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Sample records for paediatric cancer patients

  1. Seroprevalence of occult hepatitis B among Egyptian paediatric hepatitis C cancer patients.

    PubMed

    Raouf, H E; Yassin, A S; Megahed, S A; Ashour, M S; Mansour, T M

    2015-02-01

    Occult hepatitis B infection is characterized by the presence of hepatitis B virus (HBV) DNA in the serum in the absence of hepatitis B surface antigen (HBsAg). Prevalence of hepatitis C virus (HCV) infections in Egypt is among the highest in the world. In this study, we aim at analysing the rates of occult HBV infections among HCV paediatric cancer patients in Egypt. The prevalence of occult HBV was assessed in two groups of paediatric cancer patients (HCV positive and HCV negative), in addition to a third group of paediatric noncancer patients, which was used as a general control. All groups were negative for HBsAg and positive for HCV antibody. HBV DNA was detected by nested PCR and real-time PCR. HCV was detected by real-time PCR. Sequencing was carried out in order to determine HBV genotypes to all HBV patients as well as to detect any mutation that might be responsible for the occult phenotype. Occult hepatitis B infection was observed in neither the non-HCV paediatric cancer patients nor the paediatric noncancer patients but was found in 31% of the HCV-positive paediatric cancer patients. All the detected HBV patients belonged to HBV genotype D, and mutations were found in the surface genome of HBV leading to occult HBV. Occult HBV infection seems to be relatively frequent in HCV-positive paediatric cancer patients, indicating that HBsAg negativity is not sufficient to completely exclude HBV infection. These findings emphasize the importance of considering occult HBV infection in HCV-positive paediatric cancer patients especially in endemic areas as Egypt.

  2. Dental Awareness among Parents and Oral Health of Paediatric Cancer Patients Receiving Chemotherapy

    PubMed Central

    Marwaha, Mohita; Bansal, Kalpana; Sachdeva, Anupam; Gupta, Ajay

    2016-01-01

    Introduction Dental care is often overlooked by the parents of children receiving treatment for cancer including chemotherapy who are in a phase of severe immunosuppression. Aim (i) To study dental attitudes of parents of children receiving chemotherapy towards importance of dental care. (ii) To evaluate oral hygiene status and compare it with healthy controls. Materials and Methods A questionnaire assessing the awareness towards dental care was given to the parents of 47 paediatric patients suffering from cancer receiving chemotherapy and to parents of 47 paediatric patients reporting to outpatient Department of Pedodontics at SGT Dental College. Oral examination was also carried out for both the groups and DMFT/dmft, plaque and gingival index were noted. Results Parents had a varying opinion regarding dental health of their child. The caries status of children in the control group was greater than children in the study group. The mean plaque index of children in the control group (1.40) was greater than children in the study group (1.34) which was statistically significant according to Mann-Whitney U test. The gingival health of children in the study group was better than children in the control group which was also not statistically significant. Conclusion This study highlights need for a periodic referral of the child cancer patients to the paediatric dental clinic in hospitals for the timely dental care. PMID:27437369

  3. Malnourishment and length of hospital stay among paediatric cancer patients with febrile neutropaenia: a developing country perspective.

    PubMed

    Conner, J Michael; Aviles-Robles, Martha J; Asdahl, Peter H; Zhang, Fang Fang; Ojha, Rohit P

    2016-09-01

    The prevalence of malnourishment among paediatric cancer patients undergoing chemotherapy in developing countries is poorly documented despite greater potential for malnourishment in such settings. We aimed to estimate the prevalence of malnourishment among paediatric cancer patients in Mexico City, and assess the association between malnourishment and length of hospital stay. Individuals eligible for this study were paediatric cancer patients (aged <18 years) admitted to Hospital Infantil de Mexico Federico Gomez (Mexico City) with febrile neutropaenia. Our exposure of interest, malnourishment, was defined as an age-adjusted and sex-adjusted z-score<-2 (ie, 2 SDs below the expected mean of the WHO reference population). We estimated time ratios (TRs) and 95% confidence limits (CLs) for the association between malnourishment and length of hospital stay. Our study population comprised 111 paediatric cancer patients with febrile neutropaenia, of whom 71% were aged <10 years and 52% were males. The prevalence of malnourishment was 14%, equal to a 530% (standardised morbidity ratio=6.3; 95% CL 3.7, 10) excess of malnourishment compared with the world reference population. The median length of hospital stay for malnourished patients was 15 days, which corresponded with a 50% (TR=1.5, 95% CL 1.0, 2.3) relative increase in length of stay compared with patients who were not malnourished. Patients with body mass indices equal to the mean of the world reference population had the shortest length of stay. Future studies should explore potential interventions for malnourishment to reduce the length of hospital stay or other established adverse consequences of malnourishment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Impact of a modified Broviac maintenance care bundle on bloodstream infections in paediatric cancer patients

    PubMed Central

    Furtwängler, Rhoikos; Laux, Carolin; Graf, Norbert; Simon, Arne

    2015-01-01

    Background: During intensive chemotherapy, bloodstream infection (BSI) represents an important complication in paediatric cancer patients. Most patients carry a long-term central venous access device (CVAD). Improved maintenance care of these vascular catheters may decrease the risk of BSI. Methods: Intervention study (adapted CVAD prevention protocol) with two observation periods (P1: 09-2009 until 05-2011; P2: 09-2011 until 05-2013); prospective surveillance of all laboratory confirmed BSIs. In P2, ready to use sterile NaCl 0.9% syringes were used for CVAD flushing and octenidine/isopropanol for the disinfection of catheter hubs and 3-way stopcocks. Results: During P1, 84 patients were included versus 81 patients during P2. There were no significant differences between the two patient populations in terms of median age, gender, underlying malignancy or disease status (first illness or relapse). Nearly all CVADs were Broviac catheters. The median duration from implantation to removal of the CVAD was 192 days (Inter-quartile-range (IQR); 110–288 days) in P1 and 191 days (IQR; 103–270 days) in P2. 28 BSI were diagnosed in 22 patients in P1 (26% of all patients experienced at least one BSI) and 15 BSI in 12 patients in P2 (15% of all patients). The corresponding results for incidence density (ID) were 0.44 (CI95 0.29–0.62) for P1 vs. 0.34 (0.19–0.53) BSI per 100 inpatient days for P2 and for incidence rate (IR) 7.76 (5.16–10.86) in P1 vs. 4.75 (2.66–7.43) BSI per 1,000 inpatient CVAD utilization days. In P1, 9 BSI were caused by CoNS vs. only 2 in P2 (IR 2.49; CI95 0.17–4.17 vs. 0.63; CI95 0.08–1.72). In P1 two BSI (7%) lead to early removal of the device. During P2 one CVAD was prematurely removed due to a Broviac-related BSI (6.7%). Conclusion: The preventive protocol investigated in this study led to a reduction of BSI in paediatric cancer patients. This result was clinically relevant but – due to insufficient power in a single centre observation

  5. Next-generation personalised medicine for high-risk paediatric cancer patients - The INFORM pilot study.

    PubMed

    Worst, Barbara C; van Tilburg, Cornelis M; Balasubramanian, Gnana Prakash; Fiesel, Petra; Witt, Ruth; Freitag, Angelika; Boudalil, Miream; Previti, Christopher; Wolf, Stephan; Schmidt, Sabine; Chotewutmontri, Sasithorn; Bewerunge-Hudler, Melanie; Schick, Matthias; Schlesner, Matthias; Hutter, Barbara; Taylor, Lenka; Borst, Tobias; Sutter, Christian; Bartram, Claus R; Milde, Till; Pfaff, Elke; Kulozik, Andreas E; von Stackelberg, Arend; Meisel, Roland; Borkhardt, Arndt; Reinhardt, Dirk; Klusmann, Jan-Henning; Fleischhack, Gudrun; Tippelt, Stephan; Dirksen, Uta; Jürgens, Heribert; Kramm, Christof M; von Bueren, Andre O; Westermann, Frank; Fischer, Matthias; Burkhardt, Birgit; Wößmann, Wilhelm; Nathrath, Michaela; Bielack, Stefan S; Frühwald, Michael C; Fulda, Simone; Klingebiel, Thomas; Koscielniak, Ewa; Schwab, Matthias; Tremmel, Roman; Driever, Pablo Hernáiz; Schulte, Johannes H; Brors, Benedikt; von Deimling, Andreas; Lichter, Peter; Eggert, Angelika; Capper, David; Pfister, Stefan M; Jones, David T W; Witt, Olaf

    2016-09-01

    The 'Individualized Therapy for Relapsed Malignancies in Childhood' (INFORM) precision medicine study is a nationwide German program for children with high-risk relapsed/refractory malignancies, which aims to identify therapeutic targets on an individualised basis. In a pilot phase, reported here, we developed the logistical and analytical pipelines necessary for rapid and comprehensive molecular profiling in a clinical setting. Fifty-seven patients from 20 centers were prospectively recruited. Malignancies investigated included sarcomas (n = 25), brain tumours (n = 23), and others (n = 9). Whole-exome, low-coverage whole-genome, and RNA sequencing were complemented with methylation and expression microarray analyses. Alterations were assessed for potential targetability according to a customised prioritisation algorithm and subsequently discussed in an interdisciplinary molecular tumour board. Next-generation sequencing data were generated for 52 patients, with the full analysis possible in 46 of 52. Turnaround time from sample receipt until first report averaged 28 d. Twenty-six patients (50%) harbored a potentially druggable alteration with a prioritisation score of 'intermediate' or higher (level 4 of 7). Common targets included receptor tyrosine kinases, phosphoinositide 3-kinase-mammalian target of rapamycin pathway, mitogen-activated protein kinase pathway, and cell cycle control. Ten patients received a targeted therapy based on these findings, with responses observed in some previously treatment-refractory tumours. Comparative primary relapse analysis revealed substantial tumour evolution as well as one case of unsuspected secondary malignancy, highlighting the importance of re-biopsy at relapse. This study demonstrates the feasibility of comprehensive, real-time molecular profiling for high-risk paediatric cancer patients. This extended proof-of-concept, with examples of treatment consequences, expands upon previous personalised oncology endeavors

  6. Clinical Practice Audit: Perioperative Antibiotic Prophylaxis in Paediatric Cancer Patients with Broviac Catheter Implantation.

    PubMed

    Weiss, K; Simon, A; Graf, N; Schöpe, J; Meier, C M

    2016-05-01

    Perioperative antimicrobial prophylaxis (PAP) is an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients face an increased risk of surgical site infection (SSI) after implantation of long term central venous catheters (CVAD). All PATIENTS<18 years admitted to the paediatric oncology centre (POC) with implantation of a CVAD. Systematic audit in 2 groups: retrospective (Jan 01, 2012 - March 31, 2014) and prospective (April 01, 2014 - March 31, 2015) referring to an internal PAP guideline, invented in Jan 2014. Surveillance of SSI up to 30 days after the operation. In total, 97 CVAD implantations were analysed in 89 paediatric oncology patients (Broviac in 94%). The detailed analysis of PAP revealed lower Cefuroxim doses than requested (30 vs. 50 mg/kg). In addition, Cefotaxim was used in 1 case and in 3 cases Clindamycin was given without a medical history of Penicillin hypersensitivity. In the retrospective audit group PAP was administered in 22% for≤24 h); this was the case in 91% of the prospective group (p<0.001). No SSI was detected. This first comprehensive audit of PAP in a German POC outlines significant opportunities for improvement in terms of correct dosing, correct choice of the antibiotic, and shorter duration of PAP. In addition our results illustrate the challenges of optimising standard workflows in clinical practice. © Georg Thieme Verlag KG Stuttgart · New York.

  7. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy

    PubMed Central

    Brodin, N P; Björk-Eriksson, T; Birk Christensen, C; Kiil-Berthelsen, A; Aznar, M C; Hollensen, C; Markova, E; Munck af Rosenschöld, P

    2015-01-01

    Objective: To investigate the impact of including fluorine-18 fludeoxyglucose (18F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). Methods: Target volumes were first delineated without and subsequently re-delineated with access to 18F-FDG PET scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP) and estimated risk of secondary cancer (SC). Results: Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. Conclusion: Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. Advances in knowledge: 18F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT. PMID:25494657

  8. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy.

    PubMed

    Kornerup, J S; Brodin, N P; Björk-Eriksson, T; Birk Christensen, C; Kiil-Berthelsen, A; Aznar, M C; Hollensen, C; Markova, E; Munck Af Rosenschöld, P

    2015-03-01

    To investigate the impact of including fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). Target volumes were first delineated without and subsequently re-delineated with access to (18)F-FDG PET scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP) and estimated risk of secondary cancer (SC). Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. (18)F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT.

  9. Evaluation of Relationship Between Demographics and Dental Status in a Defined Group of Iranian Paediatric Patients Undergoing Cancer Therapy

    PubMed Central

    Mortazavi, Hamed; Tashvighi, Maryam; Azizian, Morteza; Khalighi, Hamid Reza; Sabour, Siamak; Movahhedian, Amir

    2015-01-01

    Context Cancer is a major cause of death in children under 15 years of age. Aims This study aimed to evaluate relationship between demographics and dental status in a defined group of Iranian paediatric patients undergoing cancer therapy. Settings and Design This cross-sectional study was accomplished on 161 subjects age ranging 8-12 years. There were 76 cancerous patients hospitalized at Mahak Hospital (one of the major children’s cancer centers in Tehran) as the study group and 85 healthy children attending at Dental School, International Branch of Shahid Beheshti University of Medical Sciences, Tehran, Iran from 2012 to 2013. Materials and Methods Demographics were gathered by using data-form. Oral examination and DMFT Index were used to describe teeth status in all teeth and in the first permanent molars. According to Becker’s definition, “D” stands for untreated decayed teeth, “M” indicates missing teeth, and “F” shows Filled teeth. It is noteworthy that full coverage crowns are considered as “F” in this Index. Statistical Analysis Chi-square, Mann-Whitney U, Student’s t-tests and Logistic Regression were used for data analysis. Results The most frequent type of cancer was acute lymphoblastic/lymphocytic leukemia (33.3%). Patients were significantly shorter than controls (p=0.03), and their fathers and mothers were of lower educational achievement (p=0.01, p= 0.001). Although DMFT of all dentition showed significantly higher score in cancerous children (p=0.001), DMFT of four first permanent molars (left, right, upper, and lower) was borderline significantly higher in patients (p= 0.06). Moreover, frequency of cancer was borderline significantly higher in children with lower birth order (p= 0.05). According to Logistic Regression, in as much as patients grew elder 1 year, DMFT index increased 1.5 units. Conclusion Patients under cancer therapy were shorter than healthy ones, and their parents were of lower educational levels. In addition

  10. Comparative evaluation of pan-fungal real-time PCR, galactomannan and (1-3)-β-D-glucan assay for invasive fungal infection in paediatric cancer patients.

    PubMed

    Gupta, Prashant; Ahmad, Abrar; Khare, Vineeta; Kumar, Archana; Banerjee, Gopa; Verma, Nitya; Singh, Mastan

    2017-04-01

    Limited specific data and investigations are available for the diagnosis of Invasive Fungal Infection (IFI) in paediatrics cancer patients. Three non-invasive tests; Platelia Aspergillus EIA for galactomannan (GM), β-D-glucan (BDG) assay and pan-fungal real-time PCR for fungal DNA in blood were evaluated. One hundred twenty-five paediatrics cancer patients at the high risk of IFI were enrolled. Single blood and serum samples were evaluated by all the three methods. Patients were classified into 10 proven, 52 probable and 63 no IFI cases in accordance with EORTC MSG 2008 revised guidelines. The sensitivity, specificity, PPV and NPV of all the three tests in proven, probable and no IFIs cases were analysed singly and in combination. The sensitivity, specificity, PPV and NPV of GM, BDG and pan-fungal real-time PCR were: 87%, 61%, 81%, 69.5% for GM, 88%, 59.5%, 81%, 71.4% for BDG and 89%, 69.2%, 85%, 67.5% for PCR (95% CI). Among different combinations, best combination was found to be GM and PCR with sensitivity, specificity, PPV and NPV of 98.2%, 89.3%, 97.1% and 90% respectively. Single samples must be evaluated by combination of tests.

  11. Postdural puncture headache in paediatric oncology patients.

    PubMed

    Burt, N; Dorman, B H; Reeves, S T; Rust, P F; Pinosky, M L; Abboud, M R; Barredo, J C; Laver, J H

    1998-08-01

    Previous studies have not determined the correlation between dural puncture and postural headache in paediatric patients. Furthermore, no studies have evaluated the correlation between atypical headache and dural puncture in the paediatric population. Therefore, we prospectively analyzed the incidence of typical postdural puncture headache (PDPHA) and atypical headache in paediatric oncology patients following dural puncture. The study population consisted of 66 paediatric patients undergoing 128 consecutive procedures, including 99 lumbar punctures and 29 bone marrow aspirations without concomitant lumbar puncture. Patients were prospectively randomized into four groups: Group I, preteens (< 13 yr) undergoing lumbar puncture, Group II, adolescents (13-21 yr) undergoing lumbar puncture, Group III, preteens undergoing bone marrow aspiration, and Group IV, adolescents undergoing bone marrow aspiration. The presence and description of headache was documented immediately after dural puncture or bone marrow aspiration, and on post-procedure days # 1, 3 and 5 by personnel blinded to the type of procedure. There was an increase in the incidence of headache (9.1%) after lumbar puncture in patients < 21 yr relative to patients undergoing bone marrow aspiration (P < 0.05). No difference was found between the incidence of typical PDPHA after dural puncture in preteens and adolescents. There was also no difference in the incidence of atypical headache after dural puncture or after bone marrow aspiration among preteens and adolescents. Paediatric patients experience an increased incidence of typical postdural puncture headache after dural puncture compared with age-matched patients undergoing bone marrow aspiration only. Atypical headache is relatively common in the paediatric population after dural puncture or bone marrow aspiration.

  12. Music therapy as a non-pharmacological anxiolytic for paediatric radiotherapy patients.

    PubMed

    O'Callaghan, C; Sexton, M; Wheeler, G

    2007-04-01

    Outpatient radiotherapy treatment in the paediatric cancer patient can be a traumatic and an anxiety-provoking experience for both the patient and the family. Music therapy has been widely reported to have psychosocial, educational and physical benefits for the paediatric cancer patient. Using individual case reports, this paper shows the successful use of music therapy as a non-pharmacological anxiolytic in the paediatric radiotherapy, outpatient waiting room setting, by providing the patient and the family with a means of communication, self-expression and creativity.

  13. Depression in paediatric cancer: an overview.

    PubMed

    Dejong, Margaret; Fombonne, Eric

    2006-07-01

    Research into depression in paediatric cancer is in its early stages, but nevertheless has presented interesting challenges regarding the recognition and measurement of depression in a medically ill population. In this article we discuss the complex interaction between physical and psychological variables, and the diagnostic difficulties arising from this. We review the epidemiological findings regarding prevalence, evaluating the apparently low prevalence rate in the light of methodological weaknesses. Hypotheses put forward to explain the findings are discussed. We conclude by highlighting areas for future research.

  14. Caring and curing: paediatric cancer services since 1960.

    PubMed

    Barnes, E

    2005-09-01

    This paper traces the history of the specialist meanings of 'cure' in paediatric oncology in the UK, how they have changed with increasing organization of the discipline, ever-rising survival rates for all childhood cancers, and with feedback from patients and families. It examines the differing ways in which those involved in researching, treating, and raising funds for work on childhood cancers have understood and used the language of cure, and speculates as to why talking about the 'cure' of survivors of childhood cancers is so problematic. The paper discusses the particular importance of holistic care in the development of paediatric oncology. Psychosocial support is delivered alongside surgery, radiotherapy and chemotherapy. The focus for support is the patient's whole family, building a tenet of palliative care into curative treatment. The concept of the 'truly cured child' is argued to have been crucial in the discipline's decision in the 1970s and 1980s to make the psychosocial needs of patients and their families central in the programme of curing children with cancer.

  15. Phase I study of temozolomide in paediatric patients with advanced cancer. United Kingdom Children's Cancer Study Group.

    PubMed Central

    Estlin, E. J.; Lashford, L.; Ablett, S.; Price, L.; Gowing, R.; Gholkar, A.; Kohler, J.; Lewis, I. J.; Morland, B.; Pinkerton, C. R.; Stevens, M. C.; Mott, M.; Stevens, R.; Newell, D. R.; Walker, D.; Dicks-Mireaux, C.; McDowell, H.; Reidenberg, P.; Statkevich, P.; Marco, A.; Batra, V.; Dugan, M.; Pearson, A. D.

    1998-01-01

    A phase I study of temozolomide administered orally once a day, on 5 consecutive days, between 500 and 1200 mg m(-2) per 28-day cycle was performed. Children were stratified according to prior craniospinal irradiation or nitrosourea therapy. Sixteen of 20 patients who had not received prior craniospinal irradiation or nitrosourea therapy were evaluable. Myelosuppression was dose limiting, with Common Toxicity Criteria (CTC) grade 4 thrombocytopenia occurring in one of six patients receiving 1000 mg m(-2) per cycle, and two of four patients treated at 1200 mg m(-2) per cycle. Therefore, the maximum-tolerated dose (MTD) was 1000 mg m(-2) per cycle. The MTD was not defined for children with prior craniospinal irradiation because of poor recruitment. Plasma pharmacokinetic analyses showed temozolomide to be rapidly absorbed and eliminated, with linear increases in peak plasma concentrations and systemic exposure with increasing dose. Responses (CR and PR) were seen in two out of five patients with high-grade astrocytomas, and one patient had stable disease. One of ten patients with diffuse intrinsic brain stem glioma achieved a long-term partial response, and a further two patients had stable disease. Therefore, the dose recommended for phase II studies in patients who have not received prior craniospinal irradiation or nitrosoureas is 1000 mg m(-2) per cycle. Further evaluation in diffuse intrinsic brain stem gliomas and other high-grade astrocytomas is warranted. Images Figure 5 p658-b Figure 6 p659-b PMID:9744506

  16. Creating a unique, multi-stakeholder Paediatric Oncology Platform to improve drug development for children and adolescents with cancer.

    PubMed

    Vassal, Gilles; Rousseau, Raphaël; Blanc, Patricia; Moreno, Lucas; Bode, Gerlind; Schwoch, Stefan; Schrappe, Martin; Skolnik, Jeffrey; Bergman, Lothar; Bradley-Garelik, Mary Brigid; Saha, Vaskar; Pearson, Andy; Zwierzina, Heinz

    2015-01-01

    Seven years after the launch of the European Paediatric Medicine Regulation, limited progress in paediatric oncology drug development remains a major concern amongst stakeholders - academics, industry, regulatory authorities, parents, patients and caregivers. Restricted increases in early phase paediatric oncology trials, legal requirements and regulatory pressure to propose early Paediatric Investigation Plans (PIPs), missed opportunities to explore new drugs potentially relevant for paediatric malignancies, lack of innovative trial designs and no new incentives to develop drugs against specific paediatric targets are some unmet needs. Better access to new anti-cancer drugs for paediatric clinical studies and improved collaboration between stakeholders are essential. The Cancer Drug Development Forum (CDDF), previously Biotherapy Development Association (BDA), with Innovative Therapy for Children with Cancer Consortium (ITCC), European Society for Paediatric Oncology (SIOPE) and European Network for Cancer Research in Children and Adolescents (ENCCA) has created a unique Paediatric Oncology Platform, involving multiple stakeholders and the European Union (EU) Commission, with an urgent remit to improve paediatric oncology drug development. The Paediatric Oncology Platform proposes to recommend immediate changes in the implementation of the Regulation and set the framework for its 2017 revision; initiatives to incentivise drug development against specific paediatric oncology targets, and repositioning of drugs not developed in adults. Underpinning these changes is a strategy for mechanism of action and biology driven selection and prioritisation of potential paediatric indications rather than the current process based on adult cancer indications. Pre-competitive research and drug prioritisation, early portfolio evaluation, cross-industry cooperation and multi-compound/sponsor trials are being explored, from which guidance for innovative trial designs will be

  17. Dental fluorosis in the paediatric patient.

    PubMed

    Atia, Gahder-Sara; May, Joanna

    2013-12-01

    Exposure to excessive fluoride intake during the early childhood years can disrupt the normal development of enamel, resulting in dental fluorosis. This varies in severity, ranging from white opacities in mild cases to more severe black and brown discoloration or enamel pitting. This article aims to give the reader a better understanding of the aetiology, diagnosis and subsequent treatment of dental fluorosis in the paediatric patient. Fluorosis can have a marked effect on dental aesthetics. The prevalence of fluorosis in the United Kingdom may increase following the publication of Delivering Better Oral Health, published by the Department of Health in 2007, which suggested changes to fluoride levels in children's toothpastes. This article highlights the importance of accurate diagnosis of fluorosis and also explains the treatment options available to paediatric patients.

  18. Paediatric orofacial tumours: new oral health concern in paediatric patients.

    PubMed

    Omoregie, F O; Akpata, O

    2014-03-01

    This study aims to determine the incidence, age, gender, orofacial sites and histological pattern of paediatric orofacial tumours in a Nigerian population. The yearly findings will be analysed to identify the interval for increase in the incidence of paediatric orofacial tumours. A 21-year (1990 to 2010) retrospective analysis of paediatric orofacial tumours in children younger than 16 years was carried out in the Department of Oral Pathology/Oral Medicine, University of Benin Teaching Hospital, Benin City, Nigeria. Of the 1013 diagnosed lesions within the study period, there were 137 (13.5%) paediatric orofacial tumours, among which 71 (51.8%) cases occurred within the last 6 years (2005 to 2010). There was male predilection for the lesions (78 males to 59 females, ratio = 1.3:1). The mean age was 9 + 4.3 years, with peak age group of 11 to 15 years (n=60, 43.8%). The mandible (n=44, 32.1%), followed by the maxilla (n=42, 30.7%) and orofacial soft tissue (n=19, 13.9%) were the most common sites. The benign tumours (n=72, 52.6%) were slightly more than the malignant tumours (n=65, 47.4%). There were more malignant tumours (n=23, 16.8%) than benign tumours (n=20, 14.6%) within the last 3 years (2008 to 2010) under review. Burkitt's lymphoma (n=38, 27.7%) was the commonest malignant lesion. This study showed a recent increase in the incidence of paediatric orofacial tumours, particularly due to a higher incidence of Burkitt's lymphoma.

  19. Osteoporosis in paediatric patients with spina bifida

    PubMed Central

    Marreiros, Humberto Filipe; Loff, Clara; Calado, Eulalia

    2012-01-01

    The prevalence and morbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified. Objective To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary osteoporosis. Methods Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury. Results Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated satisfactorily in children with SB. PMID:22330186

  20. Parental involvement in paediatric cancer treatment decisions.

    PubMed

    McKenna, K; Collier, J; Hewitt, M; Blake, H

    2010-09-01

    This study investigated parents' information needs and involvement in decision-making processes affecting the care of children diagnosed with cancer. Interviews and questionnaires were used to assess parental satisfaction in 50 mothers and 16 fathers responsible for 58 children in an English Paediatric Oncology Unit. Parents reported that doctors contributed almost twice as much to the decision-making process as they did, but parental satisfaction was positively correlated with the amount of information provided when giving informed consent. Satisfaction about their involvement in this process relied heavily upon the level of support received from others. Parents consenting to their child's involvement in non-randomised trials perceived themselves to be under greater pressure from others during the decision-making process while those whose children were further along the treatment trajectory were more uncertain about decisions previously made. Findings indicate that the accessibility, support, information and degree of control afforded to parents by healthcare professionals impacts upon their satisfaction with both the decision-making process and their confidence in the decisions thus made. Information and support tailored to parents' specific needs may therefore enhance satisfaction with clinical decision making and reassure parents about decisions made in the long-term interest of their child's health.

  1. Anaesthesia for MRI in the paediatric patient.

    PubMed

    Serafini, Gianpaolo; Zadra, Nicola

    2008-08-01

    The purpose of the present review is to focus on the literature in the past year and specifically the development of recent guidelines, the debate on who does the sedation anaesthesia for MRI in a paediatric patient, the use of medications and techniques, and the use of monitors and equipment. The revised guidelines of American Academy of Pediatrics and American Academy of Pediatric Dentistry underline the serious risks associated with the sedation of paediatric patients and emphasize the need for proper preparation and proper evaluation. Most children require deep sedation for MRI and the practitioner must have appropriate skills to rescue the patient from general anaesthesia. In the debate on 'who does the sedation', the most important goal is to achieve uniformity in the formal training of the practitioners in key practice elements (airway management, resuscitation, vascular access, medications). Recent findings about the use of anaesthetic techniques, monitors and equipment, and complications are reported. The MRI suite is a challenging environment for anaesthetists and nonanaesthetists, and has serious risks. A systematic approach, similar to that of anaesthesia provided in the operating room, is mandatory. A well equipped anaesthesia machine, standard monitoring, trained personnel and adequate planning should be standard for all procedures out of the operating room.

  2. MIH: epidemiologic clinic study in paediatric patient

    PubMed Central

    CONDÒ, R.; PERUGIA, C.; MATURO, P.; DOCIMO, R.

