Klebsiella pneumoniae-infected hemorrhagic ulcerative infantile hemangioma: A rare complication.

Key Clinical Message: Infections in infantile hemangiomas (IHs) are generally limited, and only few cases have been reported. The rapid expansion of an ulcerated IH should raise concern for possible complications to monitor and provide immediate therapeutic interventions. This case highlights the importance of prompt treatment in large segmental IHs to prevent ulceration and related complications, including bleeding and superinfection. Abstract: IH is a benign tumor proliferating during early infancy. While many IHs spontaneously resolve, complications like ulceration, bleeding, and potential damage to vital organs can occur, leading to pain, infection, and scarring. A 6-month-old girl with a previously treated IH on her left leg developed a Klebsiella-infected ulcer at the site. The ulcer resulted from non-standard treatments used before admission. Upon hospitalization, she was initially treated with cefepime and propranolol, but a week later, the wound culture revealed Klebsiella pneumoniae, prompting a switch to piperacillin/tazobactam. After successfully managing the infection and bleeding, the child was discharged in good condition with orders to continue treatment with propranolol for at least a year. This case highlights the potential of IHs to become infected even with uncommon germs such as Klebsiella and the importance of receiving appropriate medical care to prevent further complications.

Predisposing Factors and Clinical-Microbiological Profile of Neonatal Corneal Ulcer: A Systematic Review and Analysis.

OBJECTIVE: To provide a comprehensive overview of predisposing factors and clinical-microbiological profile of neonatal corneal ulcer. METHODS: The literature search was undertaken in PubMed, SCOPUS, Embase, Web of Science, and Google Scholar databases on published papers from inception to May 31, 2023. The included articles were independently assessed for methodological quality using a Joanna Briggs Institute checklist. Weighted analysis was utilized, assigning a weight of one to each case report and a weight equivalent to the sample size for the case series/original studies. RESULT: We included 34 relevant case reports/series and one original study. Seventy-four neonates were enrolled with a boy-to-girl ratio of 1.3:1 and a median age of 17 days (1-27 days). Prematurity and neonatal intensive care unit (NICU) care (21.6%), congenital horizontal tarsal kink (13.5%), neonatal herpes infection (13.5%), congenital entropion (5.4%), and jaundice (5.4%) were the most common potential risk factors and coexisting conditions. Microbiology evaluation showed positive results in 53.8% (21/39 cases). Viral and bacterial infections were the most common cause, followed by fungal infections. Herpes virus (18.9%), Pseudomonas aeruginosa (18.9%%) and Staphylococcus epidermidis (6.7%) were the most prevalent causative agents. Negative microbiology was significantly more common in neonates with structural abnormalities (14.9%) compared to others (6.8%) (p = 0.01). CONCLUSION: Based on the findings of reported studies, this systematic review has increased awareness of the risk factors and etiologies that lead to developing corneal ulcers in neonates.

Lipid accumulation product and visceral adiposity index for incidence of cardiovascular diseases and mortality; results from 13 years follow-up in Isfahan cohort study.

Background: /Aims: Visceral adiposity index (VAI) and lipid accumulation product (LAP) are novel anthropometric indices that have shown an association with metabolic syndrome; however, limited data are available regarding the predictive performance of these indices for the incidence of cardiovascular diseases (CVD) and mortality. Methods: This study was performed on the data retrieved from Isfahan Cohort Study (ICS). ICS is an ongoing population-based cohort study conducted in 3 counties in central Iran. Pearson correlation analysis was performed between LAP, VAI, and metabolic parameters. Cox regression analysis and receiver operative characteristics (ROC) curve analysis were performed in order to evaluate the ability of VAI and LAP for the incidence of CVD, CVD-associated mortality, and all-cause mortality. We further compared the predictive performance of VAI and LAP with body mass index (BMI). Results: LAP and VAI were significantly correlated with all metabolic variables, including blood pressure, fasting blood glucose, and lipid profile components. Univariate regression analysis indicated a significant association between LAP and VAI and CVD incidence. In multivariate analysis, only VAI was significantly associated with CVD incidence. Regarding CVD mortality, only VAI in the multivariate analysis revealed a significant association. Interestingly, Both VAI and LAP were negatively associated with all-cause mortality. ROC curve analysis indicated the superior performance of LAP and VAI for predicting CVD incidence compared to BMI; however, BMI was better in predicting all-cause mortality. Conclusion: Compared to BMI, LAP and VAI have better predictive performance for the incidence of CVD. In contrast, BMI was superior to VAI and LAP in the prediction of all-cause mortality.

