Acute suppurative thyroiditis due to Streptococcus anginosus leading to sepsis and acute respiratory distress syndrome: a case report

SUMMARY Acute suppurative thyroiditis (AST) is a rare but potentially life-threatening thyroid disease with a high mortality if left untreated. Thus, differentiation from other thyroid disorders is highly important in clinical practice. A 22-year-old male patient was admitted to a tertiary care hospital with cervical pain, palpitations, thyrotoxicosis, and an inhomogeneously enlarged right thyroid lobe. In view of the clinical findings, subacute thyroiditis (SAT) was suspected and treatment with glucocorticoids was started. After initial amelioration, the patient developed cervical erythema, fever, and recurrent pain. A CT scan showed extensive phlegmonous inflammation and abscess formation, suggestive of AST. We started immediate empiric antibiotic therapy and performed surgical drainage of the abscess formations. Subsequently, the patient developed hypoxic respiratory failure, leading to ICU admission and intermittent need for non-invasive ventilation. Blood and abscess cultures were positive for Streptococcus anginosus. If left untreated, AST represents a potentially life-threatening disease. Thus, in clinically doubtful cases, liberal further assessment by means of cervical CT scans or fine needle aspiration biopsy are strongly advised.

Perceptions, risk and understandings of the COVID-19 pandemic in urban South Africa

Background: How people perceive the coronavirus disease 2019 (COVID-19) pandemic and understand their risk can influence their health, behaviours and overall livelihood. The disease's novelty and severity have elicited a range of attitudes and perspectives countrywide, which consequently influence the public's adherence to public health prevention and treatment guidelines. Aim: To investigate perceptions, experiences and knowledge on COVID-19 in a communitybased cohort study. Setting: Adults living in Soweto in South Africa's Gauteng province during the first six weeks of the national lockdown regulations (i.e. Alert Level 5 lockdown from end of March to beginning of May 2020). Methods: Participants completed a series of surveys and answered open-ended questions through telephonic interviews (n = 391). We queried their perceptions of the origins of COVID-19, understandings of the disease, personal and communal risks and its relations with the existing disease burden. Results: Findings from our sample of 391 adults show that perceptions and knowledge of COVID-19 vary across several demographic characteristics. We report moderate levels of understanding about COVID-19, prevention methods and risk, as well as exposure to major physical, psychosocial and financial stressors. Depressive symptoms, perceived infection risk and concern about COVID-19 significantly predicted COVID-19 prevention knowledge. Conclusion: Public health communication campaigns should focus on continuing to improve knowledge and reduce misinformation associated with the virus. Policymakers should consider the mental health- and non-health-related impact of the pandemic on their citizens in order to curb the pandemic in a manner that maximises well-being.

Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot

BACKGROUND: Fallot (TOF) repair, and identify predictors of intensive care unit (ICU) morbidity. METHODS: We analyzed perioperative and midterm follow-up data for all cases of primary TOF repair from 2001 to 2012. The primary endpoint was early mortality and morbidity, and the secondary endpoint was survival and functional status at follow-up. RESULTS: Ninety-seven patients underwent primary repair. The median age was 4.9 months (range, 1 to 9 months), and the median weight was 5.3 kg (range, 3.1 to 9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median length of ICU stay was 6 days (range, 2 to 21 days), and the median duration of mechanical ventilation was 19 hours (range, 0 to 136 hours). By multiple regression analysis, age and weight were independent predictors of the length of ICU stay, while the surgical era was an independent predictor of the duration of mechanical ventilation. At the 8-year follow-up, freedom from death and re-intervention was 97% and 90%, respectively. CONCLUSION: Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.

Structure of mixed ombrophyllous forests with Araucaria angustifolia (Araucariaceae) under external stress in Southern Brazil

This study is part of the Floristic and Forest inventory of Santa Catarina, conceived to evaluate forest resources, species composition and structure of forest remnants, providing information to update forest conservation and land use policy in Southern Brazilian State of Santa Catarina (95 000km²). In accordance to the Brazilian National Forest inventory (IFN-BR), the inventory applies systematic sampling, with 440 clusters containing four crosswise 1 000m² plots (20x50m) each, located on a 10x10km grid overlaid to land use map based on classification of SPOT-4 images from 2005. Within the sample units, all woody individuals of the main stratum (DBH≥10cm) are measured and collected (fertile and sterile), if not undoubtedly identified in field. Regeneration stratum (height>1.50m; DBH<10cm) is registered in 100m² in each sample unit. Floristic sampling includes collection of all fertile trees, shrubs and herbs within the sample unit and in its surroundings. This study performs analysis based on 92 clusters measured in 2008 within an area of 32 320km² of mixed ombrophyllous forests with Araucaria angustifolia located at the state’s high plateau (500m to 1 560m above sea level at 26º00’-28º30’ S and 49º13’-51º23’ W). Mean density (DBH≥10cm) is 578 individuals/ha (ranging from 85/ha to 1 310/ha), mean species richness in measured remnants is 35 (8 to 62), Shannon and Wiener diversity index (H’) varies between 1.05 and 3.48. Despite high total species diversity (364 Magnoliophyta, five Coniferophyta and one tree fern) and relatively high mean basal area (25.75m²/ha, varying from 3.87 to 68.85m²/ ha), the overwhelming majority of forest fragments are considered highly impacted and impoverished, mostly by logging, burning and extensive cattle farming, turning necessary more efficient protection measures. Basal area was considered an appropriate indicator for stand quality and conservation status. Rev. Biol. Trop. 59 (3): 1371-1387. Epub 2011 September 01.