    2012-01-01

    SUMMARY The Molar Incisor Hypomineralization (MIH) is a qualitative and quantitative defect of the enamel structure of the first permanent molars, which may vary from 1 to 4 with involvement of maxillary and jaw permanent incisors. Aim. Aim of this study is that to evaluate, among 1500 paediatric patients chosen at random aged between 0 and 14 years, afferent by the Paediatric Dentistry of the Azienda Ospedialiera Policlinico Tor Vergata of Rome from 1996 to 2011, the incidents and the prevalence of the MIH distribution, and furthermore to ascertain the possible relationship with the data described in the literature. Results and discussion. From the sample of 1500 paediatric patients, the number of those affections from MIH has turned out to be pairs to 110 (7.3%) aged between 4 and 15 years, and an average age equal to 9.7. The incidence of the hypoplastic defects is greater in the elements of the permanents series in which the functional class mainly interested is that of the first molars, with a percentage of 39.8%. Regarding the elements of the deciduous series affections from hypoplasia, they turn out to be in all in number of 20 represented in 80% of the cases from the seconds molars while in the remaining 20% of the cases the items involved are the central incisors. About the percentage of elements involved in the MIH: the molars, involved with a frequency of 56%, turn out to be more hit regarding incisors (44%). As reported in the literature, it can be asserted that the MIH can hit in equal measure both the male sex that feminine one. Conclusions. MIH represents a condition quite frequent in the paediatric population. In managing this anomaly takes an essential role in the early diagnosis and in the differential one. The study done underlined the importance of a correct application of the therapeutic protocol which, starting from a careful diagnosis and articulating themselves in the execution of preventive treatments and in severe cases restorative and

  3. Guidelines on Vaccinations in Paediatric Haematology and Oncology Patients

    PubMed Central

    Cesaro, Simone; Giacchino, Mareva; Fioredda, Francesca; Barone, Angelica; Battisti, Laura; Bezzio, Stefania; Frenos, Stefano; De Santis, Raffaella; Livadiotti, Susanna; Marinello, Serena; Zanazzo, Andrea Giulio; Caselli, Désirée

    2014-01-01

    Objective. Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. Patients and Methods. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. Results and Conclusion. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity. PMID:24868544

  4. Guidelines on vaccinations in paediatric haematology and oncology patients.

    PubMed

    Cesaro, Simone; Giacchino, Mareva; Fioredda, Francesca; Barone, Angelica; Battisti, Laura; Bezzio, Stefania; Frenos, Stefano; De Santis, Raffaella; Livadiotti, Susanna; Marinello, Serena; Zanazzo, Andrea Giulio; Caselli, Désirée

    2014-01-01

    Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.

  5. Bloodstream infection in paediatric cancer centres--leukaemia and relapsed malignancies are independent risk factors.

    PubMed

    Ammann, R A; Laws, H J; Schrey, D; Ehlert, K; Moser, O; Dilloo, D; Bode, U; Wawer, A; Schrauder, A; Cario, G; Laengler, A; Graf, N; Furtwängler, R; Simon, A

    2015-05-01

    In a prospective multicentre study of bloodstream infection (BSI) from November 01, 2007 to July 31, 2010, seven paediatric cancer centres (PCC) from Germany and one from Switzerland included 770 paediatric cancer patients (58% males; median age 8.3 years, interquartile range (IQR) 3.8-14.8 years) comprising 153,193 individual days of surveillance (in- and outpatient days during intensive treatment). Broviac catheters were used in 63% of all patients and Ports in 20%. One hundred forty-two patients (18%; 95% CI 16 to 21%) experienced at least one BSI (179 BSIs in total; bacteraemia 70%, bacterial sepsis 27%, candidaemia 2%). In 57%, the BSI occurred in inpatients, in 79% after conventional chemotherapy. Only 56 % of the patients showed neutropenia at BSI onset. Eventually, patients with acute lymphoblastic leukaemia (ALL) or acute myeloblastic leukaemia (AML), relapsed malignancy and patients with a Broviac faced an increased risk of BSI in the multivariate analysis. Relapsed malignancy (16%) was an independent risk factor for all BSI and for Gram-positive BSI. This study confirms relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. On a unit level, data on BSIs in this high-risk population derived from prospective surveillance are not only mandatory to decide on empiric antimicrobial treatment but also beneficial in planning and evaluating preventive bundles. • Paediatric cancer patients face an increased risk of nosocomial bloodstream infections (BSIs). • In most cases, these BSIs are associated with the use of a long-term central venous catheter (Broviac, Port), severe and prolonged immunosuppression (e.g. neutropenia) and other chemotherapy-induced alterations of host defence mechanisms (e.g. mucositis). What is New: • This study is the first multicentre study confirming relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. • It describes the epidemiology of nosocomial BSI in

  6. Establishing an internet-based paediatric cancer registration and communication system for the Hungarian paediatric oncology network.

    PubMed

    Borgulya, Gábor; Jakab, Zsuzsanna; Schuler, Dezso; Garami, Miklós

    2004-01-01

    Cancer registration has developed in Europe over the last 50 years, and in the last decade intensive joint activities between the European Cancer Registries, in response to the need of pan-European harmonization of registration practices, have taken place. The Hungarian Paediatric Cancer Registry has been functioning as the database of the Hungarian Paediatric Oncology Network since 1971, aiming to follow the incidence and the treatment efficacy of malignant diseases. The goals of this globally unique open source information system are the following: 1) to raise the quality of the registration system to the European level by developing an Internet-based registration and communication system, modernizing the database, establishing automatic statistical analyses and adding an Internet website, 2) to support clinical epidemiological studies that we conduct with international collaborators on detailed analyses of the characteristics of patients and their diseases, evaluation of new diagnostic and therapeutic methods, prevention programs, and long-term quality of life and side effects. The benefits of the development of the Internet-based registration and communication system are as follows: a) introduction of an Internet-based case reporting system, b) modernization of the registry database according to international recommendations, c) automatic statistical summaries, encrypted mail systems, document repository, d) application of data security and privacy standards, e) establishment of a website and compilation of educational materials. The overall objective of this scientific project is to contribute towards the improvement of cancer prevention and cancer care for the benefit of the public in general and of cancer patients in particular.

  7. Amputation and prosthesis fitting in paediatric patients.

    PubMed

    Griffet, J

    2016-02-01

    Amputation of a limb is always perceived as a catastrophe. The principles underlying creation of a stump adapted to modern prosthetic fittings must be fully understood and the patient managed by a multidisciplinary team. In paediatric patients, preserving residual limb length is a crucial point that should be assessed according to the expected growth potential. Advances in prosthetic fittings have led to changes in the overall concept of socket design, which seeks to achieve three objectives: to maximise the weight-bearing surface area, to eliminate friction of the skin on the socket, and to eliminate lever-arm effects. The introduction on the market of new materials has contributed substantially to advances in prosthetic fittings. These advances require the use of new criteria for stump quality and optimisation, which exert a considerable influence on prosthesis function. Prosthetic fitting and specific management of psychological and social problems are provided during an inpatient stay in a physical medicine department, by a team of physicians, other healthcare professionals, social workers, and educators. Three-dimensional imaging and gait analysis provide valuable information.

  8. Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or allogeneic haemopoietic stem-cell transplantation.

    PubMed

    Groll, Andreas H; Castagnola, Elio; Cesaro, Simone; Dalle, Jean-Hugues; Engelhard, Dan; Hope, William; Roilides, Emmanuel; Styczynski, Jan; Warris, Adilia; Lehrnbecher, Thomas

    2014-07-01

    Invasive opportunistic fungal diseases (IFDs) are important causes of morbidity and mortality in paediatric patients with cancer and those who have had an allogeneic haemopoietic stem-cell transplantation (HSCT). Apart from differences in underlying disorders and comorbidities relative to those of adults, IFDs in infants, children, and adolescents are unique with respect to their epidemiology, the usefulness of diagnostic methods, the pharmacology and dosing of antifungal agents, and the absence of interventional phase 3 clinical trials for guidance of evidence-based decisions. To better define the state of knowledge on IFDs in paediatric patients with cancer and allogeneic HSCT and to improve IFD diagnosis, prevention, and management, the Fourth European Conference on Infections in Leukaemia (ECIL-4) in 2011 convened a group that reviewed the scientific literature on IFDs and graded the available quality of evidence according to the Infectious Diseases Society of America grading system. The final considerations and recommendations of the group are summarised in this manuscript. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Movie making as a cognitive distraction for paediatric patients receiving radiotherapy treatment: qualitative interview study

    PubMed Central

    Shrimpton, Bradley J M; Willis, David J; Tongs, Cáthal D; Rolfo, Aldo G

    2013-01-01

    Objectives To establish the outcomes achieved by using an innovative movie-making programme designed to reduce fear of radiotherapy among paediatric patients. Design Qualitative descriptive evaluation based on semistructured, qualitative interviews with purposeful sampling and thematic analysis. Setting Tertiary Cancer Centre. Participants 20 parents of paediatric patients who had produced a movie of their radiation therapy experience and were in a follow-up phase of cancer management. Results Participants attributed a broad range of outcomes to the movie-making program. These included that the programme had helped reduce anxiety and distress exhibited by paediatric patients and contributed to a willingness to receive treatment. Other outcomes were that the completed movies had been used in school reintegration and for maintaining social connections. Conclusions Allowing children to create a video of their experience of radiotherapy provided a range of benefits to paediatric patients that varied according to their needs. For some patients, movie-making offered a valuable medium for overcoming fear of the unknown as well as increasing understanding of treatment processes. For others, the development of a personalised video offered an important cognitive/attentional distraction through engaging with an age-appropriate activity. Together these outcomes helped children maintain self-control and a positive outlook. PMID:23328308

  10. Patient centric formulations for paediatrics and geriatrics: Similarities and differences.

    PubMed

    Hanning, Sara M; Lopez, Felipe L; Wong, Ian C K; Ernest, Terry B; Tuleu, Catherine; Orlu Gul, Mine

    2016-10-30

    Paediatrics and geriatrics both represent highly heterogenous populations and require special consideration when developing appropriate dosage forms. This paper discusses similarities, differences and considerations with respect to the development of appropriate medicine formulations for paediatrics and geriatrics. Arguably the most significant compliance challenge in older people is polypharmacy, whereas for children the largest barrier is taste. Pharmaceutical technology has progressed rapidly and technologies including FDCs, multi-particulates and orodispersible dosage forms provide unprecedented opportunities to develop novel and appropriate formulations for both old and new drugs. However, it is important for the formulation scientists to work closely with patients, carers and clinicians to develop such formulations for both the paediatric and geriatric population. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

    PubMed Central

    Figueroa, Diego Grimaldi; Simas, Ana Amélia Souza

    2016-01-01

    We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome. PMID:27872765

  12. Paediatric radiation oncology in the care of childhood cancer: A position paper by the International Paediatric Radiation Oncology Society (PROS).

    PubMed

    Kortmann, Rolf-Dieter; Freeman, Carolyn; Marcus, Karen; Claude, Line; Dieckmann, Karin; Halperin, Edward; Esiashvili, Natia; Paulino, Arnold; Mahajan, Anita; Seiersen, Klaus; Ahern, Verity; Ricardi, Umberto; Carrie, Christian

    2016-05-01

    Paediatric malignancies are a challenge for the radiation oncologist due to their rarity, the great variety of histological types, and the complexity of treatment concepts that evolve over time. The Paediatric Radiation Oncology Society (PROS) is the only internationally operating society for paediatric radiation oncology. The objectives of PROS are to set a world-wide standard of excellence with respect to radiation oncology aspects in curing children and adolescents with cancer, to provide a forum for communication between radiation oncologists, and to exchange information with all professionals involved in the management of paediatric and adolescent cancer. Challenges include the need to promote education and support practice in low and middle income countries (LMIC) as well as the cost and availability of modern treatment technologies for all but most especially these countries. Collaborations with other societies that include for example the education programmes provided jointly with ESTRO, and the upgraded technical platform of the PROS web site offer new possibilities to enhance the efficacy of PROS in education and support of paediatric radiation oncology practice world-wide. PROS has made an important contribution to the management of childhood malignancies over the past decade and new and developing collaborations between PROS and other societies or organizations will ultimately lead to a reduction in world-wide health care inequalities. Copyright © 2016. Published by Elsevier Ireland Ltd.

  13. Key drivers of patient experience in ambulatory paediatric cardiology.

    PubMed

    Allam, Shalini D; Mehta, Mary; Ben Khallouq, Bertha; Burrows, James F; Rosen, Paul

    2017-10-01

    Patient experience is becoming a central focus of healthcare. A broad range of studies on how to increase patient satisfaction ratings exists; however, they lack the specificity to adequately guide physicians and hospitals on how to improve patient experience. The objective of this study was to define the aspects of patient experience within paediatric cardiologist practices that can serve as predictors of excellent patient satisfaction. From 1 January, 2013 to 28 February, 2015 (26 months), outpatients who visited paediatric cardiologists were asked to complete a 39-question patient satisfaction survey regarding their experience. Surveys were collected over a 26-month period by Press Ganey, an independent provider of patient satisfaction surveys. Participants were asked to rate their experience on a 1-5 Likert-scale: a score of 1 demonstrated a "poor" experience, whereas a score of 5 demonstrated a "very good" experience. This retrospective study of 2468 responses determined that cheerfulness of the practice (r=0.85, p<0.001), a cohesive staff (r=0.83, p<0.001), and a care provider explaining problems and conditions (r=0.81, p<0.001) were key aspects of a paediatric cardiologist's practice that can be used as predictors of overall patient satisfaction. Awareness of how doctors can personalise a patient's experience is vital to achieve greater patient satisfaction and, ultimately, better patient outcomes.

  14. Eosinophilic heart disease in a paediatric patient.

    PubMed

    Dedieu, Natalie; Giardini, Alessandro; Khambadkone, Sachin; Marek, Jan

    2011-01-01

    A 12-year-old child with no previous medical history was referred with a 4-day history of cough, shortness of breath, and peripheral blood eosinophilia. Transthoracic echocardiography showed a soft tissue infiltrating the left ventricular free wall, the lateral mitral annulus, and the mitral valve leaflets. A soft tissue strand connecting the lateral left atrial wall and mitral leaflets across the mitral valve orifice was also identified, causing reduced opening and functional mitral stenosis. The diagnosis of Löeffler endocarditis was made, and after 10 weeks of treatment with oral prednisolone, there was complete resolution of symptoms and of the infiltrative tissue with normalization of mitral valve function. The present case highlights some atypical features of eosinophilic heart disease-like occurrence in paediatric age, the complete preservation of the right ventricle and left ventricular apex, and the presentation with mitral stenosis compared with mitral regurgitation typically observed in the late phase of the disease.

  15. Thyroid abnormalities in paediatric patients with vitiligo: retrospective study

    PubMed Central

    Borlu, Murat; Çınar, Salih Levent; Kesikoğlu, Ayten; Utaş, Serap

    2016-01-01

    Introduction The association between vitiligo and thyroid disease is not fully investigated especially in paediatric patients. Aim To determine the incidence of vitiligo and thyroid disorders in children. This is the first report from middle Anatolia and the second report from Turkey. Material and methods A retrospective chart review was performed to examine the presence of thyroid abnormalities in paediatric patients who had been admitted to the dermatology department with vitiligo. Results A total of 155 paediatric patients, including 80 (52%) male and 75 (48%) female patients were included. The mean age was 8.6 years. Non segmental vitiligo was the most common type of the disease in 140 (90%) reviewed patients, while segmental vitiligo appeared only in 15 (10%) patients. The mean onset of vitiligo was 5.6 ±0.9 years. A family history of vitiligo was found in 14 (9%) children. Thirty-four (22%) patients had thyroid function tests and/or thyroid autoantibody abnormality. All of these patients had non segmental vitiligo. It was statistically significant (p < 0.05) in types of vitiligo and thyroid disease parameters. Conclusions Our results show that it may be useful to screen thyroid in children with non segmental vitiligo. PMID:27512360

  16. Clinical value of stool culture in paediatric oncology patients: hospital evaluation and UK survey of practice.

    PubMed

    O'Connor, O; Cooke, R P D; Cunliffe, N A; Pizer, B

    2017-01-01

    Diarrhoea is a frequently occurring symptom in paediatric oncology patients. The role of routine testing for enteric bacteria in hospitalized patients with diarrhoea is considered limited, but the diagnostic value of testing in children with oncological conditions has not been reported. Therefore, we conducted a five-year retrospective service evaluation in our tertiary paediatric oncology unit together with a national survey of 21 centres to estimate the utility of stool cultures in oncology patients with diarrhoea and the national approach to testing. Our local survey demonstrated very low diagnostic yield using routine enteric stool cultures with only one sample out of 842 (0.1%) testing positive. The national survey demonstrated considerable variation in practice. There is little evidence to support the use of conventional stool culture for enteric bacteria in children with cancer in our centre. These findings should inform national testing policies.

  17. The effect of increased body mass index on patient dose in paediatric radiography.

    PubMed

    Ladia, Arsenoi P; Skiadopoulos, Spyros G; Karahaliou, Anna Ν; Messaris, Gerasimos A T; Delis, Harry B; Panayiotakis, George S

    2016-10-01

    Radiation protection is of particular importance in paediatric radiology. In this study, the influence of increased body mass index (BMI) in radiation dose and associated risk was investigated for paediatric patients aged 5-6.5 years, undergoing chest (64 patients) or abdomen (64 patients) radiography. Patients were categorized into normal and overweight, according to the BMI classification scheme. Entrance surface dose (ESD), organ dose, effective dose (ED) and risk of exposure induced cancer death (REID) were calculated using the Monte Carlo based code PCXMC 2.0. Statistically significant increase in patient radiation dose and REID was obtained for overweight patients as compared to normal ones, in both chest and abdomen examinations (Wilcoxon singed-rank test for paired data, p<0.001). The percentage increase in overweight as compared to normal patients of ESD, organ dose (maximum value), ED and REID was 13.6%, 24.4%, 18.9% and 20.6%, respectively, in case of chest radiographs. Corresponding values in case of abdomen radiographs were 15.0%, 24.7%, 21.8% and 19.8%, respectively. An increased BMI results in increased patient radiation dose in chest and abdomen paediatric radiography. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Detection of toxigenic Clostridium difficile in paediatric patients.

    PubMed

    Falces-Romero, Iker; Troyano-Hernáez, Paloma; García-Bujalance, Silvia; Baquero-Artigao, Fernando; Mellado-Peña, María José; García-Rodríguez, Julio

    2017-07-06

    Our main objective was a revision of clinical, microbiological and epidemiological results of Clostridium difficile-associated infection in paediatric patients (2010-2015). We compared the diagnoses performed by detection of toxins in feces and those performed by real-time PCR. This retrospective study included 82 paediatric patients. Detection of toxigenic C. difficile was performed sequentially, in diarrheal feces and under clinical request. A total of 39% of the patients were attended at Haematology-oncology Unit and >50% of them had previously received cephalosporins. Fever associated with diarrhea was more frequent in the group of toxin detection, whereas not receiving specific antibiotic treatment was more frequent in the group of positive PCR, without statistically significant differences. We highlight the presence of C. difficile infection in children under 2years old. A diagnostic testing in selected paediatric patients would be advisable when there is clinical suspicion of infection. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  19. EULAR recommendations for vaccination in paediatric patients with rheumatic diseases.

    PubMed

    Heijstek, M W; Ott de Bruin, L M; Bijl, M; Borrow, R; van der Klis, F; Koné-Paut, I; Fasth, A; Minden, K; Ravelli, A; Abinun, M; Pileggi, G S; Borte, M; Wulffraat, N M

    2011-10-01

    Evidence-based recommendations for vaccination of paediatric patients with rheumatic diseases (PaedRD) were developed by following the EULAR standardised procedures for guideline development. The EULAR task force consisted of (paediatric) rheumatologists/immunologists, one expert in vaccine evaluation, one expert in public health and infectious disease control, and one epidemiologist. A systematic literature review was conducted in MEDLINE, EMBASE, and abstracts of the EULAR and American College of Rheumatology meetings of 2008/9. The level of evidence and strength of recommendation were based on customary scoring systems. Delphi voting was applied to assess the level of agreement between task force members. 107 papers and eight abstracts were used. The majority of papers considered seasonal influenza (41) or pneumococcal (23) vaccination. 26 studies were performed specifically in paediatric patients, and the majority in adult rheumatoid arthritis and systemic lupus erythematosus patients. Fifteen recommendations were developed with an overall agreement of 91.7%. More research is needed on the safety and immunogenicity of (live-attenuated) vaccination in PaedRD, particularly in those using biologicals, and the effect of vaccination on prevention of infections.

  20. Safety and tolerability of zonisamide in paediatric patients with epilepsy.

    PubMed

    Cross, J Helen; Auvin, Stéphane; Patten, Anna; Giorgi, Luigi

    2014-11-01

    Zonisamide has recently been approved in Europe for the adjunctive treatment of partial seizures (with or without secondary generalisation) in adolescents and children aged ≥6 years. To further assess the safety of adjunctive zonisamide in paediatric epilepsy patients. A pooled analysis of data from 17 studies (including four randomised, double-blind trials) was conducted. The safety population comprised patients aged ≤16 years receiving at least one dose of study drug. Assessments included treatment-emergent adverse events (TEAEs), clinical laboratory parameters, vital signs and electrocardiography. The analysis included 398 patients treated with zonisamide (<12 years, n = 191; 12-16 years, n = 207). All but seven patients received zonisamide as adjunctive therapy. Mean duration of exposure was 318.7 days (mean dose, 253.1 mg/day). Most TEAEs were of mild or moderate intensity. The most frequently reported treatment-related TEAEs were decreased appetite (15.6%), somnolence (12.1%), fatigue (9.3%), dizziness (6.0%), decreased weight (5.8%), irritability (5.8%) and headache (5.3%). Incidence of serious zonisamide-related TEAEs was low (3.5% overall). TEAEs most commonly leading to discontinuation were lethargy (1.0%) and fatigue (1.0%). TEAEs of decreased weight and decreased appetite occurred in 28 (7.0%) and 78 (19.6%) patients, respectively. Twenty-eight patients had decreased bicarbonate levels, but there were no reports of respiratory alkalosis or metabolic acidosis. No changes in vital signs of clinical concern were observed and there were no reports of clinically significant electrocardiogram abnormalities with zonisamide treatment. Zonisamide demonstrated an acceptable safety profile when used as adjunctive treatment in paediatric patients. Copyright © 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  1. Paediatric cancer stage in population-based cancer registries: the Toronto consensus principles and guidelines.

    PubMed

    Gupta, Sumit; Aitken, Joanne F; Bartels, Ute; Brierley, James; Dolendo, Mae; Friedrich, Paola; Fuentes-Alabi, Soad; Garrido, Claudia P; Gatta, Gemma; Gospodarowicz, Mary; Gross, Thomas; Howard, Scott C; Molyneux, Elizabeth; Moreno, Florencia; Pole, Jason D; Pritchard-Jones, Kathy; Ramirez, Oscar; Ries, Lynn A G; Rodriguez-Galindo, Carlos; Shin, Hee Young; Steliarova-Foucher, Eva; Sung, Lillian; Supriyadi, Eddy; Swaminathan, Rajaraman; Torode, Julie; Vora, Tushar; Kutluk, Tezer; Frazier, A Lindsay

    2016-04-01

    Population-based cancer registries generate estimates of incidence and survival that are essential for cancer surveillance, research, and control strategies. Although data on cancer stage allow meaningful assessments of changes in cancer incidence and outcomes, stage is not recorded by most population-based cancer registries. The main method of staging adult cancers is the TNM classification. The criteria for staging paediatric cancers, however, vary by diagnosis, have evolved over time, and sometimes vary by cooperative trial group. Consistency in the collection of staging data has therefore been challenging for population-based cancer registries. We assembled key experts and stakeholders (oncologists, cancer registrars, epidemiologists) and used a modified Delphi approach to establish principles for paediatric cancer stage collection. In this Review, we make recommendations on which staging systems should be adopted by population-based cancer registries for the major childhood cancers, including adaptations for low-income countries. Wide adoption of these guidelines in registries will ease international comparative incidence and outcome studies.

  2. An mHealth system for toxicity monitoring of paediatric oncological patients using Near Field Communication technology.

    PubMed

    Duregger, Katharina; Hayn, Dieter; Morak, Jürgen; Ladenstein, Ruth; Schreier, Gunter

    2015-01-01

    Home-based monitoring might be useful to reduce the burden of long-lasting oncological treatment for children. Current telemonitoring applications focus on chronic diseases or elderly people. Based on the workflow for different stakeholders and the identification of parameters important in paediatric oncology, we developed a prototype of a smartphone-based telehealth system using Near Field Communication technology for monitoring paediatric neuroblastoma patients at home. The parameters blood pressure, heart rate, temperature, body weight, C-reactive protein, white blood cell count, wellbeing, pain level, nausea level and skin alterations could be monitored using a smartphone, a designated app, point-of-care measurement devices and a smart-poster containing RFID tags. The system has been designed to increase the quality of life for paediatric cancer patients. As a future step, a clinical trial is currently being planned to evaluate the system in clinical setting.

  3. [Neurotoxic manifestations of black widow spider envenomation in paediatric patients].

    PubMed

    Sotelo-Cruz, N; Gómez-Rivera, N

    2016-05-01

    Envenomation by black widow spiders manifests clinically with signs of neurotoxicity in paediatric patients. Identify typical neurological signs and symptoms in paediatric patients of different ages, and describe treatment and outcomes in a paediatric hospital in northwest Mexico. We reviewed 70 clinical records of patients hospitalised due to black widow spider bite between 1978 and 2014. We divided the total into 2 groups: Group 1, infants and preschool children; and Group 2, school-age children and adolescents. The demographic variables were age, sex, birthplace, place where envenomation occurred, body part(s) affected, degree of envenomation according to signs and symptoms, treatment, clinical outcome, and statistical differences. Boys accounted for 61.4% of all cases, and infants younger than one year old made up 14.2%. Most patients (70%) were bitten by the spider at home; the anatomical areas most frequently affected were the legs, neck, thorax, and abdomen. The neurological signs and symptoms displayed by Group 1 were irritability, constant crying, sialorrhoea, nausea, tachycardia, arrhythmias, fatigue when walking, agitation, muscle spasms paraesthesia, tetany, seizures, and nystagmus. Signs in Group 2 included localized pain, headache, sialorrhoea, paraesthesia, profuse sweating, anxiety, muscle weakness, muscle spasms, and fine tremor. The predominant autonomic sign in Group 1 was sialorrhoea (P<.0001) and in Group 2, paraesthesia (P<.0001). Patients who received Fab antivenom treatment displayed better outcomes and shorter hospital stays than those who did not. No deaths were reported. The neurological signs and symptoms caused by black widow spider bite are predominantly autonomic, and identifying them permits early diagnosis and more effective treatment. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Vulvar symptoms in paediatric and adolescent patients.

    PubMed

    Piippo, S; Lenko, H; Vuento, R

    2000-04-01

    Vulvovaginal symptoms in children and young adolescents are not yet very well understood, nor is the actual incidence known. This study evaluates the character and possible infectious aetiology of vulvar symptoms of females aged up to 16 y. The signs, symptoms and bacteriological findings of 68 consecutive cases were studied. The study was conducted in the University Hospital of Tampere at a special gynaecological consultation clinic for children and adolescents. Sixty-eight patients were included in the study: 48 girls (71%) were prepubertal, at Tanner stage M1P1, 26 patients were 2-4-y-old and 15 were 5-7-y-old. The duration of symptoms was known for 46 patients: 41% had had symptoms for >1 mo and 20% for >6 mo. Forty-eight patients had abnormal clinical findings on examination and 16 (33%) of them had an infectious aetiology. Streptococcus pyogenes infection was identified in 11 (16%) patients, all of whom had symptoms. Candida was identified in 6 (9%) patients. No infectious aetiology was found among 26 patients who had symptoms and abnormal clinical findings. Vulvovaginal symptoms during childhood are more common among younger children (<7 y). In 67% of patients no infectious aetiology could be found. Samples for microbiological culture should be taken from symptomatic patients and symptomatic areas. Cultures of Candida and bacteria are necessary but usually sufficient. If a microbiological aetiology is established, treatment can be assigned accordingly. Patients with vulvar symptoms and findings but with an unclear aetiology need support and advice on proper hygiene and can intermittently use mild corticosteroids locally.

  5. [Family dysfunction and paediatric patients with asthma].

    PubMed

    Guzmán-Pantoja, Jaime Eduardo; Reyes Barajas-Mendoza, Eduardo; Luce-González, Elba Graciela; Valadez-Toscano, Francisco Javier; Gutiérrez-Román, Elsa Armida; Robles-Romero, Miguel Angel

    2008-11-01

    To determine family function of pediatric patients with asthma. Cross-sectional study. Family medicine clinic number 51, Mexican Institute of Social Security, Primary Care, in Guadalajara, Jalisco, Mexico. Fifty families were studied; 25 of which had a pediatric patient previously diagnosed with asthma, and a control group of 25 with pediatric patients without asthma. From September 2006 to February 2007 family function was evaluated using family APGAR and associations were estimated using odds ratio (OR) and 95% confidence interval (CI). Family dysfunction was more often present in families with asthmatic patients compared to those without; OR=3.7 (95% CI, 1.1-13). Severe dysfunction is markedly higher in families with asthmatic members. Family dysfunction is more frequent in families with asthmatic children; family functionality should be seen as an important part of the integral approach in those families.