Complicated atopic dermatitis in a healthy infant: Homemade walnut cream.

Key Clinical Message: Healthcare providers should educate patients on the appropriate use of topical agents and the potential risks associated with non-standardized formulations, especially for infants and young children. Abstract: Complementary and alternative medicine (CAM) is an unconventional treatment method used alongside or in addition to conventional medical treatment methods to improve the healing process. Inappropriate administration of CAM can worsen the condition of diseases and have potential hazards for patients. Herbal therapy is one of the most famous and widely used CAMs in treating various skin disorders. In this case, we report a 4-month-old girl with atopic dermatitis who demonstrates ulceronecrotic lesions on her face and extremities besides sepsis 3 days after a walnut's homemade cream consumption. She was treated with intravenous clindamycin and wet-to-dry dressing to remove the scabs. This case report shows the potentially hazardous effects of misused traditional and homemade herbal therapy. It highlighted the need to pay particular attention when CAMs are used, especially for infants and young children.

Efficacy of adjunctive topical liposomal clarithromycin on systemic Glucantime in Old World cutaneous leishmaniasis: a pilot clinical study.

Aim: This study aimed to investigate the effects of topical liposomal clarithromycin in combination with meglumine antimoniate (Glucantime®) on cutaneous leishmaniasis (CL) lesions. Methods: This pilot, randomized, double-blinded clinical trial was conducted on patients with CL lesions. Patients were randomly assigned to two groups: the first group received liposomal clarithromycin in combination with Glucantime for 28 days, while the second group received Glucantime and a placebo. Afterward, patients were followed up at 1.5, 3, and 6 months after treatment initiation and were evaluated for recovery time, induration, and size of the lesions. Results: Sixty patients with CL lesions were divided into two separate groups with 30 members each and were examined. Within-group analysis revealed that recovery time in the clarithromycin group was 26.65 ± 5.12 days, while in the placebo group, it was 32.84 ± 24.43, which was statistically insignificant (p = 0.18). Lesion size comparison in the first and last follow-ups reduced in both groups: 7.73 ± 4.31 to 0.48 ± 0.50 in the clarithromycin group (p = 0.006) and 5.47 ± 5.83 to 0.76 ± 0.88 in the placebo group (p = 0.03). Moreover, the size of lesions in the intervention group was significantly reduced compared to that in the placebo group (p = 0.02). Recognizable induration reduction was observed in the clarithromycin group (2.60 ± 0.77 to 1.0 ± 0.00). No adverse effects attributable to clarithromycin were reported. Conclusion: The administration of liposomal clarithromycin in combination with systemic Glucantime had a significant beneficial effect on reducing lesion size in leishmaniasis. Further studies on larger populations are recommended. Systematic Review Registration: https://www.irct.ir/trial/46611.

Cutaneous microvascular occlusion syndrome as the first manifestation of catastrophic lupus-associated antiphospholipid antibody syndrome: a case report.

BACKGROUND: Antiphospholipid syndrome (APS), defined by thrombotic events or obstetric complications in the presence of persistently high antiphospholipid antibodies, is characterized by a wide variety of clinical presentations and the effects of vascular occlusion can impact almost any organ system or tissue. Since adult-onset APS classification criteria are not well verified in pediatrics (where pregnancy-related problems are rare), estimating childhood prevalence is challenging. Stroke and pulmonary embolism are thromboembolic events occurring in children that can cause considerable long-term morbidity. Children with APS are more prone to recurrent thromboembolism than adults. Cutaneous symptoms are prominent and typically represent the first clue of APS. Although dermatologic findings are exceedingly heterogeneous, it is essential to consider which dermatological symptoms justify the investigation of antiphospholipid syndrome and the required further management. CASE PRESENTATION: We describe a seven-year-old Iranian boy with retiform purpura and acral cutaneous ischemic lesions as the first clinical presentation of antiphospholipid syndrome in the setting of systemic lupus erythematous. CONCLUSION: APS in pediatrics, is associated with a variety of neurologic, dermatologic, and hematologic symptoms. Therefore, it is essential for pediatricians to be aware of the rare appearance of Catastrophic APS as an initial indication of APS.