Renal Fungal Abscesses

Adel is a 2-year-old boy with down syndrome, acute lymphoblastic leukemia and persistent fever despite broad spectrum antibacterial therapy. CT scan of the pelvis showed multiple peripherally enhanced cystic lesions  in the kidneys compatible with renal abscesses. The blood culture grew candida trpicalis. He is currently on antifungal treatment.

Renal Fungal Abscesses

Treatment of Group A Streptococcal Pharyngitis

Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America

Mechanisms of Actions of Chemotherapeutic Agents

Hoffman: Hematology: Basic Principles and Practice, 5th ed.

Scarlet Fever

Group A streptococcal pharyngitis with petechiae on the soft palate 

Today in ER, I saw a 3 year old girl with 2 days history of high grade fever, sore throat, runny nose, cough and intermittent abdominal pain. On physical exam, she has a rough sandpaper rash over face and trunk and erythemtous tonsils with small whitish exudates.We took a throat culture and discharge her on Augmentin 90mg/kg/day for 10 days as a treatment for scarlet fever, but what is scarlet fever?

How to Treat Croup In ER?

How to Manage Sickle Cell Pain Crisis in ER?

Hypoxemia and Respiratory Distress in a Newborn

You are the doctor on-call in neonatal intensive care unit. 

What Warfarin Can Cause!

 Laila is a 7 year old female known case of congenital  mitral valve stenosis who underwent valve replacement at age of 3 months and she is maintained on warfarin with monthly follow-up of her coagulation status. Her last INR was 5 three weeks ago so her dose of Warfarin was decreased by 15%.  She presented to ER with 2 days history of vomiting, frontal headache and somnolence. CT brain without contrast is shown below:

What's the most appropriate level of INR she could have now?

• 0.5
• 2
• 3.5
• 7

What's your most appropriate next step of management?

• Switch from Warfarin to Heparin
• Start vitamin K and fresh freozen plasma transfusion
• Transfuse with platelets
• Observation

Steroids and CNS Lyphomas

Decadron is better than solumedrol in treating CNS lymphomas because it penetrates the blood-brain barrier more efficiently. This lady got better just one hour after her first dose of Decadron!

Rotavirus Vaccines Efficacy

According to a new cochrane review, the efficacy of rotavirus vaccines in preventing severe rotavirus gastroenteritis is 70-80%

Hypothermia in a toddler

Today, I saw a 3 year old, previously healthy female in emergency department because of her parents concern about her rectal temperature of 34.3 (on multiple occasions) one hour prior to presentation. She was warmed and brought to us. She was in a warm atmosphere in her room. She started to have fever, runny nose and sore throat 3 days when she was seen by her pediatrician which prescribed a cefixime for a diagnosis of acute tonsillits with diclofenac and panadol for fever. Today she had two doses of diclofenac and panadol few hours before having the hypothermia. Upon arrival to ER, she was active and well-looking. Her vitals were: T 37.1, HR 130, BP 100/60, RR 22 and SaO2 98%. What's the most likely cause of her hypothermia?

• Sepsis
• Hypothyrodism 
• Environmental heat loss
• Medication-induced