  6. Recurrent facial nerve palsy in paediatric patients.

    PubMed

    Eidlitz-Markus, T; Gilai, A; Mimouni, M; Shuper, A

    2001-11-01

    The aim of the study was to investigate the clinical presentation and prognosis of recurrent facial nerve palsy (RFNP) in children. The files of 182 patients referred to the Schneider Children's Medical Centre of Israel for neurological evaluation of isolated peripheral facial nerve palsy between October 1992 and December 1998 were reviewed. RFNP was found in 11 patients (9 females, 2 males), with an incidence of 6%. In two males, the aetiology was traced to Melkersson-Rosenthal syndrome and these patients were separated from the rest of the group. Three children had two episodes of facial nerve paresis which completely resolved clinically within several weeks. Six other children underwent electrophysiological studies. Two of the latter with residual neurological damage, and one child with abnormal blink reflex only, showed decreased facial nerve conduction velocity and abnormal blink reflex. Three children with complete recovery had disturbed blink reflex only with normal nerve conduction. Brain imaging studies as well as laboratory work-up were non-contributory in all cases. The frequency of recurrent facial nerve palsy in children was similar to that in adults. The most significant factors in the evaluation of recurrent facial nerve palsy are medical history and physical findings at diagnosis and after short follow-up. In our patients, electrophysiological studies did not have either clinical or prognostic significance. The rate of full clinical recovery is about 70%, lower than in Bell palsy.

  7. Deferasirox pharmacokinetic evaluation in β-thalassaemia paediatric patients.

    PubMed

    Allegra, Sarah; Cusato, Jessica; De Francia, Silvia; Pirro, Elisa; Massano, Davide; Piga, Antonio; D'Avolio, Antonio

    2017-05-01

    Iron chelation in the transfusion-dependent anaemias management is essential to prevent end-organ damage and to improve survival. Deferasirox is a once-daily orally active tridentate selective iron chelator which pharmacokinetic disposition could influence treatment efficacy and toxicity. Therapeutic drug monitoring is an important tool for optimizing drug utilization and doses. A fully validated chromatographic method was used to quantify deferasirox concentration in plasma collected from paediatric patients with β-thalassaemia. Samples obtained after 5 days of washout or in naïve patients before and after 2, 4, 6 and 24 h drug administration were evaluated. Associations between variables were tested using the Pearson test. Twenty paediatric patients were enrolled; they were mainly men (13.65%), with median age of 6.35 years and body mass index of 15.45 kg/m(2) . Concerning pharmacokinetic parameters, a higher interindividual variability was shown. A positive, but not significant, correlation (r = 0.363; P = 0.115) was found between deferasirox area under the concentration curve over 24 h (AUC) and drug dose. Monitoring plasma deferasirox concentrations appears beneficial for guiding appropriate patient treatment, enhancing effectiveness and minimizing toxicity. © 2016 Royal Pharmaceutical Society.

  8. Unusual presentations of osteoarticular tuberculosis in two paediatric patients

    PubMed Central

    Cheung, Jason Pui Yin; Ho, Kenneth Wai Yip; Lam, Ying Lee; Shek, Tony Wai Hung

    2012-01-01

    Tuberculosis is a universal mimicker and thus could be a differential diagnosis of any osteolytic lesion. Bone biopsy is crucial in these cases for culture and histological proof of tuberculous infection. This is a case report of two paediatric patients with unusual presentations of tuberculosis. One patient presented with knee pain and had imaged findings of an osteolytic lesion at the epiphysis. Interval scan showed spread of the lesion through the physis to the metaphyseal region. The second patient presented with hip pain and an osteolytic lesion of the acetabulum. He was subsequently found to have involvement of the brain and spine as well. Both patients were diagnosed with tuberculosis by bone biopsy for culture and pathological examination. They were treated successfully with antituberculous medications without chronic sequelae. These two patients showed that early recognition and prompt treatment are critical for management of tuberculosis to avoid chronic sequelae. PMID:23087272

  9. Acute cerebellitis in paediatric patients: Our experience.

    PubMed

    García-Iñiguez, J P; López-Pisón, F J; Madurga Revilla, P; Montejo Gañán, I; Domínguez Cajal, M; Monge Galindo, L; Sánchez Marco, S B; García Jiménez, M C

    2017-03-15

    Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery. Copyright © 2017 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Outcomes of moderate sedation in paediatric dental patients.

    PubMed

    Özen, B; Malamed, S F; Cetiner, S; Özalp, N; Özer, L; Altun, C

    2012-06-01

    The aim of this study was to evaluate the outcomes of moderate sedation with nitrous oxide/oxygen (N(2) O/O(2)) alone or combined with different dosages and administration routes of midazolam in uncooperative paediatric dental patients using the Bispectral Index System (BIS). This one-year clinical study examined first-visit moderate sedation performed in 240 healthy children aged 4-6 years. Subjects were randomly divided into four groups according to drug, route and dosage, as follows: Group 1 - 0.20 mg/kg midazolam (40 mg/ml) delivered intranasally; Group 2 - 0.75 mg/kg midazolam (15 mg/3 ml) delivered orally; Group 3 - 0.50 mg/kg midazolam (15 mg/3 ml) delivered orally. All children in these three groups also received inhalation sedation with 50%-50% N(2) O/O(2), whereas children in Group 4 received inhalation sedation with 50%-50% N(2) O/O(2) only. The outcome of sedation was evaluated as either 'successful', 'failed' or 'not accepted'. The highest success rate was found in Group 1 (0.20 mg/kg intranasally, 87%), followed by Group 2 (0.75 mg/kg orally, 79%). The overall mean success rate for all groups was 73%. Moderate sedation can be successfully used in the clinical management of paediatric dental patients, with both intranasal and oral sedation using midazolam in conjunction with nitrous oxide found to be effective methods. © 2012 Australian Dental Association.

  11. Patient disclosure of medical errors in paediatrics: A systematic literature review.

    PubMed

    Koller, Donna; Rummens, Anneke; Le Pouesard, Morgane; Espin, Sherry; Friedman, Jeremy; Coffey, Maitreya; Kenneally, Noah

    2016-05-01

    Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified.

  12. Patient disclosure of medical errors in paediatrics: A systematic literature review

    PubMed Central

    Koller, Donna; Rummens, Anneke; Le Pouesard, Morgane; Espin, Sherry; Friedman, Jeremy; Coffey, Maitreya; Kenneally, Noah

    2016-01-01

    Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified. PMID:27429578

  13. Changing face of paediatric and adolescent thyroid cancer.

    PubMed

    Hameed, R; Zacharin, M R

    2005-11-01

    The aims of our study were to review the Royal Children's Hospital cohort of children having thyroidectomy for thyroid nodules over the last 8 years and to report the changing pattern of thyroid cancer seen in our institution over that time. We undertook a retrospective case-note review of all patients who underwent thyroid surgery between 1997 and 2004. Of 69 patients identified, the pathological diagnoses were 51 benign tumours, 14 thyroid cancers and four cases of multiple endocrine neoplasia type 2, who were treated with prophylactic thyroidectomy. Sixteen of the 69 patients had a history of childhood cancer and 10/16 had cancer treatment which included direct or scatter radiation. Of the 10 patients who received irradiation, four had follicular adenomas and six developed thyroid cancer. All six patients were euthyroid: one patient was presented with a palpable nodule and the other five were detected on surveillance ultrasound. Our results confirm a high detection of malignancy in thyroid nodules in childhood. Compared to an earlier study at this institution, the number of thyroid malignancies appears to be increasing. Surveillance at the Royal Children's Hospital has changed, with increased long-term cancer survival. Prospective 2-yearly evaluation of those with a past history of radiation exposure has resulted in earlier detection of benign and malignant thyroid lesions. Nodular changes are usually not clinically apparent for many years and lifelong surveillance is necessary for cancer detection in this group.

  14. Patient doses in paediatric CT: feasibility of setting diagnostic reference levels.

    PubMed

    Järvinen, H; Merimaa, K; Seuri, R; Tyrväinen, E; Perhomaa, M; Savikurki-Heikkilä, P; Svedström, E; Ziliukas, J; Lintrop, M

    2011-09-01

    Despite the fact that doses to paediatric patients from computed tomography (CT) examinations are of special concern, only few data or studies for setting of paediatric diagnostic reference levels (DRLs) have been published. In this study, doses to children were estimated from chest and head CT, in order to study the feasibility of DRLs for these examinations. It is shown that for the DRLs, patient dose data from different CT scanners should be collected in age or weight groups, possibly for different indications. For practical reasons, the DRLs for paediatric chest CT should be given as a continuous DRL curve as a function of patient weight. For paediatric head CT, DRLs for a few age groups could be given. The users of the DRLs should be aware of the calibration phantom applied in the console calibration for different paediatric scanning protocols. The feasibility of DRLs should be re-evaluated every 2-3 y.

  15. Choroidal thickness evaluation in paediatric patients with adenotonsillar hypertrophy.

    PubMed

    Yenigun, A; Elbay, A; Hafiz, A M; Ozturan, O

    2017-09-01

    To investigate choroidal thickness using enhanced-depth imaging optical coherence tomography in paediatric patients with adenotonsillar hypertrophy, with comparison to healthy children, three months after adenotonsillectomy. The patients were assigned to three groups: an adenotonsillar hypertrophy group, an adenotonsillectomy group and a healthy control group. In all groups, subfoveal, temporal and nasal choroidal thickness measurements were taken. In the subfoveal, temporal and nasal regions, choroidal tissue was found to be significantly thinner in adenotonsillar hypertrophy children than healthy children (p = 0.012, p = 0.027 and p = 0.020). The subfoveal and temporal choroidal thickness measurements of adenotonsillar hypertrophy group cases were significantly decreased compared to those in the adenotonsillectomy group (p = 0.038 and p = 0.048). There was a significant association between decreased choroidal thickness and adenotonsillar hypertrophy. Adenotonsillar hypertrophy may play an important role in decreased choroidal thickness.

  16. Paediatric nurse practitioner managed cardiology clinics: patient satisfaction and appointment access.

    PubMed

    Evangelista, Juli-Anne K; Connor, Jean Anne; Pintz, Christine; Saia, Teresa; O'Connell, Cheryl; Fulton, David R; Hickey, Patricia

    2012-10-01

    This article summarizes a comparative study of patient/family satisfaction and appointment wait times in physician managed vs. paediatric nurse practitioner managed cardiology clinics. Appointment wait times exceeded 40 days in the outpatient cardiology department at a children's hospital. To address the gap in available appointments, paediatric nurse practitioner managed cardiology clinics were implemented. A sample of 128 patients who presented concurrently in physician or paediatric nurse practitioner managed cardiology clinics from December 2009 through February 2010 was recruited for participation. The hospital's ambulatory patient satisfaction survey was utilized to measure level of patient satisfaction with care. Survey responses were evaluated using Fisher's exact test. Appointment wait times were compared pre and post implementation of paediatric nurse practitioner managed clinics. Sixty-five physician families and 63 paediatric nurse practitioner families completed the satisfaction survey. There was no statistically significant difference in patient satisfaction between clinic types. Appointment wait time decreased from 46 to 43 days, which was not statistically significant. Paediatric nurse practitioner clinics included a statistically higher percentage total of urgent appointments compared to that in physician clinics. Paediatric nurse practitioner managed cardiology clinics are a strategic solution for improving patient access and facilitating high quality patient care while earning high levels of patient satisfaction. This healthcare delivery model illustrates the potential for expanded utilization of advanced practice nurses. © 2012 Blackwell Publishing Ltd.

  17. The devil you know: parental online information seeking after a paediatric cancer diagnosis

    PubMed Central

    Gage, Elizabeth A.; Panagakis, Christina

    2011-01-01

    There is a growing interest in understanding the effect that online information seeking has on patient experiences, empowerment, and interactions with health care providers. This mixed-methods study combines surveys and in-depth interviews with 41 parents of paediatric cancer patients in the US to examine how parents think about, evaluate, access, and use the Internet to seek information related to their child’s cancer. We find that during the acute crisis of a child being diagnosed with cancer parents preferred to receive information related to their child’s diagnosis, prognosis, and treatment options from a trusted health care provider rather than through the Internet. To this end, we find that access to medically related cancer information through the Internet was deemed untrustworthy and frightening. Parents’ reasons for avoiding online information seeking included fear of what they might find out, uncertainty about the accuracy of information online, being overloaded by the volume of information online, and having been told not to go online by oncologists. Some parents also had logistical barriers to accessing the Internet. While most parents did not turn to the Internet as a source of health-related information, many did use the Internet to connect with sources of social support throughout their child’s illness. PMID:21854400

  18. The devil you know: parents seeking information online for paediatric cancer.

    PubMed

    Gage, Elizabeth A; Panagakis, Christina

    2012-03-01

    There is a growing interest in understanding the effect that online information-seeking has on patients' experiences, empowerment and interactions with healthcare providers. This mixed-methods study combines surveys and in-depth interviews with 41 parents of paediatric cancer patients in the USA to examine how parents think about, evaluate, access and use the internet to seek information related to their child's cancer. We find that, during the acute crisis of a child being diagnosed with cancer, parents preferred to receive information related to their child's diagnosis, prognosis and treatment options from a trusted healthcare provider rather than through the internet. We find that access to medically related cancer information through the internet was deemed to be untrustworthy and frightening. Parents' reasons for avoiding online information-seeking included fear of what they might find out, uncertainty about the accuracy of information online, being overloaded by the volume of information online and having been told not to go online by oncologists. Some parents also had logistical barriers to accessing the internet. While most parents did not turn to the internet as a source of health-related information, many did use it to connect with sources of social support throughout their child's illness.

  19. Clinical presentation and clinical outcomes in Chernobyl-related paediatric thyroid cancers: what do we know now? What can we expect in the future?

    PubMed

    Tuttle, R M; Vaisman, F; Tronko, M D

    2011-05-01

    Over the last 20 years, nearly 5000 cases of differentiated thyroid cancer have been diagnosed and treated in the regions of Russia, Ukraine and Belarus in young people previously exposed to the Chernobyl radioactive fallout during childhood. At diagnosis, 60-70% of the Chernobyl-related paediatric thyroid cancers had clinically evident cervical lymph node metastases (N1) and 10-15% had distant metastases (M1). Despite early reports suggesting that the paediatric thyroid cancer cases that developed after exposure to Chernobyl fallout were particularly aggressive, it now seems that the initial presentation and early clinical course of most of these cases are very similar to both non-radiation-associated paediatric thyroid cancers and thyroid cancers that arise after exposure to external beam irradiation. Over an average clinical follow-up period of about 10 years, the disease-specific mortality rate in these paediatric thyroid cancer cases that developed after the Chernobyl accident is quite low (1% or less). As would be expected in paediatric thyroid cancer, short-term recurrence rates range from 7 to 28% in published reports (mean 17%). However, long-term studies of paediatric thyroid cancer suggest that although the 30 year disease-specific mortality rate should be about 1%, the risk of developing structural disease recurrence is nearly 30% (of which 80% are expected to be locoregional recurrences and 20% are probably new distant metastases). Projected over 30 years of follow-up, a 1% disease-specific mortality in this cohort of 5000 patients would equate to about 50 deaths directly attributable to thyroid cancer. However, a 30% recurrence rate would also mean that about 1500 patients may develop a clinically meaningful recurrence that would need to be diagnosed and treated. It is imperative that we continue to work with our colleagues in Belarus, Ukraine and Russia to ensure that this large volume of patients destined to develop clinically significant

  20. The prioritisation of paediatrics and palliative care in cancer control plans in Africa

    PubMed Central

    Weaver, M S; Yao, A J J; Renner, L A; Harif, M; Lam, C G

    2015-01-01

    Background: Given the burden of childhood cancer and palliative care need in Africa, this paper investigated the paediatric and palliative care elements in cancer control plans. Methods: We conducted a comparative content analysis of accessible national cancer control plans in Africa, using a health systems perspective attentive to context, development, scope, and monitoring/evaluation. Burden estimates were derived from World Bank, World Health Organisation, and Worldwide Palliative Care Alliance. Results: Eighteen national plans and one Africa-wide plan (10 English, 9 French) were accessible, representing 9 low-, 4 lower-middle-, and 5 upper-middle-income settings. Ten plans discussed cancer control in the context of noncommunicable diseases. Paediatric cancer was mentioned in 7 national plans, representing 5127 children, or 13% of the estimated continental burden for children aged 0–14 years. Palliative care needs were recognised in 11 national plans, representing 157 490 children, or 24% of the estimated Africa-wide burden for children aged 0–14 years; four plans specified paediatric palliative needs. Palliative care was itemised in four budgets. Sample indicators and equity measures were identified, including those highlighting contextual needs for treatment access and completion. Conclusions: Recognising explicit strategies and funding for paediatric and palliative services may guide prioritised cancer control efforts in resource-limited settings. PMID:26042935

  1. The prioritisation of paediatrics and palliative care in cancer control plans in Africa.

    PubMed

    Weaver, M S; Yao, A J J; Renner, L A; Harif, M; Lam, C G

    2015-06-09

    Given the burden of childhood cancer and palliative care need in Africa, this paper investigated the paediatric and palliative care elements in cancer control plans. We conducted a comparative content analysis of accessible national cancer control plans in Africa, using a health systems perspective attentive to context, development, scope, and monitoring/evaluation. Burden estimates were derived from World Bank, World Health Organisation, and Worldwide Palliative Care Alliance. Eighteen national plans and one Africa-wide plan (10 English, 9 French) were accessible, representing 9 low-, 4 lower-middle-, and 5 upper-middle-income settings. Ten plans discussed cancer control in the context of noncommunicable diseases. Paediatric cancer was mentioned in 7 national plans, representing 5127 children, or 13% of the estimated continental burden for children aged 0-14 years. Palliative care needs were recognised in 11 national plans, representing 157 490 children, or 24% of the estimated Africa-wide burden for children aged 0-14 years; four plans specified paediatric palliative needs. Palliative care was itemised in four budgets. Sample indicators and equity measures were identified, including those highlighting contextual needs for treatment access and completion. Recognising explicit strategies and funding for paediatric and palliative services may guide prioritised cancer control efforts in resource-limited settings.

  2. MEDICINES RECONCILIATION FOR PAEDIATRIC PATIENTS ON ADMISSION AND DISCHARGE.

    PubMed

    Moss, Maria; Bilbul, Celine; Crook, Jo

    2016-09-01

    National guidance from National Institute for Health and Clinical Excellence (NICE), National Patient Safety Agency (NPSA), World Health Organization and the Royal Pharmaceutical Society has long highlighted the importance of accurate and timely medicines reconciliation (MR) in reducing medication errors for patients upon transfer of care setting.1 (-) 4 Current guidance for MR excludes children <16 years of age, where widespread use of off-label and unlicensed formulations puts this group of patients at a higher risk. To quantitatively assess the level of MR for paediatric inpatients on admission and discharge and to ascertain whether Discharge Summary (DSUM) information is sent to the GP in a timely manner. ▸ Data was collected retrospectively over a two week period for paediatric take home prescriptions.▸ An electronic prescribing system was used to complete a data collection form, documenting their MR process and timeframe on admission and discharge.▸ The information was recorded onto an online template of the data collection form using Qualtrics software to prepare a Microsoft Excel file for data analysis. 65 paediatric patients on four wards were audited.▸ Standard 1: 32/65 (49.2%) of patients had their drug history (DH) documented within 24 hrs of admission.▸ Standard 2: 39/65 (60.0%) of patients had their medicines reconciled by a pharmacist within 72 hrs of admission.▸ Standard 3: 46/65 (70.8%) of patients had their medicines reconciled by a pharmacist and/or doctor at discharge.▸ Standard 4: 57/65 (87.7%) of patients had their DSUM sent to the GP within 24 hrs of discharge. None of the four standards were met, emphasising the need to develop better MR practice. The following conclusions were identified:▸ A need for more MMTs at ward level to conduct accurate DHs within a timely manner.▸ MR on admission and discharge suffers out-of-hours (OOH), thus supporting plans for seven-day working.▸ A combined effort between

  3. The guardians' perspective on paediatric cancer treatment in Malawi and factors affecting adherence.

    PubMed

    Israëls, Trijn; Chirambo, Chawanangwa; Caron, Huib; de Kraker, Jan; Molyneux, Elizabeth; Reis, Ria

    2008-11-01

    Abandonment of paediatric cancer treatment is a common problem in developing countries. Little is known about the guardians' perspective on cancer treatment in these countries, especially the factors that affect adherence. Following a pilot study enquiring into the possible causes of abandonment, a problem analysis diagram was drawn which helped to develop the questionnaires. Semi-structured interviews (n = 83) and focus group discussions (n = 8) were held with the guardians of 25 Burkitt lymphoma patients and 7 Wilms tumour patients at different phases of therapy in Malawi. Parents in Malawi are very motivated to continue treatment if they think that it will cure their child. Financial costs are important concerns. Not all tasks at home are assumed by other household members. The diagnosis of cancer was unknown before being told about it in hospital and caused fear of recurrence and death. Guardians are reluctant to ask the health personnel questions. They worry that taking frequent blood samples will weaken their child. The side effects of the chemotherapy are seen as a proof of efficacy. It is important to appreciate the guardians' concerns when offering treatment that requires their sustained commitment. It is necessary to provide not only medical treatment, but also travel allowances and adequate nutritional support during long hospital stays to impoverished families. Information should be given proactively. (c) 2008 Wiley-Liss, Inc.

  4. Relapsing inappropriate antidiuretic hormone secretion in an anti-aquaporin-4 antibody positive paediatric patient.

    PubMed

    Kravljanac, Ruzica; Martinović, Vanja; Dujmović, Irena; Djurić, Milena; Kuzmanović, Miloš; Weinshenker, Brian G; Drulović, Jelena

    2014-09-01

    Paediatric patients with the syndrome of an inappropriate antidiuretic hormone secretion (SIADH), as a manifestation of inflammatory demyelinating disorders of the central nervous system, have been rarely described until now, in only a few cases of neuromyelitis optica spectrum disorders (NMOSDs). We present a case of relapsing SIADH associated with NMOSD, in an anti-aquaporin-4 antibody positive 14-year-old girl, who is, to our best knowledge, the first reported paediatric patient with relapsing SIADH and NMOSD. Additionally, our case further supports the notion that paediatric encephalomyelitis associated with SIADH should suggest the diagnosis of NMOSD.

  5. [Stroke in paediatric patients with sickle-cell anaemia].

    PubMed

    Díaz-Díaz, Judit; Camacho-Salas, Ana; Núñez-Enamorado, Noemí; Carro-Rodríguez, Miguel A; Sánchez-Galán, Victoria; Martínez de Aragón, Ana; Simón-De Las Heras, Rogelio

    2014-08-16

    Sickle-cell anaemia is the severe homozygotic form of drepanocytosis, a genetic disorder that often occurs among black people and which is characterised by the production of haemoglobin S, chronic hemolytic anaemia and tissue ischaemia due to alterations in blood flow. A quarter of the patients presented neurological manifestations; 8-10% of children will have a stroke. AIM. To analyse the cases of stroke in children with sickle-cell anaemia in our centre. We conducted a retrospective descriptive study of children with sickle-cell anaemia and stroke. Five patients (two Dominicans and three Guineans) with sickle-cell anaemia and stroke; one patient suffered two episodes of stroke. The mean age was 27 months. Five of the episodes were ischaemic infarctions. Stroke was the initial form of presentation of drepanocytosis on three occasions. Two of the strokes occurred within a context of pneumococcal meningitis. Four of the patients had previously reported fever. The initial clinical picture was hemiparesis in four cases. Mean haemoglobin on diagnosing the stroke was 6.5 g/dL. Transcranial ultrasound imaging revealed alterations in three patients and, in all the patients, magnetic resonance imaging revealed lesions, which were bilateral in half the cases. Following the stroke, a hypertransfusion regimen protocol was established and only one patient presented a new stroke. This same patient went on to develop moya-moya disease and was submitted to an indirect revascularisation; the patient progressed well, without presenting any new ischaemic events. Drepanocytosis is a disease that is emerging in our setting as a result of immigration. It should be suspected in cases of paediatric strokes associated to anaemia, above all in black children under the age of five who were not submitted to neonatal screening.

  6. Lack of Utility of Nasopharyngeal Swabs for Diagnosis of Burkholderia pseudomallei Pneumonia in Paediatric Patients

    PubMed Central

    Turner, Claudia; Suy, Kuong; Soeng, Sona; Day, Nicholas P. J.; Turner, Paul

    2016-01-01

    Diagnosis of Burkholderia pseudomallei pneumonia in children is challenging. We investigated the utility of nasopharyngeal swabs taken from 194 paediatric patients on admission with radiologically proven pneumonia. Melioidosis was proven in 0.5% of samples tested and only in a third of those known to be bacteraemic with B. pseudomallei. It appears unlikely that culture of nasopharyngeal secretions is helpful to confirm B. pseudomallei pneumonia in paediatric patients. PMID:26874977

  7. Microbial diversity on intravascular catheters from paediatric patients.

    PubMed

    Zhang, L; Marsh, N; Long, D; Wei, M; Morrison, M; Rickard, C M

    2015-12-01

    Microorganisms play important roles in intravascular catheter (IVC)-related infections, which are the most serious complications in children with IVCs, leading to increased hospitalisation, intensive care admissions, extensive antibiotic treatment and mortality. A greater understanding of bacterial communities is needed in order to improve the management of infections. We describe here the systematic culture-independent evaluation of IVC bacteriology in IVC biofilms. Twenty-four IVC samples (six peripherally inserted central catheters, eight central venous catheters and ten arterial catheters) were collected from 24 paediatric patients aged 0 to 14 years old. Barcoded amplicon libraries produced from genes coding 16S rRNA and roll-plate culture methods were used to determine the microbial composition of these samples. From a total of 1,043,406 high-quality sequence reads, eight microbial phyla and 136 diverse microbial genera were detected, separated into 12,224 operational taxonomic units (OTUs). Three phyla (Actinobacteria, Firmicutes and Proteobacteria) predominate the microorganism on the IVC surfaces, with Firmicutes representing nearly half of the OTUs found. Among the Firmicutes, Staphylococcus (15.0% of 16S rRNA reads), Streptococcus (9.6%) and Bacillus (6.1%) were the most common. Community composition did not appear to be affected by patients' age, gender, antibiotic treatment or IVC type. Differences in IVC microbiota were more likely associated with events arising from catheter dwell time, rather than the type of IVC used.

  8. Orofacial and systemic manifestations in 212 paediatric HIV patients from Chennai, South India.

    PubMed

    Ranganathan, Kannan; Geethalakshmi, Elumalai; Krishna Mohan Rao, Umadevi; Vidya, Kaazhiyur Mudimbaimannar; Kumarasamy, Nagalingeswaran; Solomon, Suniti

    2010-07-01

    Lesions in the mouth and in other tissues and organs (oral and systemic lesions) in paediatric HIV infection are diverse and show differences in clinical presentation and severity from that of adults. Very little data exist for oral lesions in paediatric population in India. To document and study oral and more widespread lesions in paediatric HIV seropositive patients. A cross-sectional study. Paediatric HIV seropositive patients at tertiary centers: Ragas Dental College and Hospital and YRG CARE, Chennai, India. Two hundred and twelve paediatric HIV patients aged 0-14 years seen over a period of 1 year were included in the study. Clinical history, oral and systemic examinations were recorded by qualified dental surgeons and physicians. One hundred and thirty-two patients had oral lesions ranging in number from one to three. Oral lesions included oral candidiasis (OC) (56.1%), gingivitis (10.8%), oral pigmentation (6.1%), depapillation of the tongue (5.7%), ulcers (4.2%), and oral hairy leukoplakia (1.4%). The most common systemic lesion observed was nonspecific lymphadenopathy (74.1%) followed by pruritic eruptions (53.8%), measles (51.4%), and tuberculosis (TB) (49.1%). Thirty-three (26%) patients were not immunosuppressed, 74 (58%) were moderately immunosuppressed, and 20 (15%) were severely immunosuppressed. Oral lesions exhibited positive correlation with lesions in other parts of the body. Oral lesions are a common feature in paediatric HIV infection. Their management is vital to improve the quality of life of the infected children.

  9. Dermatological Findings in Turkish Paediatric Haematology-Oncology Patients

    PubMed Central

    Uksal, Umit; Ozturk, Pinar; Colgecen, Emine; Taslidere, Nazan; Patiroglu, Turkan; Ozdemir, Mehmet Akif; Torun, Yasemin Altuner; Borlu, Murat

    2016-01-01

    Objective: Diagnoses of skin, mucosae, hair and nail manifestations in malignant diseases are often challenging because of life-threatening drug reactions, opportunistic infections or skin involvement of primary processes. Description of morphology, configuration and distribution of lesions is important in order to differentiate the self-healing eruptions from serious side effects of chemotherapy. There are case reports from Turkey including dermatological manifestations of malignancies and case series in adult patients but there are no published large group studies assessing all manifestations in children. The aim of this study was to evaluate the morphological features of dermatological findings in children with haemato-oncological diseases. Materials and Methods: The study was performed at the Erciyes University, Faculty of Medicine Pediatric Hematology-Oncology Clinic, Turkey. Three dermatologists daily consulted all patients admitted to the clinic during a one-year period. Results: The study group comprised of 157 children (79 female/78 male) aged 1–16 years (mean 7.19±4.63). Detailed dermatological examinations were performed, including oral-genital mucosae, hair and nails. Thorough skin examination revealed that 70% of the patients exhibited at least one dermatological finding. Generalized xerosis and hyperpigmentation were the most common findings among patients undergoing chemotherapy (24.19%). Multiple nevi on at least 10 covered areas were very frequent among patients undergoing long-term chemotherapy (18.47%). Three were identified as dysplastic nevus, but malignant transformation was not observed during the one-year study period. Conclusion: Regular dermatological consultation may help resolve the diagnostic and therapeutic problems in paediatric haemato-oncology clinics. PMID:27551173

  10. Regenerate bone fracture rate following femoral lengthening in paediatric patients

    PubMed Central

    Burke, N. G.; Cassar-Gheiti, A. J.; Tan, J.; McHugh, G.; O’Neil, B. J.; Noonan, M.; Moore, D.

