Subdural empyema, mastoiditis, and sinus venous thrombosis are rare infections that may lead to serious and potentially life-threatening complications. A 2-year-old male patient with no known underlying disease presented with a 2-day history of ear pain, sore throat, and fever. Physical examination revealed no significant pathology other than hyperemia of the left tympanic membrane. Intravenous ceftriaxone was initiated, and the patient was hospitalized because of persistent fever and poor oral intake. However, despite 3 days of treatment, the fever persisted, and an increase in acute phase reactants was observed. Subsequently, the patient developed hyperemia, swelling, and warmth in the area corresponding to the left mastoid region. Clindamycin was then added to the treatment regimen. Streptococcus pyogenes was isolated from the patient’s blood culture. Brain magnetic resonance imaging revealed a partial thrombus in the left transverse sinus and a 2.5-cm subdural empyema in the lateral aspect of the left cerebellar hemisphere. Antithrombotic therapy was initiated for the patient. Ceftriaxone was administered intravenously for 14 days and clindamycin for 11 days. The total duration of oral and intravenous antibiotic therapy was completed in 6 weeks, and enoxaparin sodium was given for 3 months. This case highlights the need for awareness of the rare complications of persistent otitis media in pediatric patients. Conditions such as subdural empyema, mastoiditis, and sinus venous thrombosis can be successfully managed with timely diagnosis and appropriate treatment. Such complications should be considered in cases that do not respond clinically to appropriate antibiotic therapy.
A novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to coronavirus disease 2019 (COVID-19), which is a global health problem that occurred in waves and resulted in high mortality globally. This is a single-center retrospective study conducted in a Medical College's dedicated COVID-19 hospital in India during the first wave (March-November 2020) and second wave (March-May 2021) of the COVID-19 pandemic on 104 children below 18 years of age to compare the clinical characteristics and outcome of COVID-19 patients during the first and second waves. During the first wave (n = 57, 54.8%), the majority of children (n = 36, 63.16%) were between 5-18 years, but during the second wave (n = 47, 62.09%), the majority of children (n = 29, 61.70%) were below 5 years. Neonates outnumbered during the second wave (n = 11, 23.4% vs. n = 1, 1.8%). Asymptomatic patients (n = 24, 42.1%) were common during the first wave, while severe-grade patients (n = 19, 40.4%) were common during the second wave. During both waves, fever and respiratory distress were the common symptoms followed by cough. Respiratory distress (p = 0.0003), C-reactive protein (p = 0.008), peripheral oxygen saturation <94% (p = 0.00002), and acidosis (p = 0.001) were significantly higher during the second wave. Use of steroids and low-molecular-weight heparin was similar in two waves, but intensive care unit (ICU) admission (p = 0.0031), oxygen via nasal prongs (p = 0.0003), use of CPAP/BIPAP (p = 0.031), blood and blood products (p = 0.044), comorbidity (p = 0.017), and mortality (p = 0.008) were significantly higher during second wave. ICU admission, use of blood and blood products, mechanical ventilation, comorbidity, and mortality were found to be higher during the second wave.
Zinc supplementation is recommended in both acute and persistent diarrhea; however, comparative data on longitudinal biochemical response between these conditions are limited. This prospective observational study was conducted at the pediatric department of a tertiary care center in Northern India, which enrolled 72 children: 36 with acute diarrhea (group A) and 36 with persistent diarrhea (group B). All participants received oral zinc sulfate syrup providing 20 mg elemental zinc daily for 14 days. Serum zinc was measured at Day 1, 14, and 28. Longitudinal analysis was performed using a linear mixed effects model with time and group as fixed effects and subject as a random effect. A gradual increase in serum zinc was observed in both groups. No statistically significant group-time interaction was detected, indicating similar trajectories. Zinc supplementation resulted in a modest but consistent increase in serum zinc levels in both groups. No significant difference was detected between acute and persistent diarrhea. These findings do not suggest a need for higher dosing; however, further adequately powered studies are warranted.