Este estudio es parte del inventario Florístico Forestal de Santa Catarina, realizado para evaluar los recursos forestales, la composición de especies y la estructura de remanentes de bosque, y proporciona información para actualizar la conservación de los bosques y políticas de uso de la tierra en el estado brasileño de Santa Catarina (95 000km²). El inventario se aplica al muestreo sistemático, de 440 conglomerados en cuatro parcelas de 1 000m² cada una, situados en una red de 10x10km. Dentro de las parcelas, todos los individuos leñosos (DAP≥10cm) fueron medidos. El estrato de regeneración (altura>1.50m, DAP<10cm) se registra en 100m² en cada conglomerado. Este estudio realiza un análisis de 92 conglomerados medidos en 2008 dentro de un área de 32 320km² de bosques ombrófilos mixtos con Araucaria angustifolia ubicados en el altiplano del estado. La densidad media (DAP≥10cm) es de 578 individuos/ha (desde 85/ha hasta 1 310/ha), la media de la riqueza de especies en los remanentes es de 35 (8-62), la diversidad (H’) de Shannon y Wiener varía entre 1.05 y 3.48. A pesar de la alta diversidad total de especies (364 Magnoliophyta, cinco Coniferophyta y un helecho arborescente) y el alto promedio del área basal (25.75m²/ha, variando de 3.87 a 68.85m²/ha), la mayoría de los fragmentos de bosque se consideran altamente impactados por la tala, quema y ganadería extensiva, por lo tanto es necesario más medidas eficaces de protección.

Massive powder aspiration in a toddler.

We report a case of aspiration of calcium carbonate powder by a toddler. Bronchoscopic removal of aspirated contents resulted in favourable outcome.

A five-year review of referrals to the developmental pediatrics section of a major tertiary hospital

Developmental disabilities involve a delay in development based on that expected for a given age level or stage of development.1 These impairments which originate before age 18 are expected to continue indefinitely and constitute a substantial impairment that may create a burden to the family and society. In a developing country like the Philippines, it is a public health problem that remains largely undetected and neglected. Local attempts to organize more systematic diagnostic services are needed.Objectives. To review the referrals made to the Section of Developmental Pediatrics for evaluation and to describe the demographic and clinical patterns of the more common developmental disabilities identified.Methods. This was a retrospective study based on the clinical census of patients seen over a five-year period from January 2004 to December 2008 by the Section of Developmental Pediatrics.Results. Referrals made to the Section of Developmental Pediatrics were usually seen during the first decade of life, were mostly males and were usually referred for developmental delay. The three most common developmental disabilities identified were mental retardation or global developmental delay, autistic spectrum disorders and cerebral palsy.

Evaluation of a cold staining method for acid-fast bacilli in sputum.

Comparison between the Ziehl-Neelsen staining method for acid-fast bacilli, applied with and without heating, was carried out in a controlled investigation using smears prepared from 306 sputum samples collected prior to treatment from suspected cases of pulmonary tuberculosis. Smear and culture positivity were graded and the colour intensity of bacilli recorded. Results showed that the chance corrected agreement (Kappa) between Z-N and cold methods was only 78%. The sensitivity of the Z-N and cold methods were 84% and 77% respectively when compared with culture results. Assuming 10% smear positivity among symptomatics reporting to Peripheral Health Institutions (PHIs), the positive predictive value of the cold method was very low (53%). When compared to culture, the positive predictive value is 71% for the Z-N method and 57% for the cold method for a symptomatic population with 15% culture positivity. In the absence of heating, penetration of the stain was significantly reduced and consequently the number of bacilli detected was less. The inability to take the stain without heating was seen in smears from all grades of culture positive samples; thus even heavy positives were missed by the cold method. The evaluation of the cold method against the standard Z-N method highlights its limitations and demonstrates that it is not as reliable as the standard Z-N method.