    2017-01-01

    Abstract Purpose Femoral lengthening using a circular or mono-lateral frame is a commonly used technique. Fracture at the site of the regenerate bone is a major concern especially following removal of the external fixator. This aim of this study was to assess the rate of fracture of the regenerate bone in this single surgeon series of paediatric patients and determine potential risk factors. Methods Retrospective review of all the femoral lengthening performed by the senior author was performed. The medical and physiotherapy notes were reviewed. The gender, age at time of surgery, disease aetiology, total days in the external fixator and length of the new regenerate bone were recorded. Patients who sustained a regenerate fracture were identified. Results A total of 176 femoral lengthening procedures were performed on 108 patients. Eight regenerate fractures occurred in seven patients (4.5%). The mechanism of injury was a fall in five cases and during physiotherapy in three cases. The regenerate fracture occurred a median number of nine days following removal of frame. There was no significant difference between gender, age at time of surgery, total time in external fixator between those who sustained a regenerate fracture and those patients who did not. A significant difference was noted between the amount of lengthening between the ‘regenerate fracture group’ and the ‘no fracture group’ (50 mm vs 38 mm, respectively; p = 0.029). There was no association between disease aetiology and risk of regenerate fracture. Conclusions Femoral lengthening of more than 50 mm increases the risk of a fracture at the regenerate site regardless of the disease aetiology. We recommend avoidance of aggressive physiotherapy for the initial four weeks following external fixator removal. PMID:28828065

  11. Healthcare professionals' perceptions of the ethical climate in paediatric cancer care.

    PubMed

    Bartholdson, Cecilia; Sandeberg, Margareta Af; Lützén, Kim; Blomgren, Klas; Pergert, Pernilla

    2016-12-01

    How well ethical concerns are handled in healthcare is influenced by the ethical climate of the workplace, which in this study is described as workplace factors that contribute to healthcare professionals' ability to identify and deal with ethical issues in order to provide the patient with ethically good care. The overall aim of the study was to describe perceptions of the paediatric hospital ethical climate among healthcare professionals who treat/care for children with cancer. Data were collected using the Hospital Ethical Climate Survey developed by Olsson as a separate section in a questionnaire. Descriptive statistics were used to analyse perceptions of the ethical climate. Participants and research context: Physicians, nurses and nurse-aides (n = 89) from three paediatric units participated in this study: haematology/oncology, chronic diseases and neurology. Ethical considerations: The study was approved by the regional ethical review board. Different perceptions of the ethical climate were rated as positive or negative/neutral. Nurses' ratings were less positive than physicians on all items. One-third of the participants perceived that they were able to practice ethically good care as they believed it should be practised. Differences in professional roles, involving more or less power and influence, might explain why physicians and nurses rated items differently. A positive perception of the possibility to practice ethically good care seems to be related to inter-professional trust and listening to guardians/parents. A negative/neutral perception of the possibility to practice ethically good care appears to be influenced by experiences of ethical conflicts as well as a lack of ethical support, for example, time for reflection and discussion. The two-thirds of participants who had a negative/neutral perception of the possibility to practice ethically good care are at risk of developing moral stress. Clinical ethics support needs to be implemented in care

  12. Association of Neisseria cinerea with ocular infections in paediatric patients.

    PubMed

    Dolter, J; Wong, J; Janda, J M

    1998-01-01

    Twenty-two strains of Neisseria cinerea were recovered from paediatric patients over a 7-year period and forwarded to the Microbial Diseases Laboratory for biochemical identification and/or confirmation. Eighteen of these 22 strains (82%) were recovered from the eyes of very young children (< or = 1 year), > 50% occurring during the neonatal period. The majority of eye isolates were involved in a variety of ocular infections including orbital cellulitis, conjunctivitis, and eye discharge (most common); in four of the 13 instances (31%) where laboratory data was available, Neisseria cinerea was recovered in pure culture. Neisseria cinerea isolates were often submitted to the Microbial Diseases Laboratory as possible 'N. gonorrhoeae' or 'Neisseria species' due to problems resulting from the use of commercial assays or unfamiliarity with the organism. These observations indicate that N. cinerea can produce eye infections in very young children, who presumably acquire this organism vertically from the mother during birth. Accurate identification of N. cinerea in such infants can preclude the social trauma and possible legal ramifications which can initially result from its misidentification as N. gonorrhoeae.

  13. Post thrombotic syndrome following deep vein thrombosis in paediatric patients.

    PubMed

    Vosicka, Klara; Qureshi, Mahim I; Shapiro, Susan E; Lim, Chung S; Davies, Alun H

    2017-01-01

    Background Although well characterised in adults, less is known about post-thrombotic syndrome in children. In this review, current knowledge regarding paediatric post-thrombotic syndrome is summarised, with particular emphasis on pathophysiology, aetiology, diagnosis and management. Methods A Medline literature review was performed using search terms 'post thrombotic syndrome', 'post phlebitic syndrome', paediatric and children. Relevant articles were identified and included for summation analysis. Results The incident of paediatric venous thromboembolism is rising. Deep vein thrombosis can cause venous hypertension through a combination of venous reflux, venous obstruction and impairment of the calf muscle pump, leading to development of post-thrombotic syndrome. In children, this is more likely to occur if deep vein thrombosis diagnosis and treatment are delayed, if a higher number of vessels are involved, and if factors such as D-dimer are elevated at diagnosis and throughout treatment. Post-thrombotic syndrome occurs in about 26% of paediatric deep vein thrombosis, though the results of individual studies vary widely. A number of tools exist to diagnose paediatric post-thrombotic syndrome, including the modified Villalta scale and Manco-Johnson instrument. Once post-thrombotic syndrome develops, the mainstay of treatment remains supportive, with little evidence of benefit from pharmacological measures. Conclusion Surgical or interventional treatment is not advised except in exceptional cirumstances, due to variable prognosis of PTS in paediatric populations with rising incidence of paediatric venous thromboembolism, it follows that the prevalence of post-thrombotic syndrome in children may also increase. Evidence-based venous thromboembolism prevention strategies need to be implemented for prevention of deep vein thrombosis, but when it does occur, deep vein thrombosis requires prompt and effective treatment to prevent post-thrombotic syndrome. Optimum

  14. 'Thinking outside the box': complementary and alternative therapies use in paediatric oncology patients.

    PubMed

    Molassiotis, Alexander; Cubbin, Denise

    2004-03-01

    The aim of this study was to determine the prevalence of complementary and alternative medicine (CAM) use among children with cancer who had received or were receiving treatment at a large hospital in the UK, including the identification of the most commonly used therapies and parental motives for doing so. Using a cross-sectional survey design, questionnaires were sent to parents of paediatric patients diagnosed with cancer. Of the 49 respondents, 32.7% reported using some type of CAM. The most commonly used therapies included multivitamins, aromatherapy massage, diets and music as therapy. Most children had used more than one therapy. Many of the factors that motivated parents to use CAM were related to helping or supporting their child's medical treatment. The main benefits identified from using CAM included increased confidence, pain relief and relaxation. The longer the time since diagnosis the more children tended to use CAM. The reasons for parents not using CAM included the child doing well and therefore not seeing the need for CAM use; not being aware of CAM; CAM not being offered and lack of information available. Parents identified a need for more information to be available both at ward level and for information about CAM to be discussed by medical staff, particularly at the start of treatment. The results indicate that CAM is frequently used by children and young people with cancer and that their use plays a substantial role in helping children through their conventional cancer treatment.

  15. Second Malignant Neoplasms in Childhood Cancer Survivors Treated in a Tertiary Paediatric Oncology Centre.

    PubMed

    Lim, Jia Wei; Yeap, Frances Sh; Chan, Yiong Huak; Yeoh, Allen Ej; Quah, Thuan Chong; Tan, Poh Lin

    2017-01-01

    Introduction: One of the most feared complications of childhood cancer treatment is second malignant neoplasms (SMNs). This study evaluates the incidence, risk factors and outcomes of SMNs in a tertiary paediatric oncology centre in Singapore. Materials and Methods: A retrospective review was conducted on patients diagnosed with childhood cancer under age 21 and treated at the National University Hospital, Singapore, from January 1990 to 15 April 2012. Case records of patients with SMNs were reviewed. Results: We identified 1124 cases of childhood cancers with a median follow-up of 3.49 (0 to 24.06) years. The most common primary malignancies were leukaemia (47.1%), central nervous system tumours (11.7%) and lymphoma (9.8%). Fifteen cases developed SMNs, most commonly acute myeloid leukaemia/myelodysplastic syndrome (n = 7). Median interval between the first and second malignancy was 3.41 (0.24 to 18.30) years. Overall 20-year cumulative incidence of SMNs was 5.3% (95% CI, 0.2% to 10.4%). The 15-year cumulative incidence of SMNs following acute lymphoblastic leukaemia was 4.4% (95% CI, 0% to 8.9%), significantly lower than the risk after osteosarcoma of 14.2% (95% CI, 0.7% to 27.7%) within 5 years (P <0.0005). Overall 5-year survival for SMNs was lower than that of primary malignancies. Conclusion: This study identified factors explaining the epidemiology of SMNs described, and found topoisomerase II inhibitor use to be a likely risk factor in our cohort. Modifications have already been made to our existing therapeutic protocols in osteosarcoma treatment. We also recognised the importance of other risk management strategies, including regular long-term surveillance and early intervention for detected SMNs, to improve outcomes of high risk patients.

  16. Compliance with dental treatment recommendations by rural paediatric patients after a live-video teledentistry consultation: A preliminary report.

    PubMed

    McLaren, Sean W; Kopycka-Kedzierawski, Dorota T

    2016-04-01

    The purpose of this research was to assess the compliance rate with recommended dental treatment by rural paediatric dental patients after a live-video teledentistry consultation. A retrospective dental chart review was completed for 251 rural paediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a paediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. The recommended treatment modalities were tabulated and comprehensive dental treatment completion rates were obtained. The recommended treatment modality options of: treatment in the paediatric dental clinic; treatment using nitrous oxide anxiolysis; treatment with oral sedation; treatment in the operating room with general anaesthesia; or teleconsultation were identified for the 251 patients. Compliance rates for completed dental treatment based on initial teleconsultation recommendations were: 100% for treatment in the paediatric dental clinic; 56% for nitrous oxide patients; 87% for oral sedation; 93% for operating room; and 90% for teleconsultations. The differences in the compliance rates for all treatment modalities were not statistically significant (Fisher's exact test, p > 0.05). Compliance rates for completed comprehensive dental treatment for this rural population of paediatric dental patients were quite high, ranging from 56% to 100%, and tended to be higher when treatment was completed in fewer visits. Live-video teledentistry consultations conducted among rural paediatric patients and a paediatric dentist in the specialty clinic were feasible options for increasing dental treatment compliance rates when treating complex paediatric dental cases. © The Author(s) 2015.

  17. Highlights of Children with Cancer UK’s Workshop on Drug Delivery in Paediatric Brain Tumours

    PubMed Central

    Nailor, Audrey; Walker, David A; Jacques, Thomas S; Warren, Kathy E; Brem, Henry; Kearns, Pamela R; Greenwood, John; Penny, Jeffrey I; Pilkington, Geoffrey J; Carcaboso, Angel M; Fleischhack, Gudrun; Macarthur, Donald; Slavc, Irene; Meijer, Lisethe; Gill, Steven; Lowis, Stephen; van Vuurden, Dannis G; Pearl, Monica S; Clifford, Steven C; Morrissy, Sorana; Ivanov, Delyan P; Beccaria, Kévin; Gilbertson, Richard J; Straathof, Karin; Green, Jordan J; Smith, Stuart; Rahman, Ruman; Kilday, John-Paul

    2016-01-01

    The first Workshop on Drug Delivery in Paediatric Brain Tumours was hosted in London by the charity Children with Cancer UK. The goals of the workshop were to break down the barriers to treating central nervous system (CNS) tumours in children, leading to new collaborations and further innovations in this under-represented and emotive field. These barriers include the physical delivery challenges presented by the blood–brain barrier, the underpinning reasons for the intractability of CNS cancers, and the practical difficulties of delivering cancer treatment to the brains of children. Novel techniques for overcoming these problems were discussed, new models brought forth, and experiences compared. PMID:27110286

  18. Off-label use of maraviroc in HIV-1-infected paediatric patients in clinical practice.

    PubMed

    Palladino, Claudia; Gómez, María Luisa Navarro; Soler-Palacín, Pere; González-Tomé, María Isabel; De Ory, Santiago J; Espiau, María; Hoyos, Santiago Pérez; León-Leal, Juan Antonio; Méndez, María; Moreno-Pérez, David; Guasch, Claudia Fortuny; Sierra, Antoni Mur; Guruceta, Itziar Pocheville; Guillén, Santiago Moreno; Briz, Verónica

    2015-10-23

    Maraviroc (MVC) is not approved for HIV-1-infected paediatric patients. This is the first assessment of the use of MVC-based salvage therapy in vertically HIV-1-infected paediatric patients in clinical settings. The results suggest that MVC-based salvage therapy is useful in children and adolescents with extensive resistance profile leading to maintained virological suppression in up to 88% of the patients with CCR5-tropic virus. The likelihood of treatment success might increase when MVC is combined with other active drugs.

  19. Compliance with anti-infective preventive measures: A multicentre survey among paediatric oncology patients.

    PubMed

    Lehrnbecher, Thomas; Laws, Hans-Jürgen; Boehm, Alexandra; Dworzak, Michael; Janssen, Gisela; Simon, Arne; Groll, Andreas H

    2008-09-01

    Infections are significant causes of morbidity and mortality among immunocompromised patients, but little is known about the adherence by the paediatric cancer patients to preventive anti-infective interventions. A voluntary and anonymised questionnaire was distributed to all patients, completing intensive anticancer therapy. Compliance was analysed by using a panel of eight commonly recommended preventive interventions and semi-quantitative scoring of adherence by the patient and/or its caretaker. Satisfaction with information and belief in the efficacy of the interventions were similarly assessed. Relationships of these factors to compliance were explored by using an overall compliance score and non-parametric correlation and/or ANOVA and logistic regression, respectively. In 216 children and adolescents (mean age: 8 years; 94 girls) included in the study, compliance rates were the highest for food restriction (89.3%), the use of topic antimycotics (88.2%) and trimethoprim/sulfamethoxazole (86.6%), and the lowest for the use of face masks (68.8%), antiseptic mouth rinses (67.1%), non-absorbable antibiotic agents (66.5%) and restrictions in social contacts (65.5%). The most frequent reasons for drug non-compliance were forgetfulness and patient refusal. Compliance correlated with haematological malignancy, younger age and belief in its efficacy, but not with the perceived degree of information, burden of interventions and overall satisfaction with quality of information and medical care. Compliance to recommended anti-infective prophylactic interventions was variable and correlated with haematological malignancy, younger age and belief in efficacy.

  20. Paediatric oncology patient preference for oral nutritional supplements in a clinical setting.

    PubMed

    Cohen, Jennifer; Rosen, Kate; Russell, Ken K; Wakefield, Claire E; Goodenough, Belinda

    2011-09-01

    Oral nutrition supplements are commonly used to increase the nutrient intake of children who are undergoing treatment for cancer. However, little research has been conducted systematically examining preferences for oral supplements in this population. This study aims to address a gap in the literature by examining taste preferences of oral nutrition supplements routinely recommended for children undergoing treatment for cancer. Twenty-one children undergoing treatment for cancer and 38 healthy control subjects participated in an acute double-blinded feeding trial. A variety of energy drinks, available both commercially and in the hospital, were sampled. Patients rated the taste of the drinks on a 10-cm coloured analogue scale. A commercially-based drink (Moove™) rated the highest in the blinded and branded tests for the treatment (mean rating out of 10, 6.44±2.69 and 7.26±2.33, respectively) and control groups (mean rating, 7.61±1.91 and 7.70±2.32, respectively). Taste ratings were significantly higher for commercially available supplements over the hospital-prepared supplements, (p=0.041), with no main effect for tasting condition (i.e. blinded versus branded, p=0.902). There was a statistically significant trend such that ratings, when the brand that was known decreased for hospital supplements, while ratings for commercially available supplements increased (p=0.014). Fresh milk-based supplements were the preferred type of oral nutrition supplement in a cohort of paediatric oncology patients. The data also suggest that commercially available products are more likely to be accepted than hospital-prepared supplements. This pilot study supports the need for further research in the area of oral nutrition supplements for paediatric oncology patients as a way of determining a reliable way to estimate preferences and therefore maximise compliance. Results from this research could be also used as the basis for designing research to study the effects of flavour

  1. Three patients and their drugs: A parallel case paper on paediatric opiate use and withdrawal

    PubMed Central

    Siden, Harold B; Collin, Kathleen

    2005-01-01

    Clinicians are increasingly aware of the important role that opioids play in the management of a variety of paediatric conditions. Frequently, clinicians encounter challenges in initiating opioid therapy and, then, in weaning paediatric patients off opioids. In the present article, three different cases (an infant and two adolescents) are used to illustrate why and how opiates may be used in paediatrics and how they can be discontinued. The presentations include neonatal abstinence syndrome, chronic headache and cystic fibrosis. The cases are meant to emphasize the distinctions rather than the similarities among the cases, which is why this is called a case parallel, rather than a case series. The article downplays the use of rigid rules in managing patients on opioids, and emphasizes a flexible and patient-centred approach. PMID:19675829

  2. When do paediatric patients with familial hypercholesterolemia need statin therapy?

    PubMed

    Hennig, Matylda; Brandt, Agnieszka; Bautembach-Minkowska, Joanna; Świętoń, Dominik; Mickiewicz, Agnieszka; Chmara, Magdalenia; Wasąg, Bartosz; Kamińska, Ewa; Balcerska, Anna; Limon, Janusz; Rynkiewicz, Andrzej; Gruchała, Marcin; Myśliwiec, Małgorzata

    effects of the statin therapy were monitored. An increase in AST levels seen in the study group was not statistically significant. The mean creatine kinase level was within the range of normal. Moreover, in our study material we estimated the risk of cardiovascular events in relation to the ApoB/ApoA index. Higher cardiovascular risk was found in 34.37% participants. Increased risk of cardiovascular events based on ApoB/ApoA index and carotid e-tracking or IMT examination in paediatric patients with FH is an indication for statin therapy initiation.

  3. Hepatic angiodynamic profile in paediatric patients with hereditary haemorrhagic telangiectasia type 1 and type 2.

    PubMed

    Giordano, Paola; Francavilla, Mariantonietta; Buonamico, Paolo; Suppressa, Patrizia; Lastella, Patrizia; Sangerardi, Maria; Miniello, Vito L; Scardapane, Arnaldo; Lenato, Gennaro M; Sabbà, Carlo

    2017-05-01

    Liver involvement is a common manifestation of hereditary haemorrhagic telangiectasia (HHT). Although a number of studies have been carried out in adult patients, no study has ever been focused on investigating HHT-related hepatic involvement in paediatric patients. The present study aimed for the first time to systematically estimate the prevalence of HHT-associated liver involvement and to characterize HHT-associated hepatic angiodynamic features in paediatric age. The study was designed as a cross-sectional survey in an HHT paediatric cohort, subclassified as HHT1 and HHT2 according to the mutated gene. The evaluation of the angiodynamic profile was performed by duplex ultrasound examination. Investigation by multi-slice computed tomography (MSCT) or magnetic resonance angiography (MRA) was performed in patients >12 years. MSCT/MRA examination disclosed silent hepatic involvement in 7/20 (35.0 %) children, and nodular regenerative hyperplasia in two cases. Diameter of common hepatic artery was significantly larger in HHT2 (0.45 ± 0.15 cm) compared to HHT1 (0.33 ± 0.09, p < 0.01) and control children (0.32 ± 0.08, p < 0.05). None of the patients had clinical manifestations of liver involvement. Angiodynamic profiles were different between paediatric and adult HHT patients. Liver involvement can be detected in paediatric HHT patients, albeit with a lower frequency compared to adults. Paediatric HHT2 children show a higher frequency of liver involvement and a trend to hepatic artery dilation when compared to HHT1 children.

  4. Second malignant neoplasms in childhood cancer survivors in a tertiary paediatric oncology centre in Hong Kong, China.

    PubMed

    Sun, Wai-Fun; Cheng, Frankie Wai-Tsoi; Lee, Vincent; Leung, Wing-Kwan; Shing, Ming-Kong; Yuen, Patrick Man-Pan; Li, Chi-Kong

    2011-11-01

    Childhood cancer survivors were at risk of development of second malignant neoplasms. The aim of this study is to evaluate the incidence, risk factors and outcome of second malignant neoplasms in childhood cancer survivors in a tertiary paediatric oncology centre in Hong Kong, China. We performed a retrospective review of patients with childhood cancer treated in Children's Cancer Centre in Prince of Wales Hospital, Hong Kong, China between May 1984 and June 2009. Case records of patients who developed second malignant neoplasms were reviewed. Totally 1374 new cases aged less than 21-year old were treated in our centre in this 25-year study period. Twelve cases developed second malignant neoplasms with 10-year and 20-year cumulative incidence of 1.3% (95% confidence interval 0.3% - 2.3%) and 2.9% (95% confidence interval 1.1% - 4.7%) respectively. Another 4 cases were referred to us from other centres for the management of second malignant neoplasms. In this cohort of 16 children with second malignant neoplasms, the most frequent second malignant neoplasms were acute leukemia or myelodysplastic syndrome (n = 6) and central nervous system tumor (n = 4). Median interval between diagnosis of primary and second malignant neoplasms was 7.4 years (range 2.1 - 13.3 years). Eight patients developed second solid tumor within the previous irradiated field. Radiotherapy significantly increased the risk of development of second solid tumor in patients with acute lymphoblastic leukemia (P = 0.027). Seven out of 16 patients who developed second malignant neoplasms had a family history of cancer among the first or second-degree relatives. Nine patients died of progression of second malignant neoplasms, mainly resulted from second central nervous system tumor and osteosarcoma. Cumulative incidence of second cancer in our centre was comparable to western countries. Radiotherapy was associated with second solid tumour among patients with acute lymphoblastic leukemia. Patients who

  5. Telehealth for paediatric burn patients in rural areas: a retrospective audit of activity and cost savings.

    PubMed

    McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona; Giles, Margaret

    2016-11-01

    Since 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred. To conduct a retrospective audit of avoided transfers and bed days in 2005/06-2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13. A retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding. Over the period 2005/06-2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89million. This study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  6. Safety and effectiveness of total splenic vessel ligations in paediatric patients with splenomegaly

    PubMed Central

    Zhen, Chen; Lishuang, Ma; Jinshan, Zhang; Guoliang, Qiao; Wangchen; Zhen, Zhang; Shuili, Liu; Jun, Zhang; Kaoping, Guan; Long, Li

    2016-01-01

    BACKGROUNDS: Splenomegaly may contribute to hypersplenism and can result in thrombocytopenia. Many approaches are used to treat splenomegaly; however, the current management of splenomegaly has intrinsic limitations or disadvantages. Now, we initiate a new approach, that of total splenic vessel (artery and vein) ligations (TSVLs) in paediatric patients with splenomegaly. The purpose of our study is to evaluate the results obtained with TVSLs procedure for paediatric patients. PATIENTS AND METHODS: Seventeen paediatric patients with splenomegaly were screened for enrolment into this retrospective analysis. PROCEDURE: We identified and dissociated the splenic vessel. Next, we ligated the splenic artery and we used clips to ligate the vein distally and proximally. RESULT: The mean [standard deviation (SD)] splenic infarction rate of a total of 17 patients was 77.5 (5.1)% in 6 months after operation. After TSVL, the mean count of platelet (PLT) and white blood cell (WBC) increased significantly and reached a steady state in the third month. Both the PLT and WBC had a significance higher than pre-TSVL in a 1-year follow-up. CONCLUSION: Based on the evidence, we make cautious conclusions that TSVLs are a safe and effective method in the treatment of paediatric patients with splenomegaly, achieving a satisfactory long-term haematological response and benefit. PMID:27609328

  7. [French organization of paediatric radiation treatment: Results of a survey conducted by the radiotherapy Committee of the French Society of Paediatric Cancers (SFCE)].

    PubMed

    Demoor-Goldschmidt, C; Claude, L; Carrie, C; Bolle, S; Helfre, S; Alapetite, C; Jouin, A; Padovani, L; Ducassou, A; Vigneron, C; Le Prisé, É; Huchet, A; Stefan, D; Kerr, C; Nguyen, T-D; Truc, G; Chapet, S; Bondiau, P-Y; Coche, B; Muracciole, X; Laprie, A; Noël, G; Leseur, J; Habrand, J-L; Potet, H; Ruffier, A; Supiot, S; Mahé, M-A; Bernier, V

    2016-07-01

    Radiotherapy is a rare indication in paediatric oncology, with 800 to 900 children in treatment per year in France. Child cancers represent approximately 1% of cancers in France and half occur before the age of 5 years. Paediatric radiation requires appropriate tools, local, time and specific training. In France, in 2015, 18 centres are accredited by the French National Cancer Institute (INCa) for this activity. Survey conducted in February 2015 on the care of children (0 to 18 years) in radiotherapy departments in France. The survey was sent to the radiation oncologists involved in the 18 centres. The questions concerned the qualitative and quantitative aspect, medical and organizational aspects, and the involvement of assistant practitioners in the management of this activity. Seventeen centres responded. In 2014, 889 children under 18 were treated in radiotherapy departments. These departments are working together with one to four paediatric oncology departments. Regarding access to general anaesthesia: three centres perform one to seven treatment(s) under anaesthesia per year, three centres eight to ten treatments under anaesthesia per year, three centres ten to 24 treatments under anaesthesia per year and nine centres out of 17 use hypnosis techniques. In terms of human resources, in 2015, 29 radiation therapists have a paediatric radiotherapy activity. Involvement of assistant practitioners is growing and specific training are desired. Regarding treatment preparation and delivery, 13 centres have specific paediatric contentions, 14 of 16 centres employ radiation intensity modulated if dosimetry is more satisfying with 11 regularly to the craniospinal irradiation. Radiotherapy on moving areas with respiratory gating or hypofractionation is under developed. Paediatric radiation therapy is a specific activity requiring a dedicated management, both in human, organizational, medical and scientific aspects. Copyright © 2016 Société française de

  8. [Transition process from paediatric to adult care in patients with inborn errors of metabolism. Consensus statement].

    PubMed

    Pérez-López, Jordi; Ceberio-Hualde, Leticia; García Morillo, José Salvador; Grau-Junyent, Josep M; Hermida Ameijeiras, Álvaro; López-Rodríguez, Mónica; Morales-Conejo, Montserrat; Nava Mateos, Juan José; Aldámiz Echevarri Azuara, Luis José; Campistol, Jaume; Couce, M Luz; García-Silva, María Teresa; González Gutiérrez-Solana, Luis; Del Toro, Mireia

    2016-12-02

    The transition process from paediatric to adult care is a subject of great interest in recent years, especially in chronic diseases with childhood onset, such as inborn errors of metabolism (IEM). Advances in diagnosis and treatment of these diseases have improved their prognosis, with a high number of patients with IEM who currently reach adult age and need to be attended to by non-paediatric professionals. The objective of this work is to establish action guidelines so that the specialists involved can guarantee a successful transition of these patients' healthcare. After carrying out a bibliographic review of the subject, the authors, beginning with their own experience, produced an initial document which was subjected to successive debates until the final document was obtained. The consensus recommendation was decided by the majority in case of criterion discrepancy. A series of recommendations are presented for the best clinical management of the transitions of care of patients with IEM from the paediatric to adult care setting in order to achieve the best results in this process given the special characteristics of this patient subgroup and the main difficulties entailed in the transition process. The role of the internal medicine doctor in this transition process and correct interrelation with the paediatric and social setting is stressed. Furthermore, actions and attitudes are suggested to improve the quality of said transition. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  9. Interventional Radiology in Paediatrics.

    PubMed

    Chippington, Samantha J; Goodwin, Susie J

    2015-01-01

    As in adult practice, there is a growing role for paediatric interventional radiology expertise in the management of paediatric pathologies. This review is targeted for clinicians who may refer their patients to paediatric interventional radiology services, or who are responsible for patients who are undergoing paediatric interventional radiology procedures. The article includes a brief overview of the indications for intervention, techniques involved and the commonest complications. Although some of the procedures described are most commonly performed in a tertiary paediatric centre, many are performed in most Children's hospitals.

  10. [Therapeutic education programme for patients with chronic endocrine conditions: Transition from paediatric to adult services].

    PubMed

    Malivoir, Sabine; Courtillot, Carine; Bachelot, Anne; Chakhtoura, Zeina; Téjédor, Isabelle; Touraine, Philippe

    2016-05-01

    The purpose of this study is to contribute to better identifying the transition of patients with chronic endocrine conditions from paediatric to adult department. The aim was to specify the means and the competences that must be used by patients and health care teams and which could be help to the best quality care. We propose group sessions and individual interviews. A thematic analysis of the sessions and the responses to questionnaires have enabled the development of individual educational diagnosis and assess the autonomy of young adolescents. Fifty of 214 patients from paediatric services participated to therapeutic education program (TEP) in the last four years. This program is based on the psychic movements of adolescence. One year after the therapeutic education program session, 48 patients came to all the medical consultations and we observed a greater autonomy in adolescent patients. However, we must improve the modalities for including patients in this "transition program". Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Transhepatic central venous catheter for long-term access in paediatric patients.

