11 research outputs found
Unusual Tuberculosis Mimicking Connective Tissue Disease: A Pediatric Case Report
No full textWe reported a child with unusual extrapulmonary tuberculosis (TB) who was misdiagnosed with a connective tissue disease leading to treatment delay. A 13-year-old boy presented with subacute joint pain, headache and diplopia. The examination revealed swelling in the right knee, cervical lymphadenopathy, impaired abduction of right eye and multiple groups of follicular papules at right forearm, cheeks and buttocks. Blood tests showed mild anemia, thrombocytosis and high erythrocyte sedimentation rate. Serological tests including antinuclear antibody, rheumatoid factor, antidouble stranded deoxyribonucleic acid and anti-human immunodeficiency virus were negative. Brain magnetic resonance imaging (MRI) illustrated multiple lobulated dural thickening areas and a small infarction of left cerebellum. Chest film and tuberculin test were normal. Joint fluid analysis suggested reactive arthritis. Cultures for TB and fungus from cervical lymph node and forearm skin lesion were negative. After an extensive investigation, the presumptive diagnosis was non-specific connective tissue disorder. The arthritis and ophthalmoparesis initially responded to prednisolone, but arthritis relapsed at the third week of treatment, and intravenous cyclophosphamide was added. Three months later, left facial palsy had developed and ophthalmoparesis increased. New skin lesions also appeared over his axillae and groins. Axilla skin biopsy showed granulomatous abscesses with caseous necrosis leading to TB diagnosis. After treatment with anti-TB agents, clinical signs and brain MRI were completely resolved at 6- month-follow-up. Our report addressed that TB may mimic connective tissue diseases and temporarily respond to immunosuppressants. Because idiopathic pachymeningitis is rare in children, TB must be excluded in cases with meningeal thickening. Re-evaluation of TB is highly recommended in atypical systemic illnesses
Bedtime Parenting Practices Associated with Social-emotional Competence in Thai Infants
No full textObjective: We aimed to determine the association between bedtime parenting practices and infant social-emotional competence (SEC).
Material and Methods: Data from a birth cohort called: Prospective Cohort Study of Thai Children, were analyzed. Information on bedtime parenting and infant’s sleep information were collected at 3 and 12 months of age. Modified Infant-Toddler Social and Emotional Assessment (MITSEA) were used to measure the SEC at 12 months of age. All participating infants with a MITSEA score >75th percentile were classified as having high SEC. The association between bedtime parenting practices and high SEC were analyzed using multiple logistic regression.
Results: Data from 2,109 infants were analyzed (male:female=1:1). Median age of mothers was 26 years. Ninety-two percent of caregivers shared a bed with their infants, at either their 3rd- or 12th-month-visits. Two-thirds of the caregivers reported bed sharing at both visits. About 70.0% of caregivers fed their infants until the infant fell asleep, and about two-thirds responded to infant’s awakening with milk feeding. Infants who were never fed until falling asleep were more likely to have high SEC, compared with infants who were always fed until sleep (odds ratio 1.49; 95% confidence interval 1.14, 1.96). Bed sharing showed no association with a high SEC. Older, female mothers, higher socioeconomic status and quality time were associated with a high SEC.
Conclusion: The bedtime parenting practice associated with a high SEC was: “non-feeding until falling asleep”. Bed sharing, which was a popular practice in this cohort, showed no association with high SEC
An Early Hearing Detection and Intervention Program in Songklanagarind Hospital
No full textObjective: To compare the results of the universal newborn hearing screening program in Songklanagarind Hospital with the Joint Committee of Infant Hearing (JCIH) recommendations in regards to early hearing detection and intervention.
Material and Methods: We retrospectively reviewed the Early Hearing Detection and Intervention (EHDI) program results between January 2017 and June 2017. Furthermore, we calculated and compared the percentages of hearing screening, diagnostic evaluation, and rehabilitation at 1, 3, and 6 months of age.
