Immunocompromised Children with Severe Adenoviral Respiratory Infection

Purpose. To investigate the impact of severe respiratory adenoviral infection on morbidity and case fatality in immunocompromised children. Methods. Combined retrospective-prospective cohort study of patients admitted to the intensive care unit (ICU) in four children’s hospitals with severe adenoviral respiratory infection and an immunocompromised state between August 2009 and October 2013. We performed a secondary case control analysis, matching our cohort 1 : 1 by age and severity of illness score with immunocompetent patients also with severe respiratory adenoviral infection. Results. Nineteen immunocompromised patients were included in our analysis. Eleven patients (58%) did not survive to hospital discharge. Case fatality was associated with cause of immunocompromised state (p=0.015), multiple organ dysfunction syndrome (p=0.001), requirement of renal replacement therapy (p=0.01), ICU admission severity of illness score (p=0.011), and treatment with cidofovir (p=0.005). Immunocompromised patients were more likely than matched controls to have multiple organ dysfunction syndrome (p=0.01), require renal replacement therapy (p=0.02), and not survive to hospital discharge (p=0.004). One year after infection, 43% of immunocompromised survivors required chronic mechanical ventilator support. Conclusions. There is substantial case fatality as well as short- and long-term morbidity associated with severe adenoviral respiratory infection in immunocompromised children

Encephalitis and cytokine storm secondary to respiratory viruses in children: Two case reports

Introduction Encephalitis is a syndrome characterized by brain damage secondary to an inflammatory process that is manifested by cognitive impairment and altered cerebral spinal fluid analysis; it may evolve with seizures and coma. Despite viral infections representing the main cause of encephalitis in children, respiratory syncytial virus (RSV) and parainfluenza virus are mostly associated with respiratory presentations. Uncommonly, the inflammatory phenomena from encephalitis secondary to viral agents may present with an exacerbated host response, the so-called cytokine storm. The link between these infectious agents and neurologic syndromes resulting in a cytokine storm is rare, and the underlying pathophysiology is still poorly understood. Case presentation A 5-year-old girl and a 2-year-old boy infected with parainfluenza and RSV, respectively, were identified through nasopharyngeal polymerase chain reaction. They were admitted into the pediatric intensive care unit due to encephalitis and multiple organ dysfunction manifested with seizures and hemodynamic instability. Magnetic resonance imaging findings from the first patient revealed a bilateral hypersignal on fluid-attenuated inversion recovery in the cerebral hemispheres, especially in the posterior parietal and occipital regions. The girl also had elevated IL-6 levels during the acute phase and evolved with a fast recovery of the clinical presentations. The second patient progressed with general systemic complications followed by cerebral edema and death. Conclusion Encephalitis secondary to respiratory viral infection might evolve with cytokine storm and multiorgan inflammatory response in children

Encephalitis and cytokine storm secondary to respiratory viruses in children: Two case reports

IntroductionEncephalitis is a syndrome characterized by brain damage secondary to an inflammatory process that is manifested by cognitive impairment and altered cerebral spinal fluid analysis; it may evolve with seizures and coma. Despite viral infections representing the main cause of encephalitis in children, respiratory syncytial virus (RSV) and parainfluenza virus are mostly associated with respiratory presentations. Uncommonly, the inflammatory phenomena from encephalitis secondary to viral agents may present with an exacerbated host response, the so-called cytokine storm. The link between these infectious agents and neurologic syndromes resulting in a cytokine storm is rare, and the underlying pathophysiology is still poorly understood.Case presentationA 5-year-old girl and a 2-year-old boy infected with parainfluenza and RSV, respectively, were identified through nasopharyngeal polymerase chain reaction. They were admitted into the pediatric intensive care unit due to encephalitis and multiple organ dysfunction manifested with seizures and hemodynamic instability. Magnetic resonance imaging findings from the first patient revealed a bilateral hypersignal on fluid-attenuated inversion recovery in the cerebral hemispheres, especially in the posterior parietal and occipital regions. The girl also had elevated IL-6 levels during the acute phase and evolved with a fast recovery of the clinical presentations. The second patient progressed with general systemic complications followed by cerebral edema and death.ConclusionEncephalitis secondary to respiratory viral infection might evolve with cytokine storm and multiorgan inflammatory response in children

The Harriet Lane Handbook

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Mental Health Illness and Frontier Community Public Stigma: Impacts of Disclosure Regarding Overall Well-being

Prior and ongoing research in the realm of mental illness and stigma has indicated there is an increase of individuals who are stigmatized. Most research conducted concerning mental illness and public stigma has been focused on urban population samples. The purpose of our research was to focus on the aspect of how public stigma of mental illness in a frontier community (the "cowboy up" mentality for example) affects an individual's biopsychosocial and spiritual well-being after being diagnosed with a mental illness. Our study aims to discover and analyze how public stigma might influence an individual's actual or perceived quality of life after diagnosis. This phenomenological study represents a continual journey of understanding between frontier macro-community philosophy and opinions regarding mental illness and a micro outlook of quality of life concerns. The findings from this study can inform frontier community members of how public stigma affects people who have a mental illness diagnosis, assist professionals in the helping professions to reduce mental illness stigma, and reduce the stigma of mental illness to improve the quality of life of those individuals who have been diagnosed with a mental illness

Bedside Rounds in Intensive Care Units during the COVID-19 Pandemic and Beyond

AbstractA survey-based pilot study was performed to examine the feasibility of videoconferencing to facilitate multidisciplinary rounds following the initiation of strict isolation and social distancing policies in a pediatric intensive care unit (PICU). The use of a mobile workstation was implemented as the central hub for rounding at the bedside by the attending physicians, while other members of the multidisciplinary and multispecialty team joined rounds from other locations with maintaining appropriate social distance. Fifty-eight staff members who participated in videoconferencing rounds completed the postimplementation survey. Eighty-eight per cent of staff agreed that the use of videoconferencing to facilitate rounds was an effective strategy to maintain social distancing between team members during the pandemic. Sixty-four percent of staff agreed that the use of videoconferencing improved participation of the PICU team and consultants by increasing access to rounds. Over 50% of staff agreed that the use of videoconferencing improved the efficiency of rounds and team productivity. Only 4% of staff responded that videoconferencing increased the duration of rounds and 37% responded that it decreased resident and team education. Fifty-five percent of staff agreed that videoconferencing was used to promote parental participation during this pandemic month. Videoconferencing was found to be a feasible solution to safely conduct multidisciplinary rounds while maintaining social distancing, and participants found it effective without interfering with normal workflow. Incorporating videoconferencing into traditional rounding practices may be advantageous following the pandemic to improve team and family access to rounds and workflow efficiency and rounding structure.</jats:p