    PubMed

    Mortell, Alan; Said, Hanan; Doodnath, Reshma; Walsh, Kevin; Corbally, Martin

    2008-02-01

    Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Access is frequently lost in this group because of thrombosis, infection, or displacement, and vascular options can quickly be exhausted. The last resort access procedure is generally a direct atrial catheter inserted via a thoracotomy. A viable alternative is the percutaneous transhepatic Broviac catheter (Bard Access Systems, Salt Lake City, UT). We retrospectively reviewed the charts of 5 patients who underwent percutaneous transhepatic Broviac insertion for long-term access over a 4-year period in a single institution. Four of the patients (80%) had a significant cardiac abnormality, with 1 patient requiring long-term parenteral nutrition after complicated necrotizing enterocolitis. All patients had significant caval thrombosis, which precluded them having placement of a standard percutaneous or openly placed central catheter. Of the 5 patients, 2 (40%) died of cardiac-related illnesses. Of the 3 surviving patients, 2 had functioning catheters electively removed because they were no longer required. One catheter was removed at thoracotomy for right atrial perforation because of catheter erosion. Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Transhepatic central venous catheters are a feasible, reliable, and relatively easily placed form of central access in patients with multiple venous thromboses requiring long-term access. This route should be considered in paediatric patients requiring central access in preference to a thoracotomy.

  12. Managing dysphonia in paediatric patients with complex airway conditions.

    PubMed

    Ojha, S; Setlur, J; Bunting, G; Hartnick, C J

    2015-08-01

    To suggest a phonosurgical management strategy that can be used for children who have previously undergone laryngotracheal reconstruction. This cases series describes three children who presented with complex, multi-level airway stenosis and marked dysphonia. Phonosurgical intervention involved endoscopic and open approaches, and was combined with voice therapy. A phonosurgical reconstruction management algorithm is suggested for evaluating and treating these complex conditions. Pre-operative assessment is critical, and should involve voice analysis and glottal anatomy assessment using office laryngoscopy and stroboscopy. The risks must be weighed up against the benefit of vocal improvement. Surgical intervention should involve combined endoscopic and open approaches. Voice restoration after paediatric airway reconstruction is a complex challenge. Surgical intervention should be conducted in a step-by-step manner to reduce the risk of worsening dysphonia and airway compromise. The risks and benefits must be carefully explored and discussed.

  13. Zinc in hair and urine of paediatric patients.

    PubMed

    van Wouwe, J P; de Wolff, F A; van Gelderen, H H

    1986-02-28

    Zinc concentrations in hair and urine were measured in groups of children varying in one condition - short stature, or after prolonged upper respiratory infection, or during non-infectious diarrhea, or while on chemotherapy for acute lymphatic leukaemia and in healthy controls. As compared with controls, hair zinc was significantly low after respiratory infection (p less than 0.0001) and high in short stature (p less than 0.01). Urinary zinc was increased during initial chemotherapy (p less than 0.001) and diarrhea (p less than 0.02). It is shown that zinc deficiency occurs in one of the common symptoms in paediatric medicine, namely upper respiratory tract infection. The high overlap (34-88%) proves hair and urine zinc to be of no use for reliable individual diagnostic statements.

  14. Diagnostic reference levels for thorax X-ray examinations of paediatric patients.

    PubMed

    Kiljunen, T; Järvinen, H; Savolainen, S

    2007-06-01

    Based on the Medical Exposure Directive of the European Commission, 97/43/Euratom, The Radiation and Nuclear Safety Authority (STUK) in Finland has the responsibility for setting national diagnostic reference levels (DRLs) for the most common radiological examinations. Paediatric patients deserve special attention because of the higher radiation risk compared with adults. The purpose of this paper is to present a method that takes into account patient size when setting DRLs in paediatric patients. The overall data consisted of patient doses collected from six hospitals during the years 1994-2001, and new measurements in two hospitals in 2004. In total, there were 700 chest examinations. The method established by the National Radiological Protection Board (UK) for setting DRLs was not considered feasible in Finnish practice. Patient doses correlated exponentially with the projection thickness, which was measured directly for each patient. Since 1 January 2006, paediatric DRLs for conventional chest examinations have been specified in Finland as a DRL curve by using both dose quantities (entrance surface doses (ESD) and dose-area product (DAP)) as a function of patient projection thickness.

  15. Detection of intestinal protozoa in paediatric patients with gastrointestinal symptoms by multiplex real-time PCR.

    PubMed

    Maas, L; Dorigo-Zetsma, J W; de Groot, C J; Bouter, S; Plötz, F B; van Ewijk, B E

    2014-06-01

    The performance of a multiplex real-time PCR for the detection of Blastocystis, Dientamoeba fragilis, Giardia lamblia, Cryptosporidium species and Entamoeba species in faecal samples was evaluated in an observational prospective study. Paediatric patients (0-18 years) presenting with gastrointestinal symptoms and suspected of having enteroparasitic disease were included. A questionnaire on gastrointestinal symptoms and the chosen treatment was completed at the start of the study and after 6 weeks. Of 163 paediatric patients (mean age, 7.8 years), 114 (70%) had a PCR-positive faecal sample. D. fragilis was detected most frequently, in 101 patients, followed by Blastocystis in 49. In faecal samples of 47 patients, more than one protozoan was detected, mainly the combination of D. fragilis and Blastocystis. Reported gastrointestinal symptoms were abdominal pain (78%), nausea (30%), and altered bowel habits (28%). Eighty-nine of the PCR-positive patients were treated with antibiotics. A significant reduction in abdominal pain was observed both in treated and in untreated patients. This study demonstrated that multiplex real-time PCR detects a high percentage of intestinal protozoa in paediatric patients with gastrointestinal symptoms. However, interpretation and determination of the clinical relevance of a positive PCR result in this population are still difficult. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  16. A Case of a Paediatric Patient With Allergic Contact Dermatitis to Benzoyl Peroxide.

    PubMed

    Sandre, Matthew; Skotnicki-Grant, Sandra

    2017-09-01

    Allergic contact dermatitis to benzoyl peroxide can occur in up to 6.5% of those with a history of exposure to this potential allergen. Conversely, irritant contact dermatitis is very common with benzoyl peroxide and can be differentiated from allergic contact dermatitis based on the patient's history and clinical signs and symptoms. We present a case of a paediatric patient with patch test-confirmed severe allergic contact dermatitis to benzoyl peroxide requiring hospitalisation and systemic treatment.

  17. The use of lamotrigine and other antiepileptic drugs in paediatric patients at a Malaysian hospital.

    PubMed

    Ab Rahman, Ab Fatah; Ibrahim, Mohamed Izham Mohamed; Ismail, Hussain Imam Mohamed; Seng, Tan Boon

    2005-10-01

    (1) To determine the effect of lamotrigine add-on therapy on the seizure frequency and cost in paediatric patients. (2) To determine the prescribing pattern of other antiepileptic drugs (AEDs). A retrospective study of medical records was carried out from October 2000 to June 2001 at the paediatric clinic, Hospital Pulau Pinang. Seizure frequency, cost of drug and types of AED prescribed. A total of 209 medical records were retrieved during the study period. Lamotrigine (LTG) was prescribed in 29 patients as add-on therapy. In 18 patients, there was a significant reduction in seizure frequency after the addition of LTG. Approximately 70% experienced a reduction in seizure frequency of more than 50%. Side effects of LTG were considered mild and manageable. However, drug cost after the addition of LTG increased by 103%. In the remaining 180 patients, the most common AED prescribed was sodium valproate (VPA). Only 15% of the patients received combination therapy. Mean monthly cost of monotherapy was found to be RM 24.4 while monthly cost of combination therapy was RM 45.4 (1 Euro-RM 5.00). The majority of paediatric patients in the study are on AED monotherapy and only a small percentage was prescribed lamotrigine. The use of lamotrigine is associated with better seizure control but with an increase in drug cost.

  18. Popliteal Cysts in Paediatric Patients: Clinical Characteristics and Imaging Features on Ultrasound and MRI

    PubMed Central

    Neubauer, Henning; Morbach, Henner; Schwarz, Tobias; Wirth, Clemens; Girschick, Hermann; Beer, Meinrad

    2011-01-01

    Popliteal cysts, or Baker cysts, are considered rare in children and may exhibit particular features, as compared with adults. We studied data from 80 paediatric patients with 55 Baker cysts, examined over a period of 7 years, and correlated clinical presentation with findings on ultrasonography and MRI. Prevalence of popliteal cysts was 57% in arthritic knees, 58% with hypermobility syndrome, and 28% without risk factors. Only one patient had a trauma history and showed an ipsilateral cyst. Mean cyst volume was 3.4 mL; cysts were larger in boys. Patients with arthritis had echogenic cysts in 53%. Cyst communication with the joint space was seen in 64% on ultrasonography and 86% on MRI. In conclusion, Baker cysts are a common finding in a clinically preselected paediatric population. Children with Baker cysts should be assessed for underlying arthritis and inherited joint hypermobility, while sporadic Baker cysts appear to be common, as well. PMID:22046524

  19. An audit of the precipitating factors for haemolytic crisis among glucose-6-phosphate dehydrogenase-deficient paediatric patients.

    PubMed

    Al-Azzam, Sayer I; Al-Ajlony, Mohammad J; Al-Khateeb, Taqwa; Alzoubi, Karem H; Mhaidat, Nizar; Ayoub, Abeer

    2009-01-01

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common genetic enzyme deficiencies leading to haemolytic anaemia. This study aimed to investigate the precipitating factors for haemolytic crisis in G6PD-deficient paediatric patients in Jordan. A retrospective study of data from the records of 258 paediatric patients admitted to a major paediatric hospital in North Jordan from January 2001 until April 2007. Patients included were G6PD-deficient children who were admitted to the hospital secondary to an episode of haemolytic anaemia. Of 258 paediatric patients, 244 (94.2%) had developed a haemolytic episode secondary to ingestion of fava beans. The remaining 14 children (5.8%) developed a haemolytic episode triggered by other factors, such as drugs and upper respiratory infections. Fava bean ingestion is the major precipitating factor for haemolytic anaemia episodes among G6PD-deficient children in Jordan.

  20. Paediatric ED BiPAP continuous quality improvement programme with patient analysis: 2005–2013

    PubMed Central

    Abramo, Thomas; Williams, Abby; Mushtaq, Samaiya; Meredith, Mark; Sepaule, Rawle; Crossman, Kristen; Burney Jones, Cheryl; Godbold, Suzanne; Hu, Zhuopei; Nick, Todd

    2017-01-01

    Objective In paediatric moderate-to-severe asthmatics, there is significant bronchospasm, airway obstruction, air trapping causing severe hyperinflation with more positive intraplural pressure preventing passive air movement. These effects cause an increased respiratory rate (RR), less airflow and shortened inspiratory breath time. In certain asthmatics, aerosols are ineffective due to their inadequate ventilation. Bilevel positive airway pressure (BiPAP) in acute paediatric asthmatics can be an effective treatment. BiPAP works by unloading fatigued inspiratory muscles, a direct bronchodilation effect, offsetting intrinsic PEEP and recruiting collapsed alveoli that reduces the patient's work of breathing and achieves their total lung capacity quicker. Unfortunately, paediatric emergency department (PED) BiPAP is underused and quality analysis is non-existent. A PED BiPAP Continuous Quality Improvement Program (CQIP) from 2005 to 2013 was evaluated using descriptive analytics for the primary outcomes of usage, safety, BiPAP settings, therapeutics and patient disposition. Interventions PED BiPAP CQIP descriptive analytics. Setting Academic PED. Participants 1157 patients. Interventions A PED BiPAP CQIP from 2005 to 2013 for the usage, safety, BiPAP settings, therapeutic response parameters and patient disposition was evaluated using descriptive analytics. Primary and secondary outcomes Safety, usage, compliance, therapeutic response parameters, BiPAP settings and patient disposition. Results 1157 patients had excellent compliance without complications. Only 6 (0.5%) BiPAP patients were intubated. BiPAP median settings: IPAP 18 (16,20) cm H2O range 12–28; EPAP 8 cmH2O (8,8) range 6–10; inspiratory-to-expiratory time (I:E) ratio 1.75 (1.5,1.75). Pediatric Asthma Severity score and RR decreased (p<0.001) while tidal volume increased (p<0.001). Patient disposition: 325 paediatric intensive care units (PICU), 832 wards, with 52 of these PED ward patients were

  1. Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients.

    PubMed

    Franck, Linda S; Naughton, Ita; Winter, Ira

    2004-12-01

    The purposes of this prospective repeated measures study were to: (a) describe the occurrence of withdrawal symptoms with the use of a standardised protocol to slowly taper opioids and benzodiazepines; and (b) to test the predictive validity of an opioid and benzodiazepine withdrawal assessment scoring tool in critically ill infants and young children after prolonged opioid and benzodiazepine therapy. Fifteen children (6 weeks-28 months of age) with complex congenital heart disease and/or respiratory failure who received opioids and benzodiazepines for 4 days or greater were evaluated for withdrawal symptoms using a standardized assessment tool. Thirteen children showed moderate to severe withdrawal symptoms a median 3 days after commencement of tapering. Symptom intensity was not related to prior opioid or benzodiazepine exposure, extracorporeal membrane oxygenation (ECMO) therapy or length of tapering. Children who received fentanyl in addition to morphine more often exhibited signs of withdrawal. This study demonstrated that significant withdrawal symptoms occur in critically ill children even with the use of a standardised assessment tool and tapering management protocol. The predictive validity and utility of the Opioid and Benzodiazepine Withdrawal Score (OBWS) was adequate for clinical use, but areas for further improvement of the tool were identified. Problems with the clinical withdrawal prevention and management guidelines were also identified. More research is needed to establish the optimal methods for prevention and management of iatrogenic opioid and benzodiazepine withdrawal in paediatric critical care.

  2. Dosimetry and Image Quality in Control Studies in Computerised Tomography Realized to Paediatric Patients

    NASA Astrophysics Data System (ADS)

    Hernández, M. R.; Dies, P.; Gamboa-deBuen, I.; Rickards, J.; Ruiz, C.

    2008-08-01

    Computerised tomography (CT) is a favourite method of medical diagnosis. Its use has thus increased rapidly throughout the world, particularly in studies relating to children. However to avoid administering unnecessarily high doses of radiation to paediatric patients it is important to have correct dose reference levels to minimize risk. The research is being developed within the public health sector at the Hospital Infantil de México "Dr. Federico Gómez." We measured the entrance surface air kerma (KP) in paediatric patients, during the radiological studies of control in CT (studies of head, thorax and abdomen). Phantom was used to evaluate image quality as the tomograph requires a high resolution image in order to operate at its optimum level.

  3. Dosimetry and Image Quality in Control Studies in Computerised Tomography Realized to Paediatric Patients

    SciTech Connect

    Hernandez, M. R.; Gamboa-deBuen, I.; Dies, P.; Rickards, J.; Ruiz, C.

    2008-08-11

    Computerised tomography (CT) is a favourite method of medical diagnosis. Its use has thus increased rapidly throughout the world, particularly in studies relating to children. However to avoid administering unnecessarily high doses of radiation to paediatric patients it is important to have correct dose reference levels to minimize risk. The research is being developed within the public health sector at the Hospital Infantil de Mexico 'Dr. Federico Gomez.' We measured the entrance surface air kerma (K{sub P}) in paediatric patients, during the radiological studies of control in CT (studies of head, thorax and abdomen). Phantom was used to evaluate image quality as the tomograph requires a high resolution image in order to operate at its optimum level.

  4. Patients' acceptance of medical photography in a French adult and paediatric dermatology department: a questionnaire survey.

    PubMed

    Hacard, F; Maruani, A; Delaplace, M; Caille, A; Machet, L; Lorette, G; Samimi, M

    2013-08-01

    Despite the increasing use of medical photography by dermatologists, no study on patients' perceptions of photography in dermatology has been performed to date. Firstly, to evaluate patients' perceptions of medical photography. Secondly, to assess whether perceptions differed between patients in our adult department and parents accompanying a child in our paediatric department. An opinion survey was conducted at the Hospital of Tours (France) among adult patients (adult department) and accompanying parents (paediatric department) by completion of a questionnaire after any medical photography had been performed. We collected 272 questionnaires regarding 158 adults and 114 children. A camera used only in the department, and storage of the images in the department's records were the most accepted modalities (> 90%), especially in the paediatric survey. Respondents agreed with the sharing of the images with other practitioners and in medical meetings (> 85%) rather than distribution via publications (58·3%), e-mails (45·5%), health magazines (44·3%) and websites (32·0%). Most (78·8%) considered that the consent form should list all the possible uses of the images. Need for renewed consent for each use of the images was significantly more often expressed in the paediatric than the adult survey (44·5% vs. 24·5%, P = 0·001). More than 95% of respondents considered medical photography to be useful for improving diagnosis, monitoring of skin disease and aiding teaching. These findings could be used to improve practice, to increase the acceptability of medical photography and for devising a standardized consent form for medical practitioners performing medical photography. © 2013 The Authors BJD © 2013 British Association of Dermatologists.

  5. Surgical management in paediatric patients with left abnormal subclavian artery and right aortic arch.

    PubMed

    Sodian, R; Rassoulian, D; Kaczmarek, I; Kozlik-Feldmann, R; Huber, A; Reichart, B; Daebritz, S

    2007-06-01

    Left abnormal subclavian artery and right aortic arch is described as a rare cause of dyspnoea and dysphagia in paediatric patients. The optimal surgical management of such cases is not clearly established. We propose a single-stage repair by transection of the patent ductus arteriosus or ligamentum arteriosum and an additional transection of the left abnormal subclavian artery with reimplantation into the common carotid artery.

  6. Computed tomographic evaluation of mouth breathers among paediatric patients

    PubMed Central

    Farid, MM; Metwalli, N

    2010-01-01

    Objectives Mouth breathing causes many serious problems in the paediatric population. It has been maintained that enlarged adenoids are principally responsible for mouth breathing. This study was designed to evaluate whether other mechanical obstacles might predispose the child to mouth breathing. Methods 67 children with ages ranging from 10 to 15 years were studied and grouped into mouth-breathers and nose-breathers. The children first underwent axial CT scans of the brain for which they were originally referred. In addition, they were subjected to a limited coronal CT examination of the paranasal sinuses. Congenital anatomical variations as well as inflammatory changes were assessed. Results 87% of mouth-breathing children had hypertrophied adenoids, 77% had maxillary sinusitis, 74% had pneumatized middle concha, 55% had a deviated nasal septum, 55% had hypertrophied inferior conchae, 45% had ethmoidal sinusitis and 23% showed frontal sinusitis. Such changes were significantly less prevalent in nose-breathers. 12.9% of mouth-breathing children did not have adenoids. Of these children, only 3.3% had one or more congenital or inflammatory change whereas the other 9.6% showed a completely normal CT scan signifying the incidence of habitual non-obstructive mouth breathing. Conclusions It is clear that adenoids have a dominant role in causing mouth breathing. Yet, we recommend that paediatricians should assess other mechanical obstacles if mouth breathing was not corrected after adenoidectomy. Further research should be performed to test the validity of correction of such factors in improving the quality of life of mouth-breathing children. PMID:20089737

  7. Micafungin: A Review in the Prophylaxis and Treatment of Invasive Candida Infections in Paediatric Patients.

    PubMed

    Scott, Lesley J

    2017-02-01

    Intravenous micafungin (Mycamine(®); Funguard(®)), an echinocandin, is approved in the EU for the treatment of invasive candidiasis in children (including neonates) and adolescents (<16 years of age) and as prophylaxis against Candida infections in patients undergoing haematopoietic stem cell transplantation (HSCT) or who are expected to have neutropenia for ≥10 days. This narrative review focuses on the use of micafungin in paediatric indications approved in the EU, which may vary from those approved elsewhere in the world. Micafungin has a broad spectrum of in vitro activity against clinically relevant isolates of Candida spp. (including fluconazole-resistant Candida glabrata isolates), a low propensity for emergence of resistant isolates and a convenient once-daily regimen. In paediatric substudies and a small multinational, phase 3 trial in neonates with proven invasive candidiasis, intravenous micafungin was effective and generally well tolerated in the treatment of candidaemia and other types of invasive candidiasis and as prophylaxis against fungal infections in patients undergoing HSCT. Hence, micafungin remains an important option for the prophylaxis and treatment of invasive Candida infections in paediatric and adult patients.

  8. Androgenetic alopecia in the paediatric population: a retrospective review of 57 patients.

    PubMed

    Gonzalez, M E; Cantatore-Francis, J; Orlow, S J

    2010-08-01

    Hair loss is an unwelcome event at any age, but it can be particularly distressing for adolescents and their families. While androgenetic alopecia (AGA) is the most common form of hair loss in adults, little is known about its prevalence, clinical features and response to treatments in the paediatric population. To better characterize the causes of alopecia in a paediatric population. We performed a retrospective chart review to identify all patients with hair loss seen in an academic paediatric dermatology practice at New York University over a 12-year period to better characterize the causes of alopecia in this population. We review the clinical and histological features, natural progression and associated laboratory abnormalities of AGA in 57 paediatric patients. AGA was identified as the most frequent cause of hair loss in adolescents and the second most common diagnosis overall. The male to female ratio was 2 : 1 and the average age at initial presentation with AGA was 14.8 years. Adolescent girls had diffuse thinning or thinning at the crown, and boys frequently presented with female pattern hair loss. When biopsies were performed, perifollicular inflammation was a common finding. A family history of AGA was reported in 83% of patients. Laboratory evaluation for androgens revealed polycystic ovarian syndrome in three girls and late-onset congenital adrenal hyperplasia in one boy. AGA is the most common form of hair loss in adolescents, and can be the presenting sign of an underlying endocrine disorder. An accurate and timely diagnosis is essential for appropriate medical and psychosocial intervention when warranted.

  9. Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability.

    PubMed

    Lind, Martin; Enderlein, Ditte; Nielsen, Torsten; Christiansen, Svend Erik; Faunø, Peter

    2016-03-01

    Medial patellofemoral ligament (MPFL) reconstruction has recently been broadly accepted as primary surgical treatment in adults. Reconstruction techniques with osseous fixation in femur cannot be used for patients with open growth plates. Operative treatment of patella instability in children therefore is a challenge and requires alternative MPFL reconstruction techniques. Limited knowledge exists concerning outcome after MPFL reconstruction in children and adolescents. This study present clinical outcome in a consecutive single clinic series of children treated with paediatric MPFL reconstruction using a soft tissue femoral fixation technique. Twenty-four MPFL reconstructions in 20 operated children aged 8-16 were included in the study. Indication for surgery was two or more patella dislocations. MPFL reconstruction was performed by looping the released gracilis tendon around the adductor magnus tendon insertion and through drill holes in the proximal medial patella edge. Clinical outcome was evaluated by Kujala score and NRS pain score preoperatively, at 1-year follow-up and final follow-up at 39 months. Outcome was compared with a cohort of 179 adult patients with recurrent patella instability operated with an adult MPFL reconstruction technique. Kujala score improved from 61 (13) to 81 (16). NRS pain score improved from 3.0 (3.1) to 1.5 (1.3) in activity. Four patients (20%) experienced redislocation within the first postoperative year compared with 5% in an adult patient population. Five patients (25%) experienced subluxations. One patient with a redislocation was re-operated with adult MPFL reconstruction technique. Cartilage injury was seen in six patients. There are clinical relevant improvements in knee function and pain after MPFL reconstruction in paediatric patients. Patella stability after MPFL reconstruction using femoral soft tissue graft fixation in paediatric patients was inferior to MPFL reconstruction using bony femoral fixation in adult patients

  10. Lumbar Disc Herniation Causing Cauda Equina Syndrome in a Paediatric Patient. A Case Report.

    PubMed

    Irshad, Mohamad; Ahmad, Khurshid; Malla, Hilal Ahmad

    2016-08-30

    Lumbar disc disease occurs mainly in the adult population. A disc prolapse in the paediatric population is very rare. Cauda equine syndrome resulting from compression of the cauda equina is a rare syndrome and is one of the few spinal surgical emergencies. Here we present a 13-year-old boy with pain in the lumbar region radiating bilaterally to the lower limbs, with asymmetrical weakness of lower the limbs, perianal hypoaesthesia and urinary retention. MRI of lumbar spine confirmed disc protrusion at the L3-L4 level with severe spinal canal stenosis. Patient was treated with microdiscectomy at the L3-L4 level. Postoperatively, his neurological deficit disappeared gradually. Although very rare, lumbar disc prolapse in the paediatric age group can lead to cauda equina syndrome. Early diagnosis and treatment can prevent life-long disability.

  11. Long-term anterior pituitary function in patients with paediatric Cushing's disease treated with pituitary radiotherapy.

    PubMed

    Chan, L F; Storr, H L; Plowman, P N; Perry, L A; Besser, G M; Grossman, A B; Savage, M O

    2007-04-01

    Pituitary radiotherapy (RT) is an effective second-line treatment for paediatric Cushing's disease (CD). Although the short-term effects of pituitary RT are well documented, there are less data on possible long-term sequelae. We report the long-term anterior pituitary function in a cohort of paediatric CD patients treated with pituitary RT. Between 1983 and 2006, 12 paediatric CD patients (10 males and 2 females) of mean age 11.4 years at diagnosis (range 6.4-17.4) underwent second-line pituitary RT (45 Gy in 25 fractions), following unsuccessful transsphenoidal surgery. Out of 12, 11 patients were cured by RT (cure interval 0.13-2.86 years) defined by mean serum cortisol of <150 nmol/l on 5-point day curve and midnight sleeping cortisol of <50 nmol/l. Long-term data are available for six male patients, who received RT at the age of 7.0-17.6 years. The mean follow-up from the completion of RT was 10.5 years (6.6-16.5). At a mean of 1.0 year (0.11-2.54) following RT, GH deficiency (peak GH <1-17.9 mU/l) was present in five out of six patients. On retesting at a mean of 9.3 years (7.6-11.3) after RT, three out of four patients were GH sufficient (peak GH 19.2-50.4 mU/l). Other anterior pituitary functions including serum prolactin in five out of six patients were normal on follow-up. All the six patients had testicular volumes of 20-25 ml at the age of 14.5-28.5 years. This series of patients illustrates the absence of serious long-term pituitary deficiency after RT and emphasises the importance of continued surveillance.

  12. Measuring antimicrobial use in hospitalized patients: a systematic review of available measures applicable to paediatrics.

    PubMed

    Fortin, E; Fontela, P S; Manges, A R; Platt, R W; Buckeridge, D L; Quach, C

    2014-06-01

    The optimal measure to use for surveillance of antimicrobial usage in hospital settings, especially when including paediatric populations, is unknown. This systematic review of literature aims to list, define and compare existing measures of antimicrobial use that have been applied in settings that included paediatric inpatients, to complement surveillance of resistance. We identified cohort studies and repeated point-prevalence studies presenting data on antimicrobial use in populations of inpatients or validations/comparisons of antimicrobial measures through a systematic search of literature using MEDLINE, EMBASE, CINAHL and LILACS (1975-2011) and citation tracking. Study populations needed to include hospitalized paediatric patients. Two reviewers independently extracted data on study characteristics and results. Overall, 3878 records were screened and 79 studies met selection criteria. Twenty-six distinct measures were found, the most frequently used being defined daily doses (DDD)/patient-days and exposed patients/patients. Only two studies compared different measures quantitatively, showing (i) a positive correlation between proportion of exposed patients and antimicrobial-days/patient-days and (ii) a strong correlation between doses/patient-days and agent-days/patient-days (r = 0.98), with doses/patient-days correlating more with resistance rates (r = 0.80 versus 0.55). The measure of antimicrobial use that best predicts antimicrobial resistance prevalence and rates, for surveillance purposes, has still not been identified; additional evidence on this topic is a necessity. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  13. Role of E-selectin for diagnosing myocardial injury in paediatric patients with mycoplasma pneumoniae pneumonia.

    PubMed

    Deng, Ming-Hong; Lin, Chun-Wang; Sun, Yan-Na; Zeng, Xiang-Lin; Wen, Fang

    2017-01-01

    Backgrounds Effects of myocardial injury on E-selectin remain unclear. Thus, we investigated the diagnostic value of E-selectin for myocardial injury in paediatric patients with mycoplasma pneumoniae pneumonia. Methods In this prospective and blinded clinical study, plasma E-selectin, cardiac troponin I, creatine kinase isoenzyme MB, interleukin-6 and tumor necrosis factor alpha concentrations were measured in paediatric patients with mycoplasma pneumoniae pneumonia (MPP group, n = 138). The control group comprised 120 healthy children. The definition of cardiac injury was based on cardiac troponin I or CK-MB (with or possibly without abnormal electrocardiogram evidence). Diagnostic value of E-selectin for myocardial injury was determined by analysing receiver operating characteristic curves. Results Among the 138 mycoplasma pneumoniae pneumonia patients, 40 patients were identified with myocardial injury, while 98 patients were identified without myocardial injury. Plasma E-selectin concentrations were: 40.22 ± 4.80 ng/mL, in patients with myocardial injury; 18.55 ± 2.16 ng/mL, in patients without myocardial injury and 12.39 ± 3.27 ng/mL, in healthy children. For the 40 patients identified with myocardial injury, area under the receiver operating characteristic curve value for plasma E-selectin concentrations was 0.945 (95% CI: 0.899-0.991), and optimal diagnostic cut-off value was 29.93 ng/mL (positive likelihood ratio = 72.5). Conclusion E-selectin was shown to be an effective index for myocardial injury in paediatric patients with mycoplasma pneumoniae pneumonia, and its role in other causes of myocardial injury warrants further investigation.