Results: A total of 1,579 (93.1%) newborns were screened for otoacoustic emissions (OAEs). One hundred and eight (6.8%) newborns showed abnormal OAE in the first phase, and 11 (0.7%) newborns failed the OAE retest before discharge and within 1 month of age. Ten newborns (90.9%) had a hearing loss diagnosis confirmed due to a complete audiologic evaluation before 3 months of age, and 100.0% of newborns with abnormal hearing were enrolled for intervention within 6 months of age. Among the 4 newborns with abnormal hearing, 3 of them had conductive hearing loss, and one had profound sensorineural hearing loss, receiving an intervention via cochlear implant. Following intervention, all newborns with hearing loss had improved their hearing ability, speech and language development.
Conclusion: The universal newborn hearing-screening program is the first step in identifying a child with hearing problems, which leads into early intervention. The key to achieve best outcomes for the newborns is to ensure family support and the involvement of an interdisciplinary team
Predictors of Neurological Deterioration during Admission for Patients with Cerebellar Strokes
No full textObjective: Despite less common, cerebellar stroke frequently results in unfavorable outcomes, especially after deterioration. Therefore, this study was aimedto identify the significant predictors of neurological deterioration during admission (NDDA) in ischemic and hemorrhagic cerebellar strokes.
Material and Methods: We retrospectively reviewed all medical records of patients diagnosed with ischemic and hemorrhagic cerebellar strokes; during 2002-2018, in Songklanagarind Hospital. Comparison of patients’ demographic data, initial clinical presentations, neuroradiological results, timing and signs of NDDA, and outcomes between cerebellar strokes were descriptively analyzed. Logistic regression model was applied for determining the significant predictors of NDDA from initial clinical presentations.
Results: From this, 74 of 100 patients were eligible. They comprised of 42 (57.0%) cerebellar ischemia (CI) and 32 (43.0%) cerebellar hemorrhage (CH). Elevated diastolic blood pressure (DBP) and neuro-radiological evidences suggesting increased posterior cranial fossa pressure were significantly prevalent in neurological deterioration patients. NDDA was found in 31 patients (42.0%), without significant difference between CI and CH. 42 (56.8%), patients had poor neurological outcomes. The independent predictors for NDDA were DBP 120 mmHg (adjusted odds ratio [adj. OR] 15.39, 95% CI 1.58- 149.59; p-value=0.004), time from onset to arrival (adj. OR 0.98, 95% CI 0.97-1.00; p-value=0.044), and hemispheric cerebellar signs at presentation (adj. OR 0.22, 95% CI 0.06-0.75; p-value=0.012).
Conclusion: CH was not an independent predictor of NDDA in overall cerebellar strokes. Only high DBP predicted NDDA; whereas, time from onset to arrival, and hemispheric cerebellar signs at presentation showed protective impact
Viral and atypical bacterial infection in young children hospitalized due to acute lower respiratory tract infection in Southern Thailand
No full textBackground:
The etiology of acute lower respiratory tract infection (ALTI) in Thailand is not well established.
Aims:
This study aims to determine the prevalence of viral and atypical bacterial infections in young children hospitalized due to ALTI.
Settings and Design:
This was a retrospective study.
Subjects and Methods:
Eighty-two leftover nasopharyngeal specimens obtained from children with ALTI admitted from May to October 2017 in Songklanagarind Hospital were analyzed. Multiplex polymerase chain reaction and the bead hybridization method (NxTAG® Respiratory Pathogen Panel) were used to detect 18 instances of respiratory virus and atypical bacteria. The clinical data for the children were retrospectively reviewed and analyzed from the medical records.
Results:
From a total of 82 ALTI patients, 60% were male. The median (interquartile range) age was 14.8 (8.0–38.1) months. Seventy-six percent of the patients were positive for at least one viral pathogen. The three most identified pathogens were respiratory syncytial virus (RSV) B (39.0%), RSV A (20.7%), and hRV (12.2%), while atypical bacteria were not found. Patients with RSV infection had significantly higher fever on admission (P < 0.01) and a longer duration of fever (log-rank P < 0.001) compared to the non-RSV group.
