ABSTRACT
BACKGROUND: Primary hyperparathyroidism may present in a myriad of manners, varying from an incidental asymptomatic biochemical finding to gastrointestinal, psychiatric, renal, and bone manifestations. While hyperparathyroidism remains a rare diagnosis in the pediatric population, the initial approach to diagnosis and management of hypercalcemia in children is imperative for the general pediatrician. Herein, we describe an adolescent who presented with a lytic bone lesion and severe, symptomatic hypercalcemia due to primary hyperparathyroidism. CASE PRESENTATION: A 14-year-old male presented with vomiting, constipation, abdominal pain, and lethargy. He had an elevated total corrected calcium of 4.3 mmol/L. He was found to have a large pelvic lytic tumor consistent with a brown tumor due to primary hyperparathyroidism. He received pharmacologic therapy for stabilization of his hypercalcemia, including intravenous saline, intravenous bisphosphonates, and calcitonin. He subsequently received definitive therapy via parathyroidectomy and his post-operative course was complicated by hungry bone syndrome. Long-term follow-up has found full resolution of the lytic lesion and restored calcium homeostasis. CONCLUSIONS: We present this case to highlight the possible presentations of hypercalcemia and hyperparathyroidism that are essential for a general pediatrician to recognize to ensure prompt diagnosis and management. Evaluation for hypercalcemia should be considered in patients with suggestive symptoms and physical exam findings. To our knowledge, this patient represents the first reported pediatric case of a pelvic brown tumor in an adolescent. While the multi-systemic complications of hyperparathyroidism may be quite severe, swift and appropriate management may mitigate these clinical outcomes.
Subject(s)
Hypercalcemia , Hyperparathyroidism, Primary , Osteitis Fibrosa Cystica , Parathyroid Neoplasms , Adolescent , Child , Humans , Hypercalcemia/diagnosis , Hypercalcemia/etiology , Hyperparathyroidism, Primary/complications , Hyperparathyroidism, Primary/diagnosis , Male , Osteitis Fibrosa Cystica/diagnosis , Osteitis Fibrosa Cystica/etiology , Osteitis Fibrosa Cystica/surgery , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/surgery , ParathyroidectomySubject(s)
Allied Health Personnel , Radiographic Image Enhancement , Child , Humans , Radiation Dosage , South AfricaABSTRACT
INTRODUCTION: Digital radiography (DR) poses the risk of unnoticed increases in patient dose, potentially resulting in the overexposure of paediatric patients. In some jurisdictions, there is a shortfall in the knowledge and application of safe paediatric radiation dose protocols. In such instances, radiographers can lack an understanding of the relationship between exposure index (EI) and the visual appearances of image noise, thereby resulting in under- or overexposure to the paediatric patient. METHODS: A quantitative, descriptive research study was conducted at six purposively selected diagnostic radiology departments in Gauteng, South Africa. The study was based on a 29-item questionnaire seeking to quantify the radiographers' knowledge of paediatric radiation dose protocols and whether their knowledge translated into safe radiation dose practice. RESULTS: A 94% (61/65) response rate was achieved. Results show a low number of respondents (35, 57%) expressed a positive opinion of their knowledge of paediatric radiation dose protocols and EI; however, 41 (67%) participants were unaware of the function of EI. CONCLUSION: The study revealed that, in Gauteng, there is an increased demand for further training in paediatric radiation dose protocols and a need for radiographers to improve awareness of exposure factors. IMPLICATIONS FOR PRACTICE: Improving radiographers' lack of knowledge of paediatric radiation dose protocols in Gauteng is important. It is essential that radiographers receive continuous training and education highlighting the importance of justification and optimisation of radiological examinations.
Subject(s)
Allied Health Personnel , Health Knowledge, Attitudes, Practice , Radiation Dosage , Radiographic Image Enhancement , Child , Female , Humans , Male , South Africa , Surveys and QuestionnairesABSTRACT
BACKGROUND: Medical equipment can transmit pathogenic bacteria to patients. This single-institution point prevalence study aimed to characterise the types and relative amount of bacteria found on surgical loupes, headlights and their battery packs. METHOD: Surgical loupes, headlights and battery packs of 16 otolaryngology staff and residents were sampled, cultured and quantified. Plate scores were summed for each equipment type, and the total was divided by the number of users to generate mean bacterial burden scores. Residents completed a questionnaire regarding their equipment cleaning practices. RESULTS: The contamination rates of loupes, headlights and battery packs were 68.75 per cent, 100 per cent and 75 per cent, respectively. Battery packs cultured more bacteria (1.58 per swab ± 1.00) than loupes (0.75 per swab ± 0.66; p = 0.024). Headlights had non-significantly greater growth (1.50 per swab ± 0.71) than loupes (p = 0.052). Bacterial growth was significantly higher from inner surfaces of loupes (p = 0.035) and headlights (p = 0.037). Potentially pathogenic bacteria were cultured from the equipment of five participants, including: Pantoea agglomerans, Acinetobacter radioresistens, Staphylococcus aureus, Acinetobacter calcoaceticus baumannii complex and Moraxella osloensis. CONCLUSION: This study demonstrates that surgical loupes and headlights used in otolaryngology harbour non-pathogenic skin flora and potentially pathogenic bacteria.