  14. Cognitive profile and disorders affecting higher brain functions in paediatric patients with neurofibromatosis type 1.

    PubMed

    Vaucheret Paz, E; López Ballent, A; Puga, C; García Basalo, M J; Baliarda, F; Ekonen, C; Ilari, R; Agosta, G

    2017-04-18

    Neurofibromatosis type 1 (NF1) is a common neurocutaneous syndrome often associated with specific cognitive deficits that are rarely monitored during follow-up of these patients. The purpose of our study is two-fold. First, we aimed to describe the cognitive profile of patients with NF1 and detect disorders in higher brain functions associated with the disease. Second, we identified the reasons for consultation associated with school performance in these patients. We conducted a descriptive cross-sectional study of 24 paediatric patients (ages 5 to 16) with NF1 who underwent neuropsychological assessment. The most frequent reasons for consultation were attention deficits (58.33%), learning disorders (25%), poor motor coordination (25%), and language impairment (0.8%). Although 96% of the patients displayed impairments in at least one of the assessed areas, only 83.34% of the parents had reported such impairments. Attention-deficit/hyperactivity disorder was present in 58.33% of the patients, whereas 33.33% had nonverbal learning disabilities, 20.83% had expressive language disorder, 8.33% had borderline intellectual functioning, 4.16% had mental retardation, and only 4.16% showed no cognitive impairment. Higher brain functions are frequently impaired in paediatric patients with NF1. Although many parents report such disorders, they can go undetected in some cases. Neuropsychological assessment is recommended for all paediatric patients with NF1 to detect cognitive impairment and provide early, effective rehabilitation treatment. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Regional anaesthesia to improve pain outcomes in paediatric surgical patients: a qualitative systematic review of randomized controlled trials.

    PubMed

    Suresh, S; Schaldenbrand, K; Wallis, B; De Oliveira, G S

    2014-09-01

    Summary The development of analgesic interventions in paediatric surgical patients is often limited by the inherent difficulties of conducting large randomized clinical trials to test interventions in those patients. Regional anaesthesia is a valid strategy to improve postoperative pain in the adult surgical population, but the effects of regional anaesthesia on postoperative pain outcomes in paediatric patients are currently not well defined. The main objective of the current review was to systematically evaluate the use of regional anaesthesia techniques to minimize postoperative pain in paediatric patients. A systematic search was performed to identify randomized controlled trials that evaluated the effects of the regional anaesthesia techniques on postoperative pain outcomes in paediatric surgical patients' procedures. Seventy-three studies on 5125 paediatric patients were evaluated. Only few surgical procedures had more than one small randomized controlled trial favouring the use of regional anaesthesia to minimize postoperative pain (ophthalmological surgery, cleft lip repair, inguinal hernia, and urological procedures). Additional evidence is required to support the use of specific regional anaesthesia techniques to improve postoperative pain for several surgical procedures (craniectomy, adenotonsillectomy, appendectomy, cardiac surgery, umbilical hernia repair, upper and lower extremity) in paediatric patients. Currently, only a very limited number of regional anaesthesia techniques have demonstrated significant improvement on postoperative pain outcomes for a restricted number of surgical procedures. More studies are needed in order to establish regional anaesthesia as a valid strategy to improve analgesia in the paediatric surgical population. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Misdiagnosis and Quality of Management in Paediatric Surgical Patients Referred to a Tertiary Care Hospital

    PubMed Central

    Cazares-Rangel, Joel; Zalles-Vidal, Cristian; Davila-Perez, Roberto

    2014-01-01

    Background: The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care. Aim: Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management. Design: Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment. Setting: Third level care hospital, Mexico City. Participants: Newborn to adolescents referred to Paediatric Surgery Department. Intervention(s): None. Main Outcome Measure(s): Misdiagnosis and quality of management prior to being referred. Result: Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first-or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management. Conclusion: We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible. PMID:24959495

  17. Patient and staff doses in paediatric interventional cardiology derived from experimental measurements with phantoms.

    PubMed

    Ubeda, Carlos; Vano, Eliseo; Miranda, Patricia; Aguirre, Daniel; Riquelme, Nemorino; Dalmazzo, Dandaro; Galaz, Sergio

    2016-01-01

    The aim of this paper was to determine experimentally the entrance surface air kerma (ESAK) and kerma-area product (KAP) levels to patients and scatter doses at the cardiologist's eyes during paediatric interventional cardiology (IC) procedures for Chile, on the basis of measurements taken from X-ray systems characterization for different thicknesses of polymethyl methacrylate, together with the average values of fluoroscopy time and number of cine frames for ten paediatric IC procedures. The range of cumulative ESAK values when the different clinical procedures were simulated was from 2 to 1100 mGy. KAP values ranged from 0.30 to 150 Gy cm(2). Scatter doses at cardiologist's eyes for the simulated procedures ranged from 0.20 to 116 µSv per procedure. Large differences between the X-ray systems were found in our study. Standardized guidelines in terms of X-ray system setting and protocols should be developed for hospitals that perform paediatric IC procedures in Chile.

  18. Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS).

    PubMed

    Ward, Elizabeth C; Hill, Anne E; Nund, Rebecca L; Rumbach, Anna F; Walker-Smith, Katie; Wright, Sarah E; Kelly, Kris; Dodrill, Pamela

    2015-06-01

    The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia. University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students' perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients. Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician. This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management.

  19. Characterization of Th17 and FoxP3(+) Treg Cells in Paediatric Psoriasis Patients.

    PubMed

    Zhang, L; Li, Y; Yang, X; Wei, J; Zhou, S; Zhao, Z; Cheng, J; Duan, H; Jia, T; Lei, Q; Huang, J; Feng, C

    2016-03-01

    Psoriasis is one of the most common inflammatory skin conditions affecting both children and adults. Growing evidence indicates that T-helper 17 (Th17) cells and CD4(+) CD25(+) regulatory T (Treg) cells play an important role in the pathogenesis of psoriasis. However, the relationship between Th17 and Treg cells and their dynamic variations in paediatric psoriasis remain unclear. In this study, we found that both Th17 and FoxP3(+) Treg cells and the ratio of Th17 to Treg cell frequency in the peripheral circulation were increased in patients with paediatric psoriasis and were positively correlated with the disease severity. The function of Treg to suppress CD4(+) CD25(-) T cell proliferation and IFN-γ secretion was impaired during the onset of psoriasis. After disease remission, both the Th17 and Treg cell frequencies were decreased, and the suppressive function of the Treg cells was obviously restored. However, neither Treg cells from the disease onset nor those after remission can regulate IL-17 secretion by CD4(+) T cells. These findings will further our understanding of the associations between Th17 and Treg cells in paediatric psoriasis and their influence on disease severity.

  20. A Retrospective Analysis of Spontaneous Adverse Drug Reactions Reports Relating to Paediatric Patients.

    PubMed

    Rosli, Rosliana; Ming, Long Chiau; Abd Aziz, Noorizan; Manan, Mohamed Mansor

    2016-01-01

    Spontaneous reporting on adverse drug reactions (ADR) has been established in Malaysia since 1987, and although these reports are monitored by the Malaysia drug monitoring authority, the National Pharmaceutical Control Bureau, information about ADRs in the paediatric patient population still remains unexplored. The aims of this study, therefore, were to characterize the ADRs reported in respect to the Malaysian paediatric population and to relate the data to specific paediatric age groups. Data on all ADRs reported to the National Pharmaceutical Control Bureau between 2000 and 2013 for individuals aged from birth to 17 years old were analysed with respect to age and gender, type of reporter, suspected medicines (using the Anatomical Therapeutic Chemical classification), category of ADR (according to system organ class) as well as the severity of the ADR. In total, 11,523 ADR reports corresponding to 22,237 ADRs were analysed, with half of these reporting one ADR per report. Vaccines comprised 55.7% of the 11,523 ADR reports with the remaining being drug related ADRs. Overall, 63.9% of ADRs were reported for paediatric patients between 12 and 17 years of age, with the majority of ADRs reported in females (70.7%). The most common ADRs reported were from the following system organ classes: application site disorders (32.2%), skin and appendages disorders (20.6%), body as a whole general disorders (12.8%) and central and peripheral nervous system disorders (11.2%). Meanwhile, ADRs in respect to anti-infectives for systemic use (2194/5106; 43.0%) were the most frequently reported across all age groups, followed by drugs from the nervous system (1095/5106; 21.4%). Only 0.28% of the ADR cases were reported as fatal. A large proportion of the reports were received from healthcare providers in government health facilities. ADR reports concerning vaccines and anti-infectives were the most commonly reported in children, and are mainly seen in adolescents, with most of the

  1. A Retrospective Analysis of Spontaneous Adverse Drug Reactions Reports Relating to Paediatric Patients

    PubMed Central

    Rosli, Rosliana; Abd Aziz, Noorizan; Manan, Mohamed Mansor

    2016-01-01

    Background Spontaneous reporting on adverse drug reactions (ADR) has been established in Malaysia since 1987, and although these reports are monitored by the Malaysia drug monitoring authority, the National Pharmaceutical Control Bureau, information about ADRs in the paediatric patient population still remains unexplored. The aims of this study, therefore, were to characterize the ADRs reported in respect to the Malaysian paediatric population and to relate the data to specific paediatric age groups. Methods Data on all ADRs reported to the National Pharmaceutical Control Bureau between 2000 and 2013 for individuals aged from birth to 17 years old were analysed with respect to age and gender, type of reporter, suspected medicines (using the Anatomical Therapeutic Chemical classification), category of ADR (according to system organ class) as well as the severity of the ADR. Results In total, 11,523 ADR reports corresponding to 22,237 ADRs were analysed, with half of these reporting one ADR per report. Vaccines comprised 55.7% of the 11,523 ADR reports with the remaining being drug related ADRs. Overall, 63.9% of ADRs were reported for paediatric patients between 12 and 17 years of age, with the majority of ADRs reported in females (70.7%). The most common ADRs reported were from the following system organ classes: application site disorders (32.2%), skin and appendages disorders (20.6%), body as a whole general disorders (12.8%) and central and peripheral nervous system disorders (11.2%). Meanwhile, ADRs in respect to anti-infectives for systemic use (2194/5106; 43.0%) were the most frequently reported across all age groups, followed by drugs from the nervous system (1095/5106; 21.4%). Only 0.28% of the ADR cases were reported as fatal. A large proportion of the reports were received from healthcare providers in government health facilities. Discussion ADR reports concerning vaccines and anti-infectives were the most commonly reported in children, and are mainly

  2. Types of anaemic crises in paediatric patients with sickle cell anaemia seen in Enugu, Nigeria

    PubMed Central

    Juwah, A; Nlemadim, E; Kaine, W

    2004-01-01

    Background: Anaemic crises in paediatric patients with sickle cell anaemia are major causes of morbidity and mortality. Some children admitted to hospitals' emergency rooms or paediatric wards of the hospitals with severe anaemia die before blood transfusion. Aims and Methods: A total of 108 episodes of anaemic crises were prospectively evaluated in 108 patients with sickle cell anaemia attending the paediatric sickle cell clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Results: Hyper-haemolytic crises were the commonest types of anaemic crises in the patients studied. The mean haemoglobin concentration of 44.66 (SD 6.42) g/l in crises was significantly lower than the mean steady state level of 78.69 (SD 8.50) g/l. Reticulocytes, unconjugated serum bilirubin concentrations, and the presence of nucleated red blood cells were also increased. About 4.6% of patients were not jaundiced at presentation even though they were profoundly anaemic. Their haematological indices gradually returned to normal without marked changes in their serum bilirubin concentrations. These patients were probably in the early recovery phase of aplastic crises. The classical presentation of acute splenic sequestration crisis with a rapidly enlarging spleen and hypotension was not observed. This was probably because of its precipitate nature and accompanying circulatory collapse, which carried a high mortality rate. Minor forms of sequestration crises may have occurred in the liver and spleen. Conclusions: Malaria appeared to have played a role in precipitating some of the hyper-haemolytic episodes. Further studies to elucidate this role are required so that appropriate recommendations regarding malaria prophylaxis can be made in patients with sickle cell anaemia. PMID:15155406

  3. Fontan operation in a paediatric patient with a history of Takotsubo cardiomyopathy.

    PubMed

    Watanabe, Maya; Shiraishi, Shuichi; Takahashi, Masashi; Tsuchida, Masanori

    2014-08-01

    Takotsubo cardiomyopathy is very rare in the paediatric population and has not been described in a single-ventricle patient yet. We report the case of a 4-year old boy with a history of Takotsubo cardiomyopathy in whom we performed a Fontan operation. After coil embolization of the minor aortopulmonary collateral arteries, the patient developed Takotsubo cardiomyopathy. His cardiac function largely recovered over 3 months. He subsequently progressed to a Fontan operation and was weaned uneventfully off cardiopulmonary bypass, on minimal doses of dopamine and milrinone; he was sedated using a dexmedetomidine infusion and a midazolam bolus. There were no signs of recurrent Takotsubo cardiomyopathy over the subsequent 2 years.

  4. Learning to diagnose using patient video case in paediatrics: perceptive and cognitive processes.

    PubMed

    Balslev, Thomas

    2012-12-01

    Thomas Balslev, a paediatric neurologist and educational researcher, defended his thesis on 24 November 2011. The thesis included five published papers, and investigated learning with authentic, brief patient video cases. With analysis of a video case in a small group, learning processes and sharing of knowledge was intensely stimulated. Small group discussion and subsequent listening to an expert's think-aloud were particularly effective approaches to enhance diagnostic accuracy among non-experts. In a descriptive study, expertise-related differences during analysis of patient video cases were characterized, and in a controlled study, different types of visual modelling were tested.

  5. Psychiatric adjustment in end-stage renal disease: a follow up study of former paediatric patients.

    PubMed

    Morton, M J; Reynolds, J M; Garralda, M E; Postlethwaite, R J; Goh, D

    1994-05-01

    Life-time psychiatric adjustment was studied in forty-five young adult survivors of a paediatric dialysis and transplantation programme and in a comparison group matched for age and sex. Renal patients reported more psychological problems in childhood and had lower self-esteem in adulthood, but adult lifetime psychiatric morbidity was comparable in both groups. There were differences in the pattern of psychiatric disorder with a trend for more depressive states in the renal group. Lower self-esteem was linked to early onset renal disease and to educational and social dysfunction. Results indicate relatively favourable adult adjustment of juvenile renal patients.

  6. Patients' Reactions to Local Anaesthetic Application Devices in Paediatric Dentistry.

    PubMed

    Bajrić, Elmedin; Kobasglija, Sedin; Jurić, Hrvoje

    2015-09-01

    Local anaesthesia is the most common medium for pain control in most dental treatments. Physical appearance of syringe itself can be considered as a provoking factor for the emergence of dental fear and anxiety (DFA). In this research the patient reactions to local anaesthesia application devices, as one of the main causes for DFA emergence, were inquired. The sample comprised of 120 patients, divided in three age groups, formed of 40 patients aged 8, 12 and 15 years. DFA prevalence was quantified by Children Fear Survey Schedule-Dental Subscale (CFSS-DS). Three different syringes were offered to the patients. Reasons for choosing one of the syringes were detected. Patients assigned statistically highest rank to plastic syringe. Boys chose metal and intraligamental syringe statistically more often than girls. Patients with higher CFSS-DS scores chose metal syringe as last option. None of the reasons for selection was dominant, except pain that could be caused by usage of any of the three syringes. A large number of patients did not mention any of the reasons for choosing particular syringes. Plastic syringe represented the most acceptable device for local anaesthetic application to our patients. Patients often linked pain with dental syringes.

  7. Is autologous chondrocyte implantation (ACI) an adequate treatment option for repair of cartilage defects in paediatric patients?

    PubMed

    Kaszkin-Bettag, Marietta

    2013-08-01

    Cartilage lesions in the knee of juvenile patients require an effective repair to regain life-long functional activity of the joint. Autologous chondrocyte implantation (ACI) is discussed to be advantageous over other methods for cartilage repair regarding long-term outcome. ACI has successfully been applied in juvenile patients, although currently recommended for patients ≥18 years of age. Only few controlled clinical trials present evidence of efficacy and safety of ACI in adolescent patients. ACI products have to undergo the process of a marketing authorisation application, including the submission of a paediatric investigation plan (PIP). Data from prospective clinical studies or retrospective collection of long-term data in paediatric patients should be submitted for risk-benefit evaluation by the Paediatric Committee (PDCO).

  8. Knowledge of carbohydrate counting and insulin dose calculations in paediatric patients with type 1 diabetes mellitus.

    PubMed

    Finner, Natalie; Quinn, Anne; Donovan, Anna; O'Leary, Orla; O'Gorman, Clodagh S

    2015-12-01

    Patients with type 1 diabetes mellitus (T1DM) who are able to adjust their insulin doses according to the carbohydrate content of a meal, as well as their blood glucose, are likely to have improved glycaemic control (Silverstein et al., 2005). With improved glycaemic control, patients have a lower risk of developing long-term microvascular complications associated with T1DM (Diabetes Control and Complications Trial Research Group, 1993). To assess the carbohydrate and insulin knowledge of patients attending our paediatric diabetes clinic at the University Hospital Limerick (UHL), the validated PedCarbQuiz (PCQ) was applied to our clinic population. This study was completed by applying a questionnaire called the PedCarbQuiz (PCQ) to children exclusively attending our paediatric diabetes clinic at UHL. Of the clinic's 220 patients, 81 participated in the study. The average total PCQ score (%) was higher in the continuous subcutaneous insulin infusion (CSII) group compared with the multiple daily insulin (MDI) injection user group (79.1 ± 12.1 versus 65.9 ± 6.6 p = 0.005). The CSII group also had a higher average carbohydrate score (%) compared with the MDI group (79.4 ± 12.4 versus 66.3 ± 16.2, p = 0.004). This study demonstrates that in a representative Irish regional paediatric T1DM clinic, knowledge of carbohydrates and insulin is better among patients treated with CSII compared with MDI. However, knowledge in both groups is poorer than in the original US sample. This study demonstrates that in a representative Irish regional paediatric T1DM clinic, knowledge of carbohydrates and insulin is poorer than in a US based sample, although this knowledge is better among patients treated with CSII compared with MDI. This highlights the need for improved resources for diabetes and carbohydrate counting education for patients with T1DM.

  9. Access to paediatric emergency departments in Italy: a comparison between immigrant and Italian patients

    PubMed Central

    Grassino, Erica Clara; Guidi, Carla; Monzani, Alice; Di Pietro, Pasquale; Bona, Gianni

    2009-01-01

    Objective The aim of the study was to investigate whether access to paediatric emergency departments differed between foreign and Italian patients. Methods We performed a cross-sectional study between January-December 2007 to analyse attendance's characteristics in the paediatric emergency departments of ten Italian public hospitals. The study population included each foreign patient and the following Italian patient admitted to the same emergency department. All causes of admission of these subjects were evaluated, together with the child's age, gender, country of birth, parents' nationality, time of admission, severity code and discharge-related circumstances. Results We enrolled 4874 patients, 2437 foreign (M:F = 1409:1028) and 2437 Italian ones (M:F = 1368:1069). Most of foreign and Italian patients' admissions were sorted as green (72.5% and 87.8%, respectively) or white codes (25.2% and 9.8%, respectively). The most frequent causes for attendance concerned respiratory tract diseases, followed by gastroenteric ones and injuries in both groups. Conclusion In our survey immigrants didn't access to emergency departments more than Italian children. Both of them referred to emergency departments mainly for semi-urgent or non-urgent problems. Foreign and Italian patients suffered from the same pathologies. Infectious diseases traditionally thought to be a potential problem in immigrant populations actually seem to be quite infrequent. PMID:19490660

  10. Radiological input during paediatric multidisciplinary team meetings and its influence on clinical patient management.

    PubMed

    Llewellyn-Jones, Glyn; Pereira, John

    2016-04-01

    There is little information about the role of the radiologist at multidisciplinary team meetings; in particular their influence on patient management. To evaluate the influence of radiologists on clinical patient management during multidisciplinary meetings. Prospective data were collected over a 5-week period from multidisciplinary team meetings across four paediatric clinical domains. Radiological input was recorded for each case discussion, including the type of influence and its potential effect on clinical patient management. One hundred and forty paediatric cases were reviewed. Radiological advice was requested from the radiologist for 25.7% (N = 36) of cases. In 17.9% (N = 25) this advice was judged to have influenced clinical patient management. There were two cases where new imaging findings were discovered. Radiologists influence clinical patient management during multidisciplinary team meetings primarily by providing differential diagnoses and guidance regarding future imaging, with respect to both the necessity and the modality. Occasionally, when imaging is reviewed at these meetings, new findings are discovered that impact on patient management. © 2016 The Royal Australian and New Zealand College of Radiologists.

  11. Determinants of parental decisions on 'drop out' from cancer treatment for childhood cancer patients.

    PubMed

    Yeh, C H; Lin, C F; Tsai, J L; Lai, Y M; Ku, H C

    1999-07-01

    Little is known about the psychosocial process of parental decisions on 'drop out' from cancer treatment for paediatric patients in Taiwan. This study, based on structured in-depth interviews, attempted to document the determinants of parental decisions on drop out. A total of 19 parents of paediatric cancer patients who dropped out from a cancer treatment for at least a month within 3 years since first treatment were interviewed. Content analysis of qualitative data revealed six categories of determinants associated with parental decisions: suffering severe pain from medical treatments and adverse side-effects; desire for better and less painful treatments; adverse effect of other patients' experiences; searching for possible explanations for disease after prolonged denial of diagnosis; lack of empathy from health care professionals; and misinterpretation of improved prognostics. These findings reflected the deficiency of psychological and emotional support for parents from health care professionals prior to and during cancer treatment.

  12. Violent behaviour from young adults and the parents of paediatric patients in the emergency department.

    PubMed

    Pich, Jacqueline; Hazelton, Michael; Kable, Ashley

    2013-07-01

    Violence in healthcare is a significant issue and one that is increasing in prevalence globally. Nurses have been identified as the professional group at most risk, with patients the main source of this violence. The aim of this study was to describe the experiences of Australian ED nurses with episodes of patient-related violence from young adults (16-25years of age) and the parents of paediatric patients. Data analysis of semi-structured interviews led to the identification of antecedents to episodes of violence and behaviours specific to these two groups of interest. These behaviours included: "performing" and attention-seeking behaviours and violent behaviours including both verbal and physical abuse. Antecedents discussed by participants included: parental emotions and alcohol and substance abuse. Overall the results speak to a working environment where participants regularly feel unsafe. Violence in the ED is perceived to occur frequently and to such an extent that participants have become resigned to expect and accept it as part of their job. The role played by distinct groups such as young adults and the parents of paediatric patients must be acknowledged and this knowledge used along with other known risk factors to help identify patients at risk of potential violence.

  13. [Appropriateness of antibiotic prescribing in paediatric patients in a hospital emergency department].

    PubMed

    Croche Santander, Borja; Campos Alonso, Elena; Sánchez Carrión, Adela; Marcos Fuentes, Laura; Diaz Flores, Isabel; Vargas, Juan Carlos; Fernández Domínguez, Bárbara; Toro Ibañez, Cristóbal

    2017-07-12

    Antibiotics represent one of the most widely prescribed therapeutic agents in children. It has been estimated that 30-50% of antibiotic prescriptions for this population are inappropriate. In this scenario, analysis of prescription data provides an invaluable source of information as a basis for implementing strategies for improvement in this field. To assess the appropriateness of antibiotic prescriptions in a paediatric population at an emergency department. An observational, descriptive, and cross-sectional study was conducted on patients under 14 years who attended the emergency department during 2013. A random sample of 630 patients was selected (confidence level 99%, accuracy 5%). To assess the suitability of antibiotic prescriptions, the clinical practice was compared with an evidence-based guideline especially designed for this study. Antibiotics were prescribed to 16.5% patients (n=104). Antibiotic treatment was inappropriate in 51.9% patients (n=54). Unnecessary treatment was indicated in 40.7%, with wrong antibiotics chosen in 35.2%, and the posology was incorrect in 24.1% of them. The most frequent diseases with incorrectly prescribed antibiotics were: acute otitis media, episodes of wheezing, fever of unknown origin, acute pharyngo-tonsillitis, and community-acquired pneumonia. Antibiotic prescribing seems to be inappropriate in up to half of the patients. These data reinforce the need to develop a paediatric antimicrobial stewardship program to decrease the unnecessary use of antimicrobial agents. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  14. The effective dose result of 18F-FDG PET-CT paediatric patients

    NASA Astrophysics Data System (ADS)

    Hussin, D.; Said, M. A.; Ali, N. S.; Tajuddin, A. A.; Zainon, R.

    2017-05-01

    Paediatric patient received high exposure from both CT and PET examination. Automatic Exposure Control (AEC) is important in CT dose reduction. This study aimed to compare the effective dose obtained from PET-CT scanner with and without the use of AEC function. In this study, 68 patients underwent PET-CT examination without the use of AEC function, while 25 patients used the AEC function during the examination. Patients involved in this study were between 2 to 15 years old with varies of malignancies and epilepsy diseases. The effective dose obtained from PET and CT examinations was calculated based on recommendation from International Commission on Radiological Protection (ICRP) Publication 106 and ICRP publication 102. The outcome of this study shows that the radiation dose was reduced up to 20% with the use of AEC function. The mean average of effective dose result obtained from PET and CT examinations without the use of AEC and AEC function were found to be as 6.67 mSv, 6.77 mSv, 6.03mSv and 4.96 mSv respectively. Where total effective dose result of PET-CT with non-AEC and AEC were found to be 13.44 mSv and 10.99 mSv respectively. Conclusion of this study is, the installation of AEC function in PET-CT machine does play important role in CT dose reduction especially for paediatric patient.

  15. Clinical management of atopic eczema with pimecrolimus cream 1% (Elidel) in paediatric patients.

    PubMed

    Eichenfield, Lawrence F; Thaci, Diamant; de Prost, Yves; Puig, Lluis; Paul, Carle

    2007-01-01

    Atopic eczema is predominantly a disease of children and infants, and is often a significant burden for both the sufferer and the family. Pimecrolimus cream 1% (Elidel) is a topical calcineurin inhibitor that has been developed for the treatment of inflammatory skin diseases. When applied twice daily, pimecrolimus has been shown to be effective and well tolerated in paediatric patients with mild to moderate atopic eczema, and appears to be particularly suitable for use on the face, the neck and skin folds. Reduction of pruritus or erythema can be seen within 48 hours of initiating treatment, and when used at the first signs or symptoms of recurrence, pimecrolimus can significantly reduce the incidence of flares and the amount of topical corticosteroid used. Long-term pimecrolimus therapy shows that the initial reduction of disease severity (Eczema Area and Severity Index) is sustained and that most patients have minimal residual disease at 2 years. The most common application-site reaction is a mild to moderate, transient, warm/burning sensation occurring in approximately 10% of patients. Blood concentrations of pimecrolimus following topical administration remain low in all patients. Currently there is no evidence for systemic adverse events, immune suppression or alterations in the vaccine response, after short-term or prolonged treatment. In conclusion, pimecrolimus is an effective treatment option for the short-term treatment and long-term control of atopic eczema in paediatric patients. Copyright 2007 S. Karger AG, Basel.

  16. Regional hyperthermia combined with chemotherapy in paediatric, adolescent and young adult patients: current and future perspectives.

    PubMed

    Seifert, Georg; Budach, Volker; Keilholz, Ulrich; Wust, Peter; Eggert, Angelika; Ghadjar, Pirus

    2016-04-30

    Here we evaluate the current status of clinical research on regional hyperthermia (RHT) in combination with chemotherapy or radiation therapy in paediatric oncology.Data were identified in searches of MEDLINE, Current Contents, PubMed, and references from relevant articles using medical subject headings including hyperthermia, cancer, paediatric oncology, children, radiation therapy and chemotherapy. Currently, only two RHT centres exist in Europe which treat children. Clinical RHT research in paediatric oncology has as yet been limited to children with sarcomas and germ cell tumours that respond poorly to or recur after chemotherapy. RHT is a safe and effective treatment delivering local thermic effects, which may also stimulate immunological processes via heat-shock protein reactions. RHT is used chiefly in children and adolescents with sarcomas or germ cell tumours located in the abdomino-pelvic region, chest wall or extremities to improve operability or render the tumour operable. It could potentially be combined with radiation therapy in a post-operative R1 setting where more radical surgery is not possible or combined with chemotherapy instead of radiation therapy in cases where the necessary radiation dose is impossible to achieve or would have mutilating consequences. RHT might also be an option for chemotherapy intensification in the neoadjuvant first-line treatment setting for children and adolescents, as was recently reflected in the promising long-term outcome data in adults with high-risk soft tissue sarcomas (EORTC 62961/ESHO trial).The limited data available indicate that combining RHT with chemotherapy is a promising option to treat germ cell tumours and, potentially, sarcomas. RHT may also be beneficial in first-line therapy in children, adolescents and young adults. The research should focus on optimising necessary technical demands and then initiate several clinical trials incorporating RHT into interdisciplinary treatment of children

  17. Neuromuscular blockade with vecuronium in paediatric patients with burn injury.

    PubMed Central

    Mills, A K; Martyn, J A

    1989-01-01

    1. The effect of body surface area (BSA) burn injury on neuromuscular pharmacodynamics of vecuronium was evaluated. 2. The neuromuscular responses of 15 burned children were compared with those in five controls. 3. The effective dose for 50% suppression of twitch tension (ED50) was 34 micrograms kg-1 for patients with less than 40% BSA burn, 55 micrograms kg-1 for 40-60% BSA burn, and 65 micrograms kg-1 for patients with greater than 60% BSA burn. These values were significantly higher than the value for control patients, which was 18 micrograms kg-1. 4. Burn injury induces a resistance to the neuromuscular effects of vecuronium, the magnitude of which is related to burn size. PMID:2570602

  18. Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan.

