Postinfectious Glomerulonephritis and Epstein-Barr Virus Co-Infection

Contrary to group A b-hemolytic streptococcus as the most common cause of postinfectious glomerulonephritis (PIGN), Epstein-Barr virus (EBV) is only occasionally associated with acute renal involvement. We describe an 11-year-old boy who presented with clinical signs of infective mononucleosis and acute glomerulonephritis characterized by edema, hypertension and dark colored urine with diminished renal function. Serology tests confirmed streptococcal infection and acute EBV infection. Persistently depressed C3 complement and gross hematuria indicated renal biopsy which shows PIGN-type picture and, in addition, acute interstitial nephritis, both conclusive of streptococcal infection. We performed tissue DNA extraction by polymerase chain reaction (PCR) and demonstrated EBV-DNA from the kidney specimen supporting EBV involvement in renal tissue. This is the first reported case of PIGN with serologically-proven streptococcal and simultaneously, acute EBV co-infection. EBV-DNA extraction supported the EBV involvement in renal tissue suggesting that both etiologic agents might have contributed to renal inflammation. Adding serology evaluation for EBV in cases with typical clinical signs of infective mononucleosis and renal symptoms, EBV might be more commonly associated with PIGN than is currently appreciated

CRIB II score versus gestational age and birth weight in preterm infant mortality prediction: who will win the bet?

Introduction. In neonatology, various illness severity scores have been developed to predict mortality and morbidity risk in neonates. The aim of our study was to validate the ability of the ‘Clinical Risk Index for Babies’ (CRIB) II score to predict mortality in neonates born before 32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU), setting. Materials and Methods. Prospective birth cohort study including all live-born neonates of 32 weeks’ gestation or less. . CRIB II score was calculated and the predicted mortality was compared with the observed mortality. Discrimination (the ability of the score to correctly predict survival or death) was assessed by calculating the receiver operating characteristic curve (ROC curve) and its associated area under the curve (AUC). Results. The ROC curve analysis in our study showed that the AUC was 0.9008 suggesting that mortality prediction was 90% accurate for all infants. Sensitivity and specificity were 77% and 88% respectively. In our study population, the CRIB II score appears to be more accurate than gestational age and birth weight in predicting mortality. Conclusions. The CRIB II scoring system is a useful tool for predicting mortality and morbidity in NICUs, and also a useful tool for evaluating the variations in mortality and other outcomes seen between different NICUs

Pediatric Idiopathic Intracranial Hypertension: Clinical and Demographic Features

Idiopathic intracranial hypertension (IIH) is a clinical condition characterized by elevated intracranial pressure and absence of clinical, laboratory or radiographic evidence of central nervous system infection, vascular malformation, intracranial space occupying lesion or hydrocephalus. In the last years the raising understanding of pediatric IIH, especially concerning its demographics and epidemiology, has brought up to a redefinition of diagnostic criteria and reevaluation of pathogenesis and treatment. The authors reviewed the records of nineteen consecutive children with newly diagnosed IIH in order to compare demographic characteristics, clinical pictures and ophthalmologic aspects as optic disc evaluation and visual field evaluation, as well as treatment modalities and follow up. Beside obesity and female gender, potential alternative risk factors remains to be investigated, which need a good collaboration between neuroophthalmologists and pediatric neurologists

Febrile seizures : guidelines in children with first seizure associated with fever

Febrilne konvulzije (FC) najzastupljenija su neurološka manifestacija ranog djetinjstva sa stopom pojavnosti od 2 do 3%. Visoko su dobno determinirane sa vrhom incidencije u drugoj godini života. Najčešće se radi o tipičnim ili jednostavnim FC karakteriziranim kratkotrajnim, generaliziranim napadima u psihomotorno zdravog djeteta, za razliku od atipičnih ili složenih FC u kojih je napad dugotrajan, unilateralan sa mogućom trajnom ili prolaznom neurološkom abnormalnošću. Febrilne konvulzije pokazuju sklonost ponavljanja koja se kreću od 20 do 50%. Rizik za kasnije javljanje afebrilnih napada je od 3 do 20%. Najvažniji nasljedni epileptički sindrom povezan s febrilnim konvulzijama je generalizirana epilepsija febrilne konvulzije plus (GEFC+). Dugotrajna antikonvulzivna profilaksa sa ciljem sprečavanja febrilnih recidiva u većini slučajeva nije preporučljiva budući da su FC u pravilu benigni poremećaj ranog djetinjstva.Febrile seizures are the most frequent neurological manifestation in early childhood with an incidence of 2% - 3%. They are highly age-specific with the peak of incidence at the age of two years. Usually they present as typical or simple febrile seizures characterised by short-term, generalised fits in a psychomotorically well child. Far more seldom are the atypical or complex febrile seizures characterised by a long-lasting, unilateral seizure with possible transitory or permanent neurological damage. The febrile seizures are prone to recidivism, which could occur in 20 to 50 percent of cases. The risk for subsequent afebrile seizures is 3 to 20%. The most important inherited epileptic syndrome linked to febrile seizures is the GEFC+. Longterm anticonvulsive prophylaxis aiming at avoiding febrile recidives is not recommended since febrile seizures are normally benign alterations of early childhood seizures