Conclusions:
Viral pathogens were detected in 76% of the children hospitalized due to ALTI. Further, 79% were positive for RSV with significantly high-grade fever
Spinal muscular atrophy in an upper-middle-income nation before the advent of reimbursed disease-modifying therapies
No full textObjective To elucidate the clinical characteristics and standard of care (SoC) of spinal muscular atrophy (SMA) patients in Thailand, focusing on primary endpoints: age at death and a composite of death or tracheostomy need.Design Retrospective observational study.Setting Seven tertiary centres across Thailand.Patients Records of 110 patients with genetically confirmed SMA, spanning 2012–2021.Interventions Historical data review; no active interventions.Main outcome measures Age at death and a composite measure of death or tracheostomy necessity.Results The cohort included 1 SMA0, 50 SMA1, 40 SMA2 and 19 SMA3 cases. Median ages at the onset and diagnosis of SMA1 were 3 and 6.2 months. Of SMA1 patients, 63% required ventilators, and eight received dimethyltryptamines (DMTs) at a median of 15 months (range 6.4–24.5 months). The median time from onset to DMT was 11 months (range 4.2–20.5 months). Among SMA1 patients, 73% died by the study’s end. SMA2 and SMA3 patients' median onset ages were 11 and 24 months, respectively, with diagnosis at 24.8 and 68.7 months. Half of all types received physical therapy.Conclusions Significant delays in diagnosis and SoC access, including DMTs, were observed, underscoring urgent needs for improved diagnostic and care strategies to enhance SMA patient outcomes in Thailand
Mutation screening of the CDKL5 gene in cryptogenic infantile intractable epilepsy and review of clinical sensitivity
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Association of HLA-A and HLA-B Alleles with Lamotrigine-Induced Cutaneous Adverse Drug Reactions in the Thai Population
No full textBackground: Lamotrigine (LTG) is commonly used for treatment of epilepsy and bipolar disorder. It is one of the common cause of cutaneous adverse drug reactions (CADR). Clinical symptoms of LTG-induced CADR range from maculopapular exanthema (MPE) to severe cutaneous adverse reactions (SCAR). This study aimed to determine the association of the LTG-induced CADR with human leukocyte antigen (HLA) alleles in Thai patients.Methods: Fifteen patients with LTG-induced CADR [10 MPE; 4 Stevens–Johnson syndrome; and 1 drug reaction with eosinophilia and systemic symptoms] and 50 LTG-tolerant controls were included in the study. HLA-A and HLA-B genotyping was performed using polymerase chain reaction-sequence-specific oligonucleotides probes.Results: The proportion of HLA-A∗02:07 and HLA-B∗15:02 allele carriers were significantly higher in the LTG-induced CADR group than in the tolerant controls [odds ratio (OR): 7.83; 95% confidence interval (CI): 1.60–38.25; P = 0.013, and OR: 4.89; 95% CI: 1.28–18.67; P = 0.014]. In addition, subjects with HLA-A∗33:03, HLA-B∗15:02, and HLA-B∗44:03 were significantly higher in the LTG-induced MPE group than in the tolerant controls (OR: 8.27; 95% CI: 1.83–37.41; P = 0.005, OR: 7.33; 95% CI: 1.63–33.02; P = 0.005; and OR: 10.29; 95% CI: 1.45–72.81; P = 0.029). In contrast to the LTG-induced MPE group, there were no significant differences between HLA alleles and LTG-induced SCAR group.Conclusion:HLA-A∗02:07 and HLA-B∗15:02 were associated with LTG-induced CADR in Thai patients. We also identified an association between HLA-A∗33:03, HLA-B∗15:02, and HLA-B∗44:03 and LTG-induced MPE in this population. These results suggest that these alleles could be useful screening markers for preventing CADR before LTG treatment in Thai patients, but further replication studies with larger sample sizes are needed
Association of HLA-A and HLA-B Alleles with Lamotrigine-Induced Cutaneous Adverse Drug Reactions in the Thai Population
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