    PubMed

    Naeem Khan, Muhammad; Shafee, Muhammad; Hussain, Kamran; Samad, Abdul; Arif Awan, Muhammad; Manan, Abdul; Wadood, Abdul

    2013-07-01

    To determine the seropositivity of typhoid fever in febrile pediatric patients presenting to tertiary care center. This observational study was conducted at Children Hospital Quetta (CHQ) from July 2011 to March 2012. The children with three or more days fever, no obvious focus of infection and clinically suspected of typhoid fever were screened. Sterile Blood samples were obtained from febrile patients and Widal and Typhidot® tests were performed for the diagnosis of Typhoid fever in the suspected populations. Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 (18.6%) patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years. Although non-significant association was observed on sex basis. The findings highlight the considerable burden of typhoid fever in pre-school and school-aged children. The variation in the disease pattern has also been observed under seasonal variation and different age groups, all of which need to be considered in deliberations to control the typhoid fever.

  19. Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan

    PubMed Central

    Naeem Khan, Muhammad; Shafee, Muhammad; Hussain, Kamran; Samad, Abdul; Arif Awan, Muhammad; Manan, Abdul; Wadood, Abdul

    2013-01-01

    Objectives: To determine the seropositivity of typhoid fever in febrile pediatric patients presenting to tertiary care center. Methods: This observational study was conducted at Children Hospital Quetta (CHQ) from July 2011 to March 2012. The children with three or more days fever, no obvious focus of infection and clinically suspected of typhoid fever were screened. Sterile Blood samples were obtained from febrile patients and Widal and Typhidot® tests were performed for the diagnosis of Typhoid fever in the suspected populations. Results: Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 (18.6%) patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years. Although non-significant association was observed on sex basis. Conclusion: The findings highlight the considerable burden of typhoid fever in pre-school and school-aged children. The variation in the disease pattern has also been observed under seasonal variation and different age groups, all of which need to be considered in deliberations to control the typhoid fever. PMID:24353661

  20. Effects of post-discharge telephone calls on the rate of emergency department visits in paediatric patients.

    PubMed

    Yang, Chen; Chen, Chung-Ming

    2012-10-01

    The aim of this study was to evaluate the effects of post-discharge telephone calls on the rate of emergency department (ED) visits within 3 days following hospitalisation in paediatric patients. Patients hospitalised on the Paediatric Service from May 2008 through December 2008 were included in the intervention group and patients hospitalised from May 2007 through December 2007 were included in the control group. Within 3 days of hospital discharge, nurse practitioners attempted daily to contact caregivers in the intervention group and asked children conditions and provided health information. There were 643 patients in the intervention group and 642 patients in the control group, respectively. Characteristics of the intervention and control groups were similar with respect to age, sex and days of hospitalisation. Ninety-two per cent of patients in the intervention group received a telephone call from a nurse practitioner within 3 days of hospital discharge. Significantly fewer patients in the intervention group (3 patients, 0.47%) had a subsequent visit to the ED within 3 days of hospital discharge than in the control group (11 patients, 1.71%) (P= 0.034). Telephone follow-up is an effective way of providing health information, managing remaining symptoms, recognising complications, advising patients of medical alternatives and giving reassurance; this may reduce unnecessary patient ED visits. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  1. Immunoglobulin a nephropathy: Pathological markers of renal survival in paediatric patients.

    PubMed

    Fabiano, Rafaela Cabral Gonçalves; Pinheiro, Sérgio Veloso Brant; de Almeida Araújo, Stanley; Simões E Silva, Ana Cristina

    2016-12-01

    IgA nephropathy (IgAN) is one of the leading causes of glomerulonephritis characterized by the findings of IgA and IgG immune deposits in the mesangium of kidney biopsies from patients with persistent microscopic haematuria. IgAN is frequently detected among adolescents and young adults. IgAN presents a highly variable course that includes a spectrum from a very mild disease to end-stage renal disease (ESRD). There are several clinical and histological factors that strongly determined the final outcome of patients with IgAN. Pathological variables associated with unfavorable outcomes are mesangial hypercellularity, segmental glomerulosclerosis, endocapillary hypercellularity and interstitial fibrosis/tubular atrophy, according to the Oxford classification. Moreover, some studies also suggest a role for complement activation in the pathogenesis of IgAN. In this regard, staining for C4d may be an independent risk factor for the development of ESRD in IgAN. Despite the growing number of studies assessing IgAN risk factors, this kind of investigation in paediatric patients is still very limited. The aim of this article is to revise pathological markers related to deterioration of renal function in paediatric patients with IgAN, particularly those that can independently affect renal survival. © 2016 Asian Pacific Society of Nephrology.

  2. Segmental haemorrhagic infarction of the testis in a paediatric patient: a rare aftermath of epididymitis.

    PubMed

    Adorisio, Ottavio; Ceriati, Emanuela; Camassei, Francesca Diomedi; De Peppo, Francesco

    2013-01-07

    Testicular infarction is an uncommon finding in paediatric age and is usually due to testicular torsion or trauma causing venous rupture with thrombosis and/or arteriolar obstruction. Other causes of segmental infarction of the testes are represented by polyarteritis nodosa, thromboangioiitis obliterans and hypersensitivity angiitis. A few cases of testicular infarction due to epididymitis have been described in the literature related mainly to adult patients. Epididymitis is usually treated in the outpatient setting with close follow-up, but according to our present experience, and reviewing the literature, there may be some cases in which, surgical exploration is mandatory in order to avoid testicular damage.

  3. Central nervous system infection after Onyx embolisation of arterio-venous malformations in two paediatric patients.

    PubMed

    Pulhorn, H; Hartley, J C; Shanmuganathan, M; Lee, C H; Harkness, W; Thompson, D N P

    2014-09-01

    Increasingly, Onyx is used for endovascular embolization of aneurysms and arterio-venous malformations. Although reports in the literature on the use of Onyx are favourable, there have been so far no reports on the central nervous system (CNS) infection rate after embolisation with Onyx and no recommendations as to the management of these infections. We present two cases of paediatric patients who acquired CNS infection with Pseudomonas aeruginosa after Onyx embolisation of AVMs and describe their subsequent management. Presence of established infection after Onyx embolisation should be dealt with by removal of infected material, administration of appropriate antibiotic therapy and supportive treatment.

  4. Paediatric candidates' attitudes to computerized patient management problems in a certifying examination.

    PubMed

    Fincham, S M; Grace, M; Taylor, W C; Skakun, E N; Davis, F C

    1976-09-01

    In September 1974 candidates who had taken a computerized patient managment problem examination (CPMP), as part of the certification process in paediatrics required by the Royal College of Physicians and Surgeons of Canada, completed a questionnaire designed to elicit their reactions to CPMPs. The results indicated that respondents were favourable to CPMPs, that there was little distraction caused by the equipment, logic or semantics of the problems, and that CPMPs were an acceptable examination technique. It was recommended that, in the future, CPMP examinees be allowed practice time to familiarize themselves with the equipment, that pre-examination instructions should be clarified, and that problems judged inadequate by candidates be revised.

  5. Fiberoptic intubation in a paediatric patient with severe temporomandibular joint (TMJ) ankylosis.

    PubMed

    Asghar, Ali; Shamim, Faisal; Aman, Asiyah

    2012-12-01

    Craniofacial abnormalities are associated with mandibular hypoplasia, reduced mandibular space with overcrowding of soft tissues and maxillary hypoplasia. Decreased mouth opening and limitation in jaw protrusion are independent predictors of difficult airway in such patients. The relative difficult problem becomes even graver in the paediatric age group because of their small mouth opening and un-cooperativeness. A child with severe temporomandibular joint (TMJ) ankylosis presented with negligible mouth opening and required surgical correction under general anaesthesia. Successful intubation was performed with endotracheal tube size 5.5 mm using an adult 4.3 mm fiberoptic bronchoscope under inhalational as well as topical anaesthesia.

  6. Successful topical treatment of hand warts in a paediatric patient with tea tree oil (Melaleuca alternifolia).

    PubMed

    Millar, B Cherie; Moore, John E

    2008-11-01

    Tea tree oil (TTO) (Melaleuca alternifolia) has been used recently as an effective topical application for the treatment of skin infections due to a variety of aetiological microbial agents, including mainly bacterial infections. We detail the first report in the peer-reviewed literature of the successful treatment with TTO of a paediatric patient with warts on her right middle finger. TTO was applied topically once daily to the lesions for 12 days, with a successful outcome, including complete re-epithelization of the infected areas. The case highlights the potential use of TTO in the treatment of common warts due to human papilloma virus.

  7. From pharmacovigilance to therapy amelioration in paediatric patients: the role of the clinical pharmacologists and family paediatricians. Part of a series on Paediatric Pharmacology, guest edited by Gianvincenzo Zuccotti, Emilio Clementi, and Massimo Molteni.

    PubMed

    Napoleone, Ettore; Radice, Sonia

    2012-02-01

    An active pharmacovigilance approach is advisable in paediatric pharmacotherapy as it contributes to generate knowledge promptly and to enhance the estimation of true risk in clinical practice. Reports and studies from the scientific community and regulatory agencies have shown that effective methods for early detection of adverse drug reaction and pharmacoepidemiological studies are a primary need since they increase drug safety in the paediatric population. In this perspective article we describe how pharmacologists and paediatricians may actively synergise to optimise drug therapies and their management in paediatric patients.

  8. Management strategy for congenital thumb differences in paediatric patients.

    PubMed

    Dautel, G

    2017-02-01

    Congenital thumb anomalies are common and have a major impact given the specific functional role of the thumb. They may occur alone or as part of a multiple congenital anomaly syndrome. The primary goal of surgical management is to improve or restore pincer grip. In patients with 'congenital' trigger thumb, the A1 pulley must be released if the interphalangeal joint remains in fixed flexion. Thumb duplication is generally managed by reconstruction of the thumb from the predominant (ulnar-based) digit; the accessory (radial-based) digit is excised after collection of its tissue components needed for the reconstruction programme. Thumb aplasia requires pollicisation of the index finger by island flap transfer of the second ray to give it the shape, position, and function of a thumb. Among patterns of digital hypoplasia, some require reconstruction of the existing thumb and others excision of the rudimentary thumb followed by pollicisation. In patients with aplasia of multiple hand digits, a toe transfer may be considered when there is no natural tendency to develop digital prehension at the hand.

  9. Proteinuria in paediatric patients with human immunodeficiency virus infection

    PubMed Central

    Giacomet, Vania; Erba, Paola; Di Nello, Francesca; Coletto, Sonia; Viganò, Alessandra; Zuccotti, GianVincenzo

    2013-01-01

    In human immunodeficiency virus (HIV)-infected people kidney disease is as an important cause of morbidity and mortality. Clinical features of kidney damage in HIV-infected patients range from asymptomatic microalbuminuria to nephrotic syndrome. The lack of specific clinical features despite the presence of heavy proteinuria may mask the renal involvement. Indeed, it is important in HIV patients to monitor renal function to early discover a possible kidney injury. After the introduction of antiretroviral therapy, mortality and morbidity associated to HIV-infection have shown a substantial reduction, although a variety of side effects for long-term use of highly active antiretroviral therapy, including renal toxicity, has emerged. Among more than 20 currently available antiretroviral agents, many of them can occasionally cause reversible or irreversible nephrotoxicity. At now, three antiretroviral agents, i.e., indinavir, atazanavir and tenofovir disoproxil fumarate have a well established association with direct nephrotoxicity. This review focuses on major causes of proteinuria and other pathological findings related to kidney disease in HIV-infected children and adolescents. PMID:24303454

  10. Proteinuria in paediatric patients with human immunodeficiency virus infection.

    PubMed

    Giacomet, Vania; Erba, Paola; Di Nello, Francesca; Coletto, Sonia; Viganò, Alessandra; Zuccotti, Gianvincenzo

    2013-04-16

    In human immunodeficiency virus (HIV)-infected people kidney disease is as an important cause of morbidity and mortality. Clinical features of kidney damage in HIV-infected patients range from asymptomatic microalbuminuria to nephrotic syndrome. The lack of specific clinical features despite the presence of heavy proteinuria may mask the renal involvement. Indeed, it is important in HIV patients to monitor renal function to early discover a possible kidney injury. After the introduction of antiretroviral therapy, mortality and morbidity associated to HIV-infection have shown a substantial reduction, although a variety of side effects for long-term use of highly active antiretroviral therapy, including renal toxicity, has emerged. Among more than 20 currently available antiretroviral agents, many of them can occasionally cause reversible or irreversible nephrotoxicity. At now, three antiretroviral agents, i.e., indinavir, atazanavir and tenofovir disoproxil fumarate have a well established association with direct nephrotoxicity. This review focuses on major causes of proteinuria and other pathological findings related to kidney disease in HIV-infected children and adolescents.

  11. [Preoperative information for paediatric patients. The anaesthesiologist's point of view].

    PubMed

    Orliaguet, G

    2006-04-01

    Medical information is mandatory before any medical procedure, including pediatric anesthesia. Preoperative information covers many aspects, including medico-psychologic and judicial aspects. When the patient is a child, information must be delivered to the parents in priority. However, the French law has given a particular attention to the opinion of the child. In 70% of the cases, preoperative anxiety of the parents is more related to anesthesia than to the surgical procedure itself. We have to explain the most frequent adverse effects, as well as the more severe and well known complications to the parents, even though they are very infrequent. The only cases where preoperative information is not required are: emergency cases and refusal of the patient or the parents to be informed. While information is necessarily oral, it may be completed using a written document. The quality of the preoperative information directly influences the quality of the psychological preoperative preparation of the parents, and thereafter of the child. Preoperative preparation programs have been developed, but controversial results have been observed. The great majority of the studies on preoperative programs were performed in the USA, where the demand for preoperative information is very important. It is far from sure that the results of all these studies may be extrapolated to French parents, and French studies are needed.

  12. [Vitamin D deficiency and morbimortality in critically ill paediatric patients].

    PubMed

    García-Soler, Patricia; Morales-Martínez, Antonio; Rosa-Camacho, Vanessa; Lillo-Muñoz, Juan Antonio; Milano-Manso, Guillermo

    2017-08-01

    To determine the prevalence and risks factors of vitamin D deficiency, as well as its relationship with morbidity and mortality in a PICU. An observational prospective study in a tertiary children's University Hospital PICU conducted in two phases: i: cohorts study, and ii: prevalence study. The study included 340 critically ill children with ages comprising 6 months to 16 years old. Chronic kidney disease, known parathyroid disorders, and vitamin D supplementation. Total 25-hydroxyvitamin D [25(OH)D] was measured in the first 48hours of admission to a PICU. Parathormone, calcium, phosphate, blood gases, blood count, C-reactive protein, and procalcitonin were also analysed. A record was also made of demographic features, characteristics of the episode, and complications during the PICU stay. The overall prevalence rate of vitamin D deficiency was 43.8%, with a mean of 22.28 (95% CI 21.15-23.41) ng/ml. Patients with vitamin D deficiency were older (61 vs 47 months, P=.039), had parents with a higher level of academic studies (36.5% vs 20%, P=.016), were admitted more often in winter and spring, had a higher PRISM-III (6.8 vs 5.1, P=.037), a longer PICU stay (3 vs 2 days, P=.001), and higher morbidity (61.1% vs 30.4%, P<001) than the patients with sufficient levels of 25(OH)D. Patients who died had lower levels of 25(OH)D (14±8.81ng/ml versus 22.53±10.53ng/ml, P=.012). Adjusted OR for morbidity was 5.44 (95%CI; 2.5-11.6). Vitamin D deficiency is frequent in critically ill children, and it is related to both morbidity and mortality, although it remains unclear whether it is a causal relationship or it is simply a marker of severity in different clinical situations. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. [Parental anxiety increases pre-operative anxiety in the paediatric patient subjected to day surgery].

    PubMed

    Rangel Ávila, F; Haro Haro, J M; García Méndez, N

    2012-02-01

    To evaluate the pre-operative anxiety associated with parental anxiety in children subjected to day surgery, by studying the parent-child behaviour and interaction in the surgical environment. A prospective, observational and cross-sectional study was conducted on 98 paediatric patients, between 2 and 10 years-old, scheduled for elective day surgery with general anaesthesia. The modified YALE Pre-operative Anxiety Scale was applied, and the parents were independently evaluated using the Hamilton Anxiety Test. Pre-operative anxiety was present in 71.4% of the patients. Children between 5 and 7 years had a significantly higher risk of presenting with anxiety (P=.05). In the parents group, 55.2% showed mild anxiety, and 9.2% moderate. The mother was the family member who most often accompanied the paediatric patient. The anxiety in children subjected to surgery is characterised by subjective feelings of tension, fear, nervousness, and worry that could be expressed in diverse forms. The evaluation of anxiety in the pre-operative period is an excellent tool to start and to perform both psychological and pharmacological interventions. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  14. Prevalence of and Reasons for Patients Leaving Against Medical Advice from Paediatric Wards in Oman

    PubMed Central

    Al-Ghafri, Mohamed; Al-Bulushi, Abdullah; Al-Qasmi, Ahmed

    2016-01-01

    The objective of this study was to determine the prevalence of and reasons for patients leaving against medical advice (LAMA) in a paediatric setting in Oman. This retrospective study was carried out between January 2007 and December 2009 and assessed patients who left the paediatric wards at the Royal Hospital, Muscat, Oman, against medical advice. Of 11,482 regular discharges, there were 183 cases of LAMA (prevalence: 1.6%). Dissatisfaction with treatment and a desire to seek a second opinion were collectively the most cited reasons for LAMA according to data from the hospital’s electronic system (27.9%) and telephone conversations with patients’ parents (55.0%). No reasons for LAMA were documented in the hospital’s electronic system for 109 patients (59.6%). The low observed prevalence of LAMA suggests good medical practice at the Royal Hospital. This study indicates the need for thorough documentation of all LAMA cases to ensure the availability of high-quality data for healthcare workers involved in preventing LAMA. PMID:26909217

  15. Usefulness of ultrasound for selecting a correctly sized uncuffed tracheal tube for paediatric patients.

    PubMed

    Bae, J-Y; Byon, H-J; Han, S-S; Kim, H-S; Kim, J-T

    2011-11-01

    The purpose of this study was to assess whether ultrasonography is useful for determining uncuffed tracheal tube sizes for paediatric patients. The equation for selecting the correctly sized tracheal tube was developed using data on the subglottic diameter measured by ultrasonography and air leak test. The efficacy of the new equation was evaluated by comparing it with the conventional age-based formula (4 + age/4) in another 100 patients. Tracheal tube sizes were selected using two methods, and air leakage pressure was measured after each intubation. The ultrasonographic method allowed the correct tube size to be selected in 60% of cases, whereas the age-based method enabled this in 31% of cases (p < 0.001). Ultrasound can offer a useful means of selecting correct tracheal tube size compared with the age-based formula in paediatric patients. However, even using ultrasound, the success rate of correct tube size selection is still not very high. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

  16. Burns ITU admissions: length of stay in specific levels of care for adult and paediatric patients.

    PubMed

    Maan, Zeshaan N; Frew, Quentin; Din, Asmat H; Unluer, Zeynep; Smailes, Sarah; Philp, Bruce; El-Muttardi, Naguib; Dziewulski, Peter

    2014-12-01

    Prediction of total length of stay (LOS) for burns patients based on the total burn surface area (TBSA) is well accepted. Total LOS is a poor measure of resource consumption. Our aim was to determine the LOS in specific levels of care to better inform resource allocation. We performed a retrospective review of LOS in intensive treatment unit (ITU), burns high dependency unit (HDU) and burns low dependency unit (LDU) for all patients requiring ITU admission in a regional burns service from 2003 to 2011. During this period, our unit has admitted 1312 paediatric and 1445 adult patients to our Burns ITU. In both groups, ITU comprised 20% of the total LOS (mean 0.23±0.02 [adult] and 0.22±0.02 [paediatric] days per %burn). In adults, 33% of LOS was in HDU (0.52±0.06 days per %burn) and 48% (0.68±0.06 days per %burn) in LDU, while in children, 15% of LOS was in HDU (0.19±0.03 days per %burn) and 65% in LDU (0.70±0.06 days per %burn). When considering Burns ITU admissions, resource allocation ought to be planned according to expected LOS in specific levels of care rather than total LOS. The largest proportion of stay is in low dependency, likely due to social issues.

  17. Value of protein concentration in cerebrospinal fluid in paediatric patients with Guillain-Barre syndrome.

    PubMed

    Vidrio-Becerra, Martha Esther; Valle-Leal, Jaime; Loaiza-Sarabia, María Enriqueta; Alvarez-Bastidas, Lucia; Lachica-Valle, Jesus Ignacio; López-Morales, Cruz Mónica

    2017-09-01

    The albumin-cytologic dissociation in cerebrospinal fluid (CSF) supports the diagnosis of Guillain-Barre syndrome (GBS) but does not support the prognosis, so the aim of this study is to determine the usefulness of protein numbers in the CSF to predict progression in paediatric patients. A diagnostic test was performed in paediatric patients with GBS, analysing sociodemographic, clinical and protein variables in CSF as well as electromyography. The presence of dysautonomia was also documented. Data were analysed from 23 patients, predominantly males (87%), school age (43.5%) and history of digestive infection (73.9%). Using the ROC curve, an area under the curve of 0.966 with best CSF protein cut-off point of 87-92 proteins/mm was found for the presence of dysautonomias and to evaluate the poor response to treatment with 0.969 intravenous immunoglobulin with better cut-off point in 157 proteins/mm. The amount of proteins in the CSF can be used as a prognostic indicator and severity, such that proteins greater than 100 in CSF translate into a torpid evolution and with greater complications. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  18. Peri-operative management of high-risk paediatric adenotonsillectomy patients: A survey of 35 UK tertiary referral centres.

    PubMed

    Cheong, Ryan Chin Taw; Bowles, Philippe; Moore, Andrew; Watts, Simon

    2017-05-01

    Peri-operative management of high-risk paediatric patients undergoing adenotonsillectomy for treatment of obstructive sleep apnoea varies between tertiary referral hospitals. 'Day of surgery cancellation' (DoSC) rates of up to 11% have been reported due to pre-booked critical care being unavailable on the day of surgery as a result of competing needs from other hospital departments. We report the results of a survey of peri-operative management in UK tertiary care centres of high-risk paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea (OSA). An 8-point questionnaire was developed using a cloud-based software platform (www.surveymonkey.com). A web-link to the survey was embedded in a customised e-mail which was sent via secure server to the Clinical Leads for Paediatric Otolaryngology at 35 United Kingdom (UK) Tertiary referral centres. The survey response rate was 60% (n = 21). Almost all (94.1%) of centres considered paediatric critical care facilities to be limited, with 70.6% (n = 12) stating that DoSC often occurred due to unavailable paediatric critical care capacity. There was variation between tertiary referral units in the practice applied for pre-booking critical care beds (our survey identifies 6 variations) (Table 1). The most frequent selection method reported (47.1%) was at the discretion of the booking clinician at the time of listing the patient for surgery. In the context of limited critical care resources, variation in practice and difficulty in accurately predicting which patients will require post-operative critical care beds, a review and consensus on best practice in the peri-operative management of high risk paediatric adenotonsillectomy patients may offer a safe means of reducing cancellations and improving patient care, resource allocation and hospital efficiency. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Hepatotoxicity caused by montelukast in a paediatric patient

    PubMed Central

    Bobrus-Chociej, Anna; Kłusek, Monika; Uscinowicz, Miroslawa; Lotowska, Joanna; Sobaniec-Lotowska, Maria; Kaczmarski, Maciej

    2014-01-01

    Montelukast is a selective and competitive cysteinyl leukotriene receptor antagonist (CystLTRA) which is increasingly used for the treatment of allergic asthma. Recently, hepatotoxicity has been reported with this drug in adult patients, but only one letter to the editor has reported a case of probable montelukast-induced hepatotoxicity in a child. We present a case of a 3.5-year-old boy, receiving treatment with montelukast, who developed hepatocellular injury. The exclusion of other causes of increased activity of aminotransferases (viral, metabolic, autoimmune), improvement after dechallenge, the morphological findings and previous reports of comparable cases support the diagnosis of montelukast-induced liver injury in this boy. Physicians should strictly analyse indications for this drug and be aware of potential drug-induced liver disease caused by this agent. Therefore, the periodical assessment of aminotransferases should be recommended during treatment with this leukotriene modifier. PMID:25061494

  20. Hepatotoxicity caused by montelukast in a paediatric patient.

    PubMed

    Lebensztejn, Dariusz M; Bobrus-Chociej, Anna; Kłusek, Monika; Uscinowicz, Miroslawa; Lotowska, Joanna; Sobaniec-Lotowska, Maria; Kaczmarski, Maciej

    2014-01-01

    Montelukast is a selective and competitive cysteinyl leukotriene receptor antagonist (CystLTRA) which is increasingly used for the treatment of allergic asthma. Recently, hepatotoxicity has been reported with this drug in adult patients, but only one letter to the editor has reported a case of probable montelukast-induced hepatotoxicity in a child. We present a case of a 3.5-year-old boy, receiving treatment with montelukast, who developed hepatocellular injury. The exclusion of other causes of increased activity of aminotransferases (viral, metabolic, autoimmune), improvement after dechallenge, the morphological findings and previous reports of comparable cases support the diagnosis of montelukast-induced liver injury in this boy. Physicians should strictly analyse indications for this drug and be aware of potential drug-induced liver disease caused by this agent. Therefore, the periodical assessment of aminotransferases should be recommended during treatment with this leukotriene modifier.

  1. An elusive cause of hypoxaemia in a paediatric patient

    PubMed Central

    Bola, Sundeep Singh; Narang, Indra

    2014-01-01

    Summary A 5-year-old girl presented to an ambulatory cardiology clinic with shortness of breath, described by the patient's mother and chest discomfort on exertion. At this visit, she was noted to have low baseline room air oxygen saturations of 89%. Subsequent cardiac, respiratory and haematological investigations including contrast echocardiography, CT scan of the chest, polysomnography and haemoglobin electrophoresis were unhelpful in yielding a diagnosis. A CT scan of the chest with contrast was performed which revealed a persistent left-sided superior vena cava that appeared to be draining into the left atrium, creating a right-to-left shunt. This was not revealed on contrast echocardiography as contrast (micro bubbles) had been injected into the right arm. This case report highlights the nuances of diagnostic investigations, which without a high index of suspicion may exclude a timely diagnosis and therapeutic intervention. PMID:24859546

  2. Flexor digitorum accessorius causing tarsal tunnel syndrome in a paediatric patient: A case report and review of the literature.

    PubMed

    Molloy, A P; Lyons, R; Bergin, D; Kearns, S R

    2015-06-01

    The flexor digitorium accessorius muscle is an unusual anatomical variant found in the posteromedial aspect of the hindfoot and ankle. As previously described, its location predisposes patients to developing tarsal tunnel syndrome. This case illustrates the diagnosis, treatment and resolution of tarsal tunnel syndrome in a paediatric patient, secondary to the presence of flexor digitorium accessorius muscle.

  3. Transition from paediatric care to adult care for patients with mucopolysaccharidosis.

    PubMed

    Couce, M L; Del Toro, M; García-Jiménez, M C; Gutierrez-Solana, L; Hermida-Ameijeiras, Á; López-Rodríguez, M; Pérez-López, J; Torralba, M Á

    2017-07-18

    Mucopolysaccharidosis are multisystem diseases that require large multidisciplinary teams for their care. Specific recommendations are therefore needed for the transition from childhood to adulthood in this patient group. To overcome the barriers that might arise during the transition, the authors consider it essential to implement a flexible plan with a coordinator for the entire process, systematising the information through a standardised paediatric discharge report and educating the patient and their family about the disease, showing the characteristics of the healthcare system in this new stage. The final objective is that, once the transition to adulthood has been completed, the patient's autonomy and potential development are maximised and that the patient receives appropriate healthcare during this transition. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. Oral Health Status of Chinese Paediatric and Adolescent Oncology Patients with Chemotherapy in Hong Kong: a Pilot Study

    PubMed Central

    Kung, A.Y.H; Zhang, S; Zheng, L.W; Wong, G.H.M; Chu, C.H

    2015-01-01

    Aim: To study the oral health status of Chinese children and adolescents undergoing chemotherapy in Hong Kong. Method: All Chinese children and adolescent oncology patients aged 18 or below attending the Children's Centre for Cancer and Blood Disease at a hospital for chemotherapy were invited and parental consent was sought before they were accepted into the study. The study comprised of 1) a parental questionnaire, 2) the collection of medical history and 3) a clinical examination for tooth decay (caries) and mucosal status. Results: A total of 69 patients were invited, and they all participated in this study. Their mean age was 9.2±5.0 and 44 (64%) were males. Twenty-six patients (38%) had no caries experience (DMFT and/or dmft = 0). Higher caries experience was detected in participants that were not born in Hong Kong, had completed active chemotherapy, participated in school dental care service and whose parents had low educational levels. There were 41 patients with active chemotherapy, 24 of whom were diagnosed with acute leukaemia, 5 with haematological malignancies other than leukaemia and 11 with solid tumours. Antimetabolites, cytotoxic antibiotics, alkylating agents and plant alkaloids were administered in 49%, 32%, 24% and 22% of them, respectively. Twenty-six (63%) patients showed no mucosal complications. The most common oral complication was oral mucositis (24%) followed by petechiae (10%). Conclusion: About two-thirds of paediatric and adolescent cancer patients had caries experience, which was more common among those who had completed chemotherapy. Oral mucositis followed by petechiae were the two most common complications of receiving chemotherapy. PMID:25674168

  5. Assessment of the Absorbed Dose in the Kidney of Nuclear Nephrology Paediatric Patients using ICRP Biokinetic Data and Monte Carlo Simulations with Mass-Scaled Paediatric Voxel Phantoms.

