RESUMO
Myasthaenia gravis [MG] is an autoimmune disease involving the postsynaptic receptors in the neuromuscular junction. The condition is characterised by fatigable weakness of the skeletal muscles and is uncommon in children. Acetylcholinesterase inhibitors and immune-modifying medications are usually considered the mainstay of treatment. However, these medications have to be given on a lifelong basis so that patients remain in remission; furthermore, drug-related side-effects can have a major impact on quality of life. We report two paediatric cases who were treated for MG at the Sultan Qaboos University Hospital, Muscat, Oman, in 2007 and 2008, respectively. Rituximab was eventually administered to each patient after their condition failed to improve despite several years of standard treatment with acetylcholinesterase inhibitors and immune-modifying medications. Overall, rituximab resulted in complete remission in one case and significant clinical improvement in the other case
RESUMO
Objectives: Most children presenting with febrile illness require a blood culture to determine the causative organism as well as its sensitivity to antibiotics. However, false-positive results lead to unnecessary hospitalisations, prescriptions and tests. This study aimed to evaluate the impact of false-positive blood cultures among a paediatric population at a tertiary hospital in Oman
Methods: This retrospective study included all 225 children <13 years old with positive blood cultures who presented to the Sultan Qaboos University Hospital, Muscat, Oman, between July 2011 and December 2013. Blood cultures were reviewed to determine whether they were true-positive or contaminated
Results: A total of 344 positive blood cultures were recorded during the study period, of which 185 [53.8%] were true-positive and 159 [46.2%] were contaminated. Most true-positive isolates [26.5%] were coagulase-negative Staphylococcus spp. [CONS] followed by Escherichia coli [9.7%], while the majority of contaminated isolates were CONS [67.9%] followed by Streptococcus spp. [6.9%]. Children with contaminated cultures were significantly younger [P <0.001] while those with true-positive cultures required significantly more frequent hospital admissions, longer hospital stays and more frequent antibiotic prescriptions [P <0.001 each]. Chronic illness and mortality was significantly more frequent among those with true-positive cultures [P <0.001 and 0.04, respectively]. While white blood cell and absolute neutrophil counts were significantly higher in truepositive cultures [P <0.001 each], there was no significant difference in C-reactive protein [CRP] level [P = 0.791]
Conclusion: In this population, CRP level was not an adequate marker to differentiate between true- and falsepositive cultures. A dedicated well-trained phlebotomy team for paediatric patients is essential