seizures in children: A clinical study

Introduction: Febrile seizure (FS) is a highly frequent presenting complaint in children. It is defined as a seizure that occurs in children between 6 to 60 months related to a fever of 38°C or more without any other explanatory causes of seizure such as evidence of central nervous system (CNS) infection or a previous seizure without fever. The aim od study is to evaluate mean folic acid serum levels in febrile children with or without seizures.Methods: The mean folic acid serum levels and demographic data of 100 children aged 6 to 60 months, admitted to the Ghaem Hospital of Mashhad, Iran in 2018-2019, were collected, where the patients with febrile seizure were considered as the case group and the febrile ones without seizure as the control group. The inclusion criteria were children aged 6 to 60 months with febrile seizures who were admitted to the pediatric ward. The exclusion criteria were having a past medical history of seizure, meningitis, or encephalitis.Results: There were 49 febrile convulsive children (cases) and 51 febrile children without a seizure (controls). The mean serum folic acid level was 7.07 and 9.89 ng/ml for cases and controls respectively (P-value < 0.001).Conclusion: Children with febrile seizures had significantly lower serum folic acid levels than febrile children without a seizure.

Are mechanical and chemical trauma the reason of meatal stenosis after newborn circumcision?

Mechanical and chemical trauma are a widely accepted theories to explain the pathogenesis of meatalstenosis after newborn circumcision. The aim of the present study was to explore the theory that an exposed glans is prone to meatal stenosis. This was done by a novel investigation of boys who were born with "hooded prepuce", a condition in which the glans is completely exposed. Physical examination, lower urinary tract symptoms, urethral meatus configuration, and surgical procedures of 18 children admitted for routine circumcision, who had congenital hooded prepuce with normally located urethral meatus, were analyzed. The study period was 2013 and 2018. All the cases have been seen because of neonatal circumcision request, but was postponed due to hooded prepuce. The only presenting complaint in children was a cosmetically unattractive appearance. There were no symptoms associated with meatal stenosis, they circumcised in an average of 6 years and non of them required any additional procedure.Conclusion: Meatal stenosis did not occur in cases whose glans penis are naked with hooded prepuce. These findings do not support the default chemical and mechanical trauma theories. Hooded prepuce without any penile anomalies is only a cosmetically unattractive appearance and circumcision can correct this. What is known: • The common theory of meatal stenosis etiology is that the meatus undergoes irritation with chemical/mechanical trauma in the absence of a prepuce after newborn circumcision. • Circumcision is usually postponed in newborns with hooded prepuce. What is new: • We did not notice meatal stenosis in cases whose urethral meatus were not covered with a prepuce congenitally. Ammoniacal dermatitis or mechanical trauma theories may not explain the cause of meatal stenosis. • Hooded prepuce is not a handicap to newborn circumcision. It is just a cosmetic problem and circumcision can solve it.

Esophageal polyps in pediatric patients undergoing routine diagnostic upper gastrointestinal endoscopy: a multicenter study

Esophageal polyps are uncommon findings in pediatric patients, and reports have been limited to case reports. Esophageal polyps have been previously ascribed to esophagitis secondary to gastroesophageal reflux, medications, infections and recurrent vomiting. They have been associated with underlying conditions such as hiatal hernia, Barrett's esophagus, eosinophilic esophagitis and Crohn's disease. Presenting complaints of children with esophageal polyps have included vomiting, dysphagia, hematemesis and abdominal pain. The aim of this paper is to characterize the incidence, clinical presentation and progression, histologic subtypes and associated mucosal abnormalities in children with esophageal polyps. A retrospective multicenter study was performed at four institutions identifying diagnosis of esophageal polyps in pediatric patients (<21 years). Information was obtained from patient charts, endoscopy reports and histopathology reports. Specimens and slides were examined by experienced pediatric pathologists for all included cases. Esophageal polyps were identified in 13 patients (9 M) from 9438 esophagogastroduodenoscopies (0.14%). Mean age of subjects was 9.2 years. Vomiting was the most common indication for endoscopy. Polyp location was at the gastroesophageal junction in 7 of the 13 cases. Most polyps were inflammatory (n = 7). Esophagitis was noted in 69% of those with esophageal polyps. Repeat endoscopies in six patients at a mean interval of 8 months noted persistence of polyps in all six patients. This paper is the first to characterize esophageal polyps in pediatrics. These polyps are rare in children and often are associated with esophagitis. Presenting complaints seem to vary by age. Polyps did not consistently change with either time or acid suppression. The optimal management strategy has yet to be defined and likely depends on the underlying pathophysiologic process.

The presenting complaints of children with severe malaria

Background: Severe malaria (SM) remains a major health problem confronting the people of Sub-Sahara Africa, where children under five years of age are at great risk. Aims: To document the presenting complaints of children with this life-threatening disease, with the ultimate aim of identifying non-laboratory criteria for the grading of case severity of SM. Material and Methods: The study documented the presenting complaints of 155 Niger Delta children whose disease conditions fulfilled the 2000 World Health Organization (WHO) criteria for severe malaria. The required data were extracted from the hospital records of the patients of two Nigerian tertiary hospitals. Results: A total of eight most common presenting complaints were identified, namely fever (100%), anemia (86%), vomiting (54%), convulsion (43%), impaired consciousness/coma (43%), cough (36%), respiratory distress (28%) and prostration (19%). In addition, the presenting complaint-related fatality rates were calculated. Overall severe malaria mortality was 10.3%. Conclusion: The data obtained from this study will be used, in the next stage of our study, in formulating a non-laboratory method of grading SM in children.

Motor delay : cerebral palsy

Motor delay, when present, is usually the first concern brought by the parents of children with developmental delay. Cerebral palsy that is the most common motor delay, is a nonspecific, descriptive term pertaining to disordered motor function that is evident in early infancy and is characterized by changes in muscle tone, muscle weakness, involuntary movements, ataxia, or a combination of these abnormalities. A wide range of causative disorders and risk factors have been identified for cerebral palsy, and broadly classified into 5 groups; perinatal brain injury, brain injury related to prematurity, developmental abnormalities, prenatal risk factors, and postnatal brain injury. Delay in attaining developmental milestones is the most distinctive presenting complaint in children with cerebral palsy. A detailed history and thorough physical and neurologic examinations are crucial in the diagnostic process. The clinician should be cautious about diagnostic pronouncement unless the findings are unequivocal. Several serial examinations and history review are necessary. All children with cerebral palsy should undergo a neuroimaging study, preferably MRI, because an abnormality is documented on head MRI(89%) and CT(77%). The high incidence rates for mental retardation, epilepsy, ophthalmologic defects, speech and language disorders and hearing impairment make it imperative that all children with cerebral palsy be screened for mental retardation, ophthalmologic and hearing impairments, and speech and language disorders; nutrition, growth, and swallowing also should be closely monitored