    PubMed

    Teles, P; Mendes, M; Zankl, M; de Sousa, V; Santos, A I; Vaz, P

    2016-04-21

    The aim of this work is to use Monte Carlo simulations and VOXEL phantoms to estimate the absorbed dose in paediatric patients (aged from 2 weeks to 16 y), with normal renal function, to whom technetium-99m-dimercaptosuccinic acid ((99m)Tc-DMSA) was administered, for diagnostic renal scintigraphy purposes; and compare them with values obtained using the International Commission on Radiological Protection (ICRP) methodology. In the ICRP methodology, the cumulated absorbed dose in the kidneys is estimated by multiplying the administered activity with the corresponding given dose coefficients. The other methods were based on Monte Carlo simulations performed on two paediatric voxel phantoms ( ITALIC! CHILDand ITALIC! BABY), and another three phantoms, which were modified to suit the mass of the patients' kidneys, and other anatomical factors. Different ITALIC! S-values were estimated using this methodology, which together with solving the ICRP biokinetic model to determine the cumulated activities, allowed for the estimation of absorbed doses different from those obtained with the ICRP method, together with new dose coefficients. The obtained values were then compared. The deviations suggest that the ITALIC! S-values are strongly dependent on the patient's total body weight, which could be in contrast with the ICRP data, which is provided by age, regardless of other anatomical parameters.

  6. Audiovisual interventions to reduce the use of general anaesthesia with paediatric patients during radiation therapy.

    PubMed

    Willis, D; Barry, P

    2010-06-01

    Clinical audiovisual interventions were implemented to avoid the use of general anaesthesia with children undergoing radiation therapy treatment. A retrospective audit and case study review was conducted to evaluate the utility of distraction interventions aimed at improving immobilisation and reducing separation anxiety for children aged between 2 and 6 years old who received radiation therapy. A simple, inexpensive audiovisual system was established using commercially available equipment. Paediatric patients could elect to (i) use a closed-circuit TV system that allowed them to see their carer(s); (ii) watch a DVD movie; or (iii) listen to carer(s) on a microphone during their treatment. Over a 2-year period (March 2007-May 2009), 37 paediatric patients aged 2-6 years received radiation therapy at the centre. Twenty-four children participated in audiovisual interventions, and 92% (n = 22) of these children did not require the use of general anaesthesia for some or all of their treatment. Case study review illustrates the utility and limitations of the system. The audit and case studies suggest that the audiovisual interventions provided supportive care and reduced the need to anaesthetise children undergoing radiation therapy treatment.

  7. Clinical coding of prospectively identified paediatric adverse drug reactions--a retrospective review of patient records.

    PubMed

    Bellis, Jennifer R; Kirkham, Jamie J; Nunn, Anthony J; Pirmohamed, Munir

    2014-12-17

    National Health Service (NHS) hospitals in the UK use a system of coding for patient episodes. The coding system used is the International Classification of Disease (ICD-10). There are ICD-10 codes which may be associated with adverse drug reactions (ADRs) and there is a possibility of using these codes for ADR surveillance. This study aimed to determine whether ADRs prospectively identified in children admitted to a paediatric hospital were coded appropriately using ICD-10. The electronic admission abstract for each patient with at least one ADR was reviewed. A record was made of whether the ADR(s) had been coded using ICD-10. Of 241 ADRs, 76 (31.5%) were coded using at least one ICD-10 ADR code. Of the oncology ADRs, 70/115 (61%) were coded using an ICD-10 ADR code compared with 6/126 (4.8%) non-oncology ADRs (difference in proportions 56%, 95% CI 46.2% to 65.8%; p < 0.001). The majority of ADRs detected in a prospective study at a paediatric centre would not have been identified if the study had relied on ICD-10 codes as a single means of detection. Data derived from administrative healthcare databases are not reliable for identifying ADRs by themselves, but may complement other methods of detection.

  8. Safety and efficacy of tranexamic acid in bleeding paediatric trauma patients: a systematic review protocol

    PubMed Central

    Urban, Denisa; Dehaeck, Ruben; Lorenzetti, Diane; Guilfoyle, Jonathan; Poon, Man-Chiu; Steele, MacGregor; Lardner, David; Ma, Irene Wai Yan; Brindle, Mary Elizabeth

    2016-01-01

    Introduction Trauma is the leading cause of death among children aged 1–18. Studies indicate that better control of bleeding could potentially prevent 10–20% of trauma-related deaths. The antifibrinolytic agent tranexamic acid (TxA) has shown promise in haemorrhage control in adult trauma patients. However, information on the potential benefits of TxA in children remains sparse. This review proposes to evaluate the current uses, benefits and adverse effects of TxA in the bleeding paediatric trauma population. Methods and analysis A structured search of bibliographic databases (eg, MEDLINE, EMBASE, PubMed, CINAHL, Cochrane CENTRAL) has been undertaken to retrieve randomised controlled trials and cohort studies that describe the use of TxA in paediatric trauma patients. To ensure that all relevant data were captured, the search did not contain any restrictions on language or publication time. After deduplication, citations will be screened independently by 2 authors, and selected for inclusion based on prespecified criteria. Data extraction and risk of bias assessment will be performed independently and in duplicate. Meta-analytic methods will be employed wherever appropriate. Ethics and dissemination This study will not involve primary data collection, and formal ethical approval will therefore not be required. The findings of this study will be disseminated through a peer-reviewed publication and at relevant conference meetings. Trial registration number CRD42016038023. PMID:27660323

  9. [Increased lipoprotein(a) in a paediatric patient associated with nephrotic syndrome].

    PubMed

    Menéndez Valladares, Paloma; Arrobas Velilla, Teresa; Bermúdez de la Vega, José Antonio; Romero Pérez, María Del Mar; Fabiani Romero, Fernando; González Rodríguez, Concepción

    A common complication in paediatric patients with nephrotic syndrome (NS) is hyperlipidaemia. About 20% of children do not respond to treatment with corticosteroids, presenting with a cortico-resistant NS (CRNS), which can progress to kidney failure. It has been observed that paediatric patients with CRNS have an elevated low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), and triglycerides levels, as well as elevated Lipoprotein-a [Lp (a)] levels. The case is presented of a 5 year old boy, diagnosed with CRNS, presenting with dyslipidaemia with increased LDL-c, Apo-B100, and Lp(a) levels. After the poor prognosis of the renal function, immunosuppressant treatment was started with tacrolimus and atorvastatin to control dyslipidaemia. Although tacrolimus causes an elevation of total cholesterol and LDL-c, the significant alterations of the children lipid profile suggest the existence of a high cardiovascular risk. In these cases, it would be interesting to have reference values in children in our health area. Copyright © 2016 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Risk factors for morphoea disease severity: a retrospective review of 114 paediatric patients.

    PubMed

    Pequet, M S; Holland, K E; Zhao, S; Drolet, B A; Galbraith, S S; Siegel, D H; Chiu, Y E

    2014-04-01

    Morphoea is a rare fibrosing disease of the skin and subcutaneous tissue with an unpredictable disease course, running the spectrum from mild skin involvement to severe disfigurement or extracutaneous complications. Our objective was to describe the natural history of paediatric morphoea and determine patient variables that were associated with severe disease. We conducted a retrospective chart review of patients with morphoea seen in one paediatric hospital system. Information about demographics, clinical characteristics, disease course and treatment were collected. Statistical analysis was performed using appropriate univariate tests and a multivariable model. One hundred and fourteen patients met study inclusion criteria. The female : male ratio was 2·6 : 1, and the median age of onset was 7 years old. There were 55 patients (48%) with linear morphoea, 38 patients (33%) with circumscribed morphoea, 12 patients (11%) with generalized morphoea, and nine patients (8%) with mixed morphoea. Neurological symptoms and joint involvement were present in 27 subjects (24%). Extracutaneous manifestations occurred in 38% of subjects with linear morphoea, compared with 15% with generalized morphoea and 3% with circumscribed morphoea (P = 0·0001). Thirty-six per cent of children with disease onset prior to 10 years of age and 5% of children with disease onset after 10 years of age had extracutaneous manifestations (P = 0·0002). Both linear morphoea and early-onset disease were significantly associated with extracutaneous involvement in a multivariable model. Children with linear morphoea and disease onset before 10 years of age should be monitored closely for extracutaneous manifestations and need early treatment with systemic medications to prevent disease complications. © 2013 British Association of Dermatologists.

  11. Radiation doses to paediatric patients and comforters undergoing chest X rays.

    PubMed

    Sulieman, A; Vlychou, M; Tsougos, I; Theodorou, K

    2011-09-01

    Pneumonia is an important cause of hospital admission among children in the developed world and it is estimated to be responsible for 3-18 % of all paediatric admissions. Chest X ray is an important examination for pneumonia diagnosis and for evaluation of complications. This study aims to determine the entrance surface dose (ESD), organ, effective doses and propose a local diagnostic reference level. The study was carried out at the university hospital of Larissa, Greece. Patients were divided into three groups: organ and effective doses were estimated using National Radiological Protection Board software. The ESD was determined by thermoluminescent dosemeters for 132 children and 76 comforters. The average ESD value was 55 ± 8 µGy. The effective dose for patients was 11.2 ± 5 µSv. The mean radiation dose for comforter is 22 ± 3 µGy. The radiation dose to the patients is well within dose constraint, in the light of the current practice.

  12. Inadvertently boarding a pirate ship: disease progression in a paediatric patient with relapsed metastatic Ewing sarcoma receiving treatment at a centre for alternative therapy in Mexico.

    PubMed

    Cheng, Jessica H; Chiang, Leslie Y; Kuo, Dennis John

    2017-01-06

    Complementary and alternative medicine (CAM) therapies are commonly incorporated into the care of patients with paediatric cancer. Many modalities are safe and effective during cancer treatment and have proved beneficial for symptom relief and quality of life. However, situations where alternative therapy is provided without allopathic medical care supportive care resources can pose a safety risk to patients. This report describes the case of a 16-year-old Chinese girl with metastatic Ewing sarcoma who sought treatment with alternative treatment in Mexico. When her disease progressed with an ensuing significant loss of function, the centre personnel were unable to respond to her acute deterioration or provide necessary medical care. This resulted in her being stranded in a foreign country paralysed, isolated, and with large unanticipated financial expenditures. 2017 BMJ Publishing Group Ltd.

  13. [NASO-OROGASTRIC TUBE IN PAEDIATRIC PATIENTS. REVIEW OF METHODS OF CONFIRMATION OF PLACEMENT].

    PubMed

    Guerrero-Márquez, Gloria; Martínez-Serrano, Ana; Míguez-Navarro, Concepción

    2014-09-01

    Nasogastric tube (NGT) placement is a frequent procedure in the paediatric population. Nasogastric and orogastric tubes are commonly used in hospitalized children, in the paediatric emergency departments and in critical care departments. They have diagnostic, therapeutic, descompression or evacuation of gastric aspirates objectives. Making a blind placement of nasogastric tubes, involve that nasogastric tube could be misplaced in 4.7 % to 69 % of cases. An accurate method for confirmation of nasogastric tube positioning is therefore needed. Chest X-ray remains the only hundred per cent reliable method (gold standard), but it only confirms tube positioning at the exact time of the X-ray. Non-radiologic verification methods provide an accurate alternative and contribute to decrease radiation exposure for pediatric patients. Non-radiologic methods to verify appropiate placement of tubes are many and are supported by different degrees of evidence in the literature: measurement of tube length from point of entry; auscultation; placing the tube in water to assess bubbling; aspiration of stomach or intestinal contents for visual inspection; pH testing; use of CO2 monitoring devices, or combinations of these methods. In this article we thoroughly review the reliability and safety of these non radiologic methods for the verification of nasogastric tube placement.

  14. Outcome of Corneal Collagen Crosslinking for Progressive Keratoconus in Paediatric Patients

    PubMed Central

    Kumar, Nikhil L.; Males, John J.

    2014-01-01

    Purpose. To evaluate the efficacy of corneal collagen crosslinking for progressive keratoconus in paediatric patients. Methods. This prospective study included 25 eyes of 18 patients (aged 18 years or younger) who underwent collagen crosslinking performed using riboflavin and ultraviolet-A irradiation (370 nm, 3 mW/cm2, 30 min). Results. The mean patient age was 14.3 ± 2.4 years (range 8–17) and mean followup duration was 20.1 ± 14.25 months (range 6–48). Crosslinked eyes demonstrated a significant reduction of keratometry values. The mean baseline simulated keratometry values were 46.34 dioptres (D) in the flattest meridian and 50.06 D in the steepest meridian. At 20 months after crosslinking, the values were 45.67 D (P = 0.03) and 49.34 D (P = 0.005), respectively. The best spectacle corrected visual acuity (BSCVA) and topometric astigmatism improved after crosslinking. Mean logarithm of the minimum angle of resolution (logMAR) BSCVA decreased from 0.24 to 0.21 (P = 0.89) and topometric astigmatism reduced from mean 3.50 D to 3.25 D (P = 0.51). Conclusions. Collagen crosslinking using riboflavin and ultraviolet-A is an effective treatment option for progressive keratoconus in paediatric patients. Crosslinking stabilises the condition and, thus, reduces the need for corneal grafting in these young patients. PMID:25013757

  15. [The association between thenar eminence and I-gel™ dimensions in paediatric patients].

    PubMed

    Cuvas Apan, Ozgun; Apan, Alparslan

    2016-01-01

    A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. The mean (SD) values for (Ig-w) and (Ig-l) were 2.98cm (0.53) and 4.54cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99cm (0.60) and 3.88cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r=0.794, p<0.001), and between Th-l and Ig-l (r=0.820, p<0.001). The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  16. Information Seeking Behaviour of Parents of Paediatric Patients for Clinical Decision Making: The Central Role of Information Literacy in a Participatory Setting

    ERIC Educational Resources Information Center

    Kostagiolas, Petros; Martzoukou, Konstantina; Georgantzi, Georgia; Niakas, Dimitris

    2013-01-01

    Introduction: This study investigated the information seeking behaviour and needs of parents of paediatric patients and their motives for seeking Internet-based information. Method: A questionnaire survey of 121 parents was conducted in a paediatric clinic of a Greek university hospital. Analysis: The data were analysed using SPSS; descriptive…

  17. Experience with biosimilar infliximab (CT-P13) in paediatric patients with inflammatory bowel diseases.

    PubMed

    Sieczkowska, Joanna; Jarzębicka, Dorota; Meglicka, Monika; Oracz, Grzegorz; Kierkus, Jaroslaw

    2016-09-01

    Infliximab was the first monoclonal antibody used in the treatment of inflammatory bowel disease (IBD). Over several years, this antitumour necrosis factor (TNF) treatment proved its efficacy in both induction and maintenance therapy. In many cases this biological treatment stopped the progression of the disease, probably also decreasing morbidity and hospitalization rates, and improving patients' comfort. When the patent on infliximab started to expire, the first biosimilar of a monoclonal antibody was introduced onto the pharmacological market. Biosimilar infliximab was studied in rheumatology and proved a high similarity to the reference drug. Based on extrapolation, biosimilars were approved to treat adult and paediatric IBD patients. Biosimilar infliximab, mainly because of its lower cost, has started to be in common use in Europe. The first studies have shown a similar efficacy and safety profile in comparison with reference drug. Biosimilar infliximab is raising hopes for improving the availability of this effective treatment.

  18. Trismus in the paediatric population.

    PubMed

    Shires, Peter M; Chow, Gabriel

    2015-04-01

    Trismus is a rare presentation affecting neonates, children, and adults. In newborns there are serious implications, with potential to affect feeding, cause airway problems, and make intubation difficult. Causes of trismus seen in the paediatric patient are discussed in this review article; they are divided into intra- and extra-articular types. The extra-articular group consists of congenital and acquired disorders. The acquired group includes infective causes such as tetanus, iatrogenic causes related to drugs, cancer or dental treatment, and trauma causing articulation difficulty or triggering a rare type of bone growth in myositis ossificans. Changes in the mouth resulting from oral submucous fibrosis can undergo malignant transformation. This review aims to raise awareness of potential causes of trismus in paediatric populations, helping clinicians identify the underlying pathology so appropriate strategies for treatment be applied, with the ultimate aim of improving long-term outlook and quality of life for affected children. © 2014 Mac Keith Press.

  19. [Celiac block in paediatric patients using endoscopic ultrasound for management of severe pain due to chronic pancreatitis. Review of the technique in 2 cases].

    PubMed

    Membrillo-Romero, Alejandro; Rascón-Martínez, Dulce María

    Pancreatic diseases such as cancer, idiopathic recurrent pancreatitis, and chronic pancreatitis, can cause pain that is difficult to control. Pain is one of the most debilitating symptoms and demands increasing doses of analgesics and narcotics, as well as the number of hospital admissions, with a direct implication in the costs of medical treatments. To describe the experience with 2 paediatric patients who were subjected to an ultrasound-guided endoscopic celiac ganglion block for difficult pain management, secondary to chronic pancreatitis disease. The first case concerns a 9-year-old male with a diagnosis of chronic pancreatitis, and the second case is a 12-year-old female who developed episodes of intermittent acute pancreatitis. Both cases suffered from chronic abdominal pain, which was difficult to control with stronger painkillers, such as opioids. The pain decreased after patients were subjected to an ultrasound-guided endoscopic celiac ganglion block. This technique showed that both patients obtained satisfactory pain relief, with significant improvements in general symptomatology and the stopping of almost all analgesic medication. The authors suggest that celiac ganglion block must be considered, and implemented early before the usual complications, such as a consumption syndrome that is frequent in paediatric patients with chronic pancreatitis. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  20. Corneal collagen cross-linking in paediatric patients affected by keratoconus.

    PubMed

    Knutsson, Karl Anders; Paganoni, Giorgio; Matuska, Stanislav; Ambrosio, Oriella; Ferrari, Giulio; Zennato, Arianna; Caccia, Michela; Rama, Paolo

    2017-06-27

    To evaluate the effectiveness of corneal collagen cross-linking (CXL) in paediatric patients. Fifty-two eyes of 43 paediatric patients with progressive keratoconus were enrolled in a prospective cohort study. Corneal CXL was performed using a conventional technique with instillation of 0.1% riboflavin solution containing dextran 20% for 30 min during the soaking phase and during the 30 min ultraviolet A irradiation (3 mW/cm(2)). Visual outcomes, topographic keratometry, maximum keratometry (K-max), refractive astigmatism, demarcation line and endothelial cell density were measured postoperatively. A significant decrease of K-max from 59.30±7.08 to 57.07±6.46 (p<0.001) was observed 2 years after treatment. Uncorrected visual acuity improved from 0.59±0.41 LogMAR (logarithm of the minimum angle resolution) to 0.46±0.33 LogMAR (p=0.06) 2 years after the procedure, while best spectacle corrected visual acuity improved from 0.17±0.11 LogMAR to 0.15±0.12 LogMAR (p=0.17). Twenty-five eyes had K-max values of 60 dioptres (D) or greater. In this subgroup, K-max significantly decreased from 64.94±4.99 D to 62.25±4.42 D at 2 years (p<0.001). The demarcation line of the CXL treatment had a mean value of 249±74 µm and did not show a significant correlation with K-max flattening (Spearman r=0.019, p=0.899). Endothelial cell density remained stable 2 years after the procedure, changing from 2800±363 to 2736±659 cells/mm(2) (p=0.90). CXL is an effective treatment for avoiding keratoconus progression in paediatric patients. The procedure is safe and successful in stabilising keratoconus in eyes with more advanced forms of the disease, characterised by topographic K-max values greater than 60 D. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Social paediatrics.

    PubMed

    Spencer, Nick; Colomer, Concha; Alperstein, Garth; Bouvier, Paul; Colomer, Julia; Duperrex, Olivier; Gokcay, Gulbin; Julien, Gilles; Kohler, Lennart; Lindström, Bengt; Macfarlane, Aidan; Mercer, Raul; Panagiotopoulos, Takis; Schulpen, Tom

    2005-02-01

    Social paediatrics is an approach to child health that focuses on the child, in illness and in health, within the context of their society, environment, school, and family. The glossary clarifies the range of terms used to describe aspects of paediatric practice that overlap or are subsumed under social paediatrics and defines key social paediatric concepts. The glossary was compiled by a process of consultation and consensus building among the authors who are all members of the European Society for Social Paediatrics. Social paediatricians from outside Europe were included giving a more international perspective.

  2. Social paediatrics

    PubMed Central

    Spencer, N.; Colomer, C.; Alperstein, G.; Bouvier, P.; Colomer, J.; Duperrex, O.; Gokcay, G.; Julien, G.; Kohler, L.; Lindstrom, B.; Macfarlane, A.; Mercer, R.; Panagiotopoulos, T.; Schulpen, T.; on, b

    2005-01-01

    Social paediatrics is an approach to child health that focuses on the child, in illness and in health, within the context of their society, environment, school, and family. The glossary clarifies the range of terms used to describe aspects of paediatric practice that overlap or are subsumed under social paediatrics and defines key social paediatric concepts. The glossary was compiled by a process of consultation and consensus building among the authors who are all members of the European Society for Social Paediatrics. Social paediatricians from outside Europe were included giving a more international perspective. PMID:15650140

  3. Effectiveness and Comparison of Various Audio Distraction Aids in Management of Anxious Dental Paediatric Patients.

    PubMed

    Navit, Saumya; Johri, Nikita; Khan, Suleman Abbas; Singh, Rahul Kumar; Chadha, Dheera; Navit, Pragati; Sharma, Anshul; Bahuguna, Rachana

    2015-12-01

    Dental anxiety is a widespread phenomenon and a concern for paediatric dentistry. The inability of children to deal with threatening dental stimuli often manifests as behaviour management problems. Nowadays, the use of non-aversive behaviour management techniques is more advocated, which are more acceptable to parents, patients and practitioners. Therefore, this present study was conducted to find out which audio aid was the most effective in the managing anxious children. The aim of the present study was to compare the efficacy of audio-distraction aids in reducing the anxiety of paediatric patients while undergoing various stressful and invasive dental procedures. The objectives were to ascertain whether audio distraction is an effective means of anxiety management and which type of audio aid is the most effective. A total number of 150 children, aged between 6 to 12 years, randomly selected amongst the patients who came for their first dental check-up, were placed in five groups of 30 each. These groups were the control group, the instrumental music group, the musical nursery rhymes group, the movie songs group and the audio stories group. The control group was treated under normal set-up & audio group listened to various audio presentations during treatment. Each child had four visits. In each visit, after the procedures was completed, the anxiety levels of the children were measured by the Venham's Picture Test (VPT), Venham's Clinical Rating Scale (VCRS) and pulse rate measurement with the help of pulse oximeter. A significant difference was seen between all the groups for the mean pulse rate, with an increase in subsequent visit. However, no significant difference was seen in the VPT & VCRS scores between all the groups. Audio aids in general reduced anxiety in comparison to the control group, and the most significant reduction in anxiety level was observed in the audio stories group. The conclusion derived from the present study was that audio distraction

  4. Population pharmacokinetics of ganciclovir following administration of valganciclovir in paediatric renal transplant patients.

    PubMed

    Zhao, Wei; Baudouin, Véronique; Zhang, Daolun; Deschênes, Georges; Le Guellec, Chantal; Jacqz-Aigrain, Evelyne

    2009-01-01

    To develop a population pharmacokinetic model for valganciclovir in paediatric renal transplant recipients, identify covariates that explain variability, and determine valganciclovir dosage regimens for cytomegalovirus (CMV) prophylaxis in children. The pharmacokinetics of valganciclovir were described with plasma concentrations from 22 patients (age range 3-17 years) using nonlinear mixed-effects modelling (NONMEM) software. A two-compartment model with lag-time and first-order absorption and elimination was developed. The final model was validated using a bootstrap and visual predictive check. The dosage regimens of valganciclovir for CMV prophylaxis in children were simulated using the final model. The mean population pharmacokinetic parameters were apparent systemic clearance (CL) 10.1L/h, apparent central volume of distribution 5.2 L, apparent peripheral volume of distribution 30.7 L, inter-tissue clearance 3.97 L/h, absorption rate constant 0.369 h-1 and lag-time 0.743 h. The covariate analysis identified creatinine clearance (CL(CR)) and bodyweight (WT) as individual factors influencing the apparent oral clearance: CL= 8.04 x (CL(CR)/89)(2.93) + 3.62 x (WT/28) L/h. The results of the simulation showed that for a typical patient (WT 28 kg and CL(CR) 89 mL/min), an area under the plasma concentration-time curve of 43 +/- 10.6 mg x h/mL will be achieved with valganciclovir 500 mg once daily. The dosage regimens of valganciclovir for CMV prophylaxis have been defined using the final population pharmacokinetic model based on WT and CLCR for paediatric renal transplantation patients.

  5. Impact of multidisciplinary simulation-based training on patient safety in a paediatric emergency department.

    PubMed

    Patterson, Mary D; Geis, Gary L; LeMaster, Thomas; Wears, Robert L

    2013-05-01

    Cincinnati Children's Hospital is one of the busiest paediatric emergency departments (ED) in the USA; high volume, high acuity and frequent interruptions contribute to an increased risk for error. To improve patient safety in a paediatric ED by implementing a multidisciplinary, simulation-based curriculum emphasising teamwork and communication. Subjects included all healthcare providers in the ED. Multidisciplinary teams participated in simulation-based training focused on teamwork and communication behaviours in critical clinical scenarios. The Safety Attitudes Questionnaire, tests of knowledge and evaluations of critical simulations and actual performance in the ED resuscitation bay were assessed. Methods to sustain improvements included mandatory participation of all new staff in simulation-based training and the introduction of routine in situ simulations. 289 participants attended the initial training. 151 participants attended the re-evaluation at a mean of 10.2 months later. Sustained improvements in knowledge and attitudes were demonstrated. Knowledge tests at baseline, postintervention and re-evaluation had scores of 86%, 96% and 93%, respectively. Friedman's test analysis of SAQ scores at baseline, postintervention and re-evaluation indicated significant attitude changes. The ED with a preintervention baseline of 2-3 patient safety events per year has now sustained more than 1000 days without a patient safety event. This improvement occurred even though the time required in initial simulation training has been condensed from 12 to 4 h. Simulation training is an effective tool to modify safety attitudes and teamwork behaviours in an ED. Sustaining cultural and behavioural changes requires repeated practice opportunities.

  6. Clinical Profile of Cardiac Arrhythmias in Children Attending the Out Patient Department of a Tertiary Paediatric Care Centre in Chennai.

    PubMed

    Premkumar, Sarala; Sundararajan, Premkumar; Sangaralingam, Thangavelu

    2016-12-01

    The presentation of symptoms of paediatric arrhythmias vary depending on the age and underlying heart disease. Physical examination of children with important arrhythmias may be entirely normal. Aim is to study the characteristics of cardiac arrhythmias in paediatric patients in a tertiary paediatric care centre in Chennai, India. The participants (n=60) were from birth to 12 years of age. Patients with sinus arrhythmias, sinus tachycardia and sinus bradycardia were excluded. Proportions of various parameters of interest like clinical features, age and sex distribution and underlying heart disease of children presenting with cardiac arrhythmias were arrived. Statistical analysis was performed using SPSS version 16.0. Ventricular ectopics were the most common type of arrhythmias observed in the present study followed by Sinus Node Dysfunction (SND). The most common type of SND was sino atrial arrest. Supra ventricular tachycardia was the most frequently sustained tachyarrhythmia in the present study. An increased association of WPW (Wolf Parkinson White Syndrome) with specific congenital cardiac defects was noted. Cardiac arrhythmias in children can present at anytime from fetal life to adolescence and their recognition requires high index of suspicion. While majority of children with arrhythmias have structurally normal heart, they are frequently encountered in children with underlying heart disease. Treatment of paediatric arrhythmias should be guided by the severity of the patient, the structure and function of the heart.

  7. Clinical Profile of Cardiac Arrhythmias in Children Attending the Out Patient Department of a Tertiary Paediatric Care Centre in Chennai

    PubMed Central

    Sundararajan, Premkumar; Sangaralingam, Thangavelu

    2016-01-01

    Introduction The presentation of symptoms of paediatric arrhythmias vary depending on the age and underlying heart disease. