1/4. Use of nitazoxanide as a new therapeutic option for persistent diarrhea: a pediatric perspective.Despite advances in the management of diarrheal disorders, diarrhea is the second most frequent illness in the world. Persistent diarrhea, common in community pediatrics, is often caused by organisms such as giardia lamblia, cryptosporidium parvum and, less frequently, cyclospora, isospora belli, and clostridium difficile. Identifying the causative organism is often challenging, and diagnostic tests may be inaccurate and expensive and, thus, of limited benefit. Consequently, carefully chosen empiric therapy guided by a physician's clinical impressions may be a useful and cost-effective option in children with persistent diarrhea, particularly those whose signs and symptoms suggest a protozoal etiology. This article discusses the empiric use of anti-infective nitazoxanide, a thiazolide compound, in three case reports of children with persistent diarrhea, and presents an overview of the diagnostic and therapeutic issues associated with this disorder and the pharmacodynamics and pharmacokinetics of the drug.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. A febrile child with seizure and hemiparesis.Febrile seizures are the most common neurological disorders in children and are among the more common symptoms that lead to an emergency department visit. Although most febrile seizures are simple and benign, these seizures can infrequently create a diagnostic dilemma. The diagnosis of cerebral venous thrombosis is challenging to emergency physicians because it can mimic the presentation of many other disorders, including ischemic and hemorrhagic stroke, tumor, and abscess. In addition, the broad variety of signs and symptoms makes the clinical diagnosis difficult. The patients may be presented with signs of increased intracranial pressure or focal neurological deficits. It is an uncommon but potentially dangerous cause of hemiparesis after seizure. Early recognition of this condition and appropriate management may reduce the mortality rate. We present a young child with dural sinus thrombosis who presented with seizures associated with fever and subsequent hemiparesis, and explained a possible mechanism of focal neurological deficit.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Isolated congenital enterokinase deficiency. Recent findings and review of the literature.We report a 13-mo-old patient with isolated congenital enterokinase deficiency and review the clinical features, diagnostic approach, and management of all 8 reported patients. Our patient presented with failure to thrive, diarrhea, and hypoproteinemia since birth. A normal sweat chloride with small intestinal histology, and nondetectable trypsin activity in the duodenal fluid should alert the physician to the possibility of isolated enterokinase deficiency. All reported patients, including our own, responded favorably to pancreatic enzyme replacement. in vitro studies of the small intestinal mucosal biopsy specimen suggest that enterokinase deficiency at least in part is due to altered enzymes with low enterokinase activity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Madeleine's death.Despite visits to two physicians and two hospitals within 4 days in September 1994, 7-week-old Madeleine Hunter died of flu-related dehydration. The coroner at an inquest into the baby's death said he had never seen a case in which so many things went wrong. The coroner's jury, which made 46 recommendations, determined that physicians and others involved in the care of very small infants should give "due respect to the instinct of the mother." Madeleine's mother, Georgina Hunter, recounts the story of her baby's death.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |