RESUMEN
A 2-year-old boy presented to the emergency department with a history of sudden onset of cough, dyspnoea and a slight expiratory wheeze on the right lung base. He also had subcutaneous emphysema on the left side of the chest anteriorly. Chest x ray confirmed subcutaneous emphysema and also revealed pneumomediastinum and pneumopericardium. He had had no previous episode and was not known to have asthma. He was apyrexial but had a raised white cell count. The eosinophil count was within normal limits. He was successfully treated with nebulised salbutamol, steroids, antibiotics and high flow oxygen. He made a good recovery and was discharged after 7 days. This case highlights the need for a high index of suspicion of asthma in very young children presenting for the first time with such complications.
Asunto(s)
Asma/complicaciones , Enfisema Mediastínico/etiología , Neumopericardio/etiología , Enfisema Subcutáneo/etiología , Albuterol/uso terapéutico , Antiasmáticos/uso terapéutico , Antibacterianos/uso terapéutico , Asma/tratamiento farmacológico , Preescolar , Quimioterapia Combinada , Humanos , Masculino , Enfisema Mediastínico/terapia , Terapia por Inhalación de Oxígeno , Neumopericardio/terapia , Esteroides/uso terapéutico , Enfisema Subcutáneo/terapia , Resultado del TratamientoRESUMEN
The present study aimed to find out the prevalence and severity of acute viral hepatitis and fulminant hepatitis during pregnancy in North India. The study was conducted on 97 consecutive pregnant patients in third trimester with acute viral hepatitis (AVH) or fulminant hepatic failure (FHF). The patients were evaluated on the basis of history, examination, liver function profile and serological markers for hepatitis A,B,C and E viruses. Hepatitis E virus (HEV) was the causative agent in 47.4% of the cases of viral hepatitis and 52.6% were caused by non-E viruses(HAV-5.2%,HBV-7.2%,HCV-0%,non A-E 47.4%). HEV was responsible for 36.2% of the cases of AVH and 75% of the cases of FHF. The mortality was 24.7% (24/97). All of them had FHF. Eighteen of 24 cases (75%) who expired were HEV positive. The mortality rate was 39.1% in HEV group and 11.7% in non HEV group. Majority of patients (87.5%) who expired had died undelivered. Hepatitis E was the commonest etiological agent in those who had fulminant disease during pregnancy and was associated with high mortality rate.