Objectives:Vitamin D deficiency is linked to rickets in children, precocious puberty in adolescents, polycystic ovarian syndrome in adults and osteoporosis in older adults. Its requirements for females differ according to the stages of life. This study aims to estimate the proportion of vitamin D deficiency in female patients at different stages of life. Materials and methods:This cross-sectional retrospective study was done on female patients undergoing vitamin D estimation from January to December 2024 in All India Institute of Medical Sciences, Raebareli, India.. Vitamin D estimation in serum was conducted on VITROS 5600 Immunodiagnostic Systems by chemiluminescence immunoassay technique. Serum levels of ≥30 ng/mL, 20-30 ng/mL and < 20 ng/mL were considered normal, insufficient and deficient, respectively. Data was collected in a Microsoft Excel spreadsheet and analysed by IBM SPSSv25. Results:Vitamin D estimation was done on 8 403 female patients. Deficient, insufficient and normal vitamin D levels were seen in 33.3%, 31.0% and 35.7% of subjects, respectively. Analysis according to the life stages highlighted that adolescents (13-18 years) had the highest (46.8%) deficiency, followed by young adults (19-24 years) (40.0%). Mean vitamin D levels were the lowest (24.2±15.9 ng/dL) in adolescents (13-18 years) and the highest (40.9±27.6 ng/dL) in newborns and babies (0-1.9 years) (F=22.8, p=0.00). Significant seasonal differences in vitamin D levels were observed, with the lowest (25.9±18.8 ng/dL) being seen in February and the highest (31.8±17.1 ng/dL) in August (F=7.1, p=0.00). Conclusion:Across the stages of life in female patients, adolescents (13-18.9 years) had the highest burden of vitamin D deficiency. Incorporating vitamin D supplementation under the national health programme for adolescent females will be beneficial.
Background:Bacillus Calmette-Guérin (BCG)-related complications, non-tuberculous mycobacteria (NTM) and classical tuberculosis (TB) are all examples of mycobacterial diseases. Accurate pathogen identification and host immunological state are essential for diagnosis and treatment. Case presentation:A four-month-old male child with disseminated BCG (Bacillus Calmette-Guérin) infection and TB as a result of STAT1 deficiency (Mendelian susceptibility to mycobacterial diseases MSMD) and a 17-year-old girl with a chronic cutaneous and soft tissue Mycobacterium abscessus infection are the two different examples that we describe. Granulomatous inflammation and acid-fast bacilli (AFB) were present in both individuals. The infant was awaiting hematopoietic stem cell transplantation after receiving extended antimycobacterial therapy but did not survive. Following the failure of initial empirical antitubercular treatment (ATT), the adolescent needed NTM-targeted combination therapy with clarithromycin, amikacin, and ethambutol. Conclusion:The need of careful clinical evaluation and ongoing diagnostic vigilance is underscored by the highlighted diagnostic problems. These instances show how unusual mycobacterial illness presentations might cause delays in diagnosis, especially in susceptible groups. Accurate diagnosis depends on confidence in complete diagnostic methods, which include thorough clinical examination, suitable imaging, microbiological testing and immunological assessment. This case series emphasizes how important it is to combine interdisciplinary skills in order to handle complex diagnoses, identify uncommon mycobacterial infections in a timely manner and direct efficient treatment plans, all of which improve patient outcomes.
Introduction:Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue neoplasm, typically located at the deep tissues of the trunk and extremities, that occurs mostly in the young adult age. Very few cases of children affected are reported in the literature, that interestingly tend to present with superficially sited tumors. Though benign in appearance, LGFMS can potentially behave as a malignant tumor with local recurrence or even distal metastases. Case description:We report a case of a six-year-old boy with a rare presentation of an asymptomatic superficial thoracic mass, that raised our suspicion due to its progressively enlarging size and when surgically excised it proved to be a LGFMS. Conclusion:This case raises awareness for atypical presentations of LGFMS in children with superficial growing lesions, which can be misdiagnosed and therefore maltreated. Complete excision and long-term surveillance are the main treatment components for the patients' safety, since the potential of malignancy cannot be ruled out in this type of tumor.
Urinary tract infections (UTIs) are common both in adults and particularly in children. It is estimated that the number of UTI cases has reached 4.49 billions in 2021, while common and often successfully treated with antibiotics UTIs pose the risk for sepsis, kidney complications and occurrence of antibiotic-resistant microbial strains. Symptoms of UTIs in children vary from non-specific, such as fever and lethargy, to specific such as difficult voiding, dysuria and suprapubic, abdominal or lumbar pain. Urinary tract infections may be lower (cystitis) or upper (pyelonephritis) and the etiological diagnosis is based on urinalysis and urine culture. There are several resistance mechanisms that commonly occur across different bacterial species (some of them being found in the same family) responsible for pediatric UTIs. For instance, an extensive mechanism of resistance is the production of beta-lactamase. Gram-negative bacilli may also develop polymyxin resistance; Staphylococcus aureus may become methicillin resistant and vancomycin resistance may appear in both S. aureus and Enterococcus spp. The present review presents the mechanisms of resistance of bacteria involved in UTIs in children.
Introduction: Continuous positive airway pressure (CPAP) therapy is the main therapeutic method for obstructive sleep apnea syndrome (OSAS). The way of accommodating the patient with the CPAP mask is very important for adherence to therapy. In this study, we tried to determine the patient-reported causes for suboptimal use of CPAP therapy and to draw up some recommendations for their management, with the aim to improve adherence to CPAP therapy. Materials and methods: The present study investigated 86 patients diagnosed with OSAS who were divided into two categories by CPAP adherence (at least four hours per night therapy in at least 70% of the recommended days): CPAP adherent patients (n = 50) and non-adherent patients (n = 36). All participants completed a questionnaire to report the side effects of therapy and the main reasons for suboptimal use of CPAP therapy. Results: The reported causes for the inappropriate use of therapy with statistical significance included side effects of the mask and device, misperception of disease severity and lack of confidence that CPAP therapy is useful for treating OSAS. Dry mouth, the main side effect reported by both adherent and non-adherent patients, was not a predictor of statistical significance for adherence to therapy. Suboptimal use of therapy, a statistically significant factor for adherence to treatment, occurred in some of the OSAS patients who developed anxiety related to CPAP device. Many non-adherent participants used an air humidifier attached to CPAP to treat dry mouth as a side effect, which did not help increase adherence in this group of patients. Conclusion: Multiple factors may be involved in OSAS patients' adherence to CPAP therapy. Of these, side effects in therapy can play an important role and resolving them can be an essential factor for patient adherence.