Postinfectious Glomerulonephritis and Epstein-Barr Virus Co-Infection

Contrary to group A b-hemolytic streptococcus as the most common cause of postinfectious glomerulonephritis (PIGN), Epstein-Barr virus (EBV) is only occasionally associated with acute renal involvement. We describe an 11-year-old boy who presented with clinical signs of infective mononucleosis and acute glomerulonephritis characterized by edema, hypertension and dark colored urine with diminished renal function. Serology tests confirmed streptococcal infection and acute EBV infection. Persistently depressed C3 complement and gross hematuria indicated renal biopsy which shows PIGN-type picture and, in addition, acute interstitial nephritis, both conclusive of streptococcal infection. We performed tissue DNA extraction by polymerase chain reaction (PCR) and demonstrated EBV-DNA from the kidney specimen supporting EBV involvement in renal tissue. This is the first reported case of PIGN with serologically-proven streptococcal and simultaneously, acute EBV co-infection. EBV-DNA extraction supported the EBV involvement in renal tissue suggesting that both etiologic agents might have contributed to renal inflammation. Adding serology evaluation for EBV in cases with typical clinical signs of infective mononucleosis and renal symptoms, EBV might be more commonly associated with PIGN than is currently appreciated

Febrile seizures : guidelines in children with first seizure associated with fever

Febrilne konvulzije (FC) najzastupljenija su neurološka manifestacija ranog djetinjstva sa stopom pojavnosti od 2 do 3%. Visoko su dobno determinirane sa vrhom incidencije u drugoj godini života. Najčešće se radi o tipičnim ili jednostavnim FC karakteriziranim kratkotrajnim, generaliziranim napadima u psihomotorno zdravog djeteta, za razliku od atipičnih ili složenih FC u kojih je napad dugotrajan, unilateralan sa mogućom trajnom ili prolaznom neurološkom abnormalnošću. Febrilne konvulzije pokazuju sklonost ponavljanja koja se kreću od 20 do 50%. Rizik za kasnije javljanje afebrilnih napada je od 3 do 20%. Najvažniji nasljedni epileptički sindrom povezan s febrilnim konvulzijama je generalizirana epilepsija febrilne konvulzije plus (GEFC+). Dugotrajna antikonvulzivna profilaksa sa ciljem sprečavanja febrilnih recidiva u većini slučajeva nije preporučljiva budući da su FC u pravilu benigni poremećaj ranog djetinjstva.Febrile seizures are the most frequent neurological manifestation in early childhood with an incidence of 2% - 3%. They are highly age-specific with the peak of incidence at the age of two years. Usually they present as typical or simple febrile seizures characterised by short-term, generalised fits in a psychomotorically well child. Far more seldom are the atypical or complex febrile seizures characterised by a long-lasting, unilateral seizure with possible transitory or permanent neurological damage. The febrile seizures are prone to recidivism, which could occur in 20 to 50 percent of cases. The risk for subsequent afebrile seizures is 3 to 20%. The most important inherited epileptic syndrome linked to febrile seizures is the GEFC+. Longterm anticonvulsive prophylaxis aiming at avoiding febrile recidives is not recommended since febrile seizures are normally benign alterations of early childhood seizures

CRIB II score versus gestational age and birth weight in preterm infant mortality prediction: who will win the bet?

Introduction. In neonatology, various illness severity scores have been developed to predict mortality and morbidity risk in neonates. The aim of our study was to validate the ability of the ‘Clinical Risk Index for Babies’ (CRIB) II score to predict mortality in neonates born before 32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU), setting. Materials and Methods. Prospective birth cohort study including all live-born neonates of 32 weeks’ gestation or less. . CRIB II score was calculated and the predicted mortality was compared with the observed mortality. Discrimination (the ability of the score to correctly predict survival or death) was assessed by calculating the receiver operating characteristic curve (ROC curve) and its associated area under the curve (AUC). Results. The ROC curve analysis in our study showed that the AUC was 0.9008 suggesting that mortality prediction was 90% accurate for all infants. Sensitivity and specificity were 77% and 88% respectively. In our study population, the CRIB II score appears to be more accurate than gestational age and birth weight in predicting mortality. Conclusions. The CRIB II scoring system is a useful tool for predicting mortality and morbidity in NICUs, and also a useful tool for evaluating the variations in mortality and other outcomes seen between different NICUs

CRIB II score versus gestational age and birth weight in preterm infant mortality prediction: who will win the bet?

Introduction. In neonatology, various illness severity scores have been developed to predict mortality and morbidity risk in neonates. The aim of our study was to validate the ability of the ‘Clinical Risk Index for Babies’ (CRIB) II score to predict mortality in neonates born before 32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU), setting. Materials and Methods. Prospective birth cohort study including all live-born neonates of 32 weeks’ gestation or less. . CRIB II score was calculated and the predicted mortality was compared with the observed mortality. Discrimination (the ability of the score to correctly predict survival or death) was assessed by calculating the receiver operating characteristic curve (ROC curve) and its associated area under the curve (AUC). Results. The ROC curve analysis in our study showed that the AUC was 0.9008 suggesting that mortality prediction was 90% accurate for all infants. Sensitivity and specificity were 77% and 88% respectively. In our study population, the CRIB II score appears to be more accurate than gestational age and birth weight in predicting mortality. Conclusions. The CRIB II scoring system is a useful tool for predicting mortality and morbidity in NICUs, and also a useful tool for evaluating the variations in mortality and other outcomes seen between different NICUs

Mediastinal tube placement in a premature infant with cardiorespiratory derangement due to ventilator associated pneumomediastinum

While mediastinal free air in the ventilated newborn is usually benign, tension pneumomediastinum can lead to further cardiorespiratory compromise due to the compression of mediastinal structures, including the heart and large blood vessels. The authors present a case of life-threatening pneumomediastinum in a ventilated preterm leading to abrupt onset of cardiorespiratory failure. An 8 French (Fr) drainage catheter was placed in the anterior mediastinum using the 2nd right intercostal space as an insertion site, with prompt hemodynamic improvement. A brief description of the drainage technique and a literature review is presented