Fulminant Delta COVID-19 myocarditis: a case report of fatal primary cardiac dysfunction.

Background: Whilst myocarditis or myocardial injury due to severe acute respiratory syndrome coronavirus 2 infection is commonly reported, profound primary cardiac dysfunction requiring mechanical circulatory support, with the development of fulminant myocarditis prior to respiratory failure, is rarely described. The endomyocardial biopsy (EMB) findings in these patients is seldom reported, the findings are varied, and effective treatment unknown.

Case Summary: A 39-year-old female with no significant past medical history and confirmed Delta variant coronavirus disease 2019 (COVID-19) infection (Day 3), presented with a 1 day history of diarrhoea, vomiting, and abdominal pain.

Changes in the sublingual microcirculation and endothelial adhesion molecules during the course of severe meningococcal disease treated in the paediatric intensive care unit.

Purpose: The sublingual microcirculation can be visualised in real time using sidestream dark-field (SDF) imaging. Endothelial activation mediated through adhesion molecules may alter flow patterns in the microcirculation. We studied sublingual microcirculatory disturbances in children with meningococcal disease (MCD) and simultaneously measured plasma levels of adhesion molecules.

Meningococcal disease in children in Merseyside, England: a 31 year descriptive study.

Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors.

Diagnostic efficacy of activated partial thromboplastin time waveform and procalcitonin analysis in pediatric meningococcal sepsis.

Objective: A biphasic activated partial thromboplastin time waveform predicts sepsis and disseminated intravascular coagulation in adults. This has not been previously investigated in children. Our aim is to ascertain whether there are changes in the activated partial thromboplastin time waveform in children with meningococcal disease and to compare its diagnostic use with procalcitonin.

How paediatricians can prepare for revalidation.

Revalidation has begun with relicensing in 2009. All paediatricians will have to demonstrate that they meet generic standards in the General Medical Council's (GMC) Good Medical Practice for continued relicensing. Paediatricians on the specialist register will have to demonstrate that they meet the specialist standards set by the College and approved by the GMC in order to recertify.

Prognostic value of procalcitonin in children with meningococcal sepsis.

Objective: To compare procalcitonin, lactate, and C-reactive protein as prognostic markers in children with meningococcal septic shock.

Design: Prospective observational study.

Setting: Alder Hey Children's Hospital, Liverpool, UK.

Prospective validation of the Glasgow Meningococcal Septicaemia Prognostic Score. Comparison with other scoring methods.

Unlabelled: A prospective observational study was done to derive performance characteristics for the Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS) and compare it with nine other severity scores (Stokland, Stiehm and Damrosch, Ansari, Niklasson, Leclerc, Kahn and Blum, Lewis, Istanbul and Bjark) and laboratory markers of disease severity. In the paediatric departments of six hospitals in Merseyside, UK, 278 children with confirmed or probable meningococcal disease were admitted between November 1988 and August 1990 ( n=152) and between September 1992 and April 1994 ( n=126); 26 of whom died. GMSPS was recorded on admission and again if there was clinical deterioration.

Severity of meningococcal disease in children and the angiotensin-converting enzyme insertion/deletion polymorphism.

Critical illness outcome may be causally related to inflammatory response severity. Given that tissue angiotensin-converting-enzyme (ACE) regulates such responses and that the deletion (D) [rather than insertion (I)] variant of the ACE gene is associated with higher tissue ACE levels, DD genotype might be associated with a poorer outcome in a uniform infectious disease state. Illness severity (Pediatric RIsk of Mortality score, the Glasgow Meningococcal Septicaemia Prognostic Score [GMSPS], and clinical course) was recorded for consecutive white patients with meningococcal disease (n = 110, 34 DD genotype, 61 male, aged 49.

How has imaging of the head, neck and spine changed over 5 years in a district general hospital?

Background: Over recent years, MRI has become the imaging modality of choice for examination of the head, neck and spine.

Objective: The primary objective was to compare the clinical benefit of CT with MRI for children being investigated at a district general hospital. Secondary outcome measures were the change in amount of and indications for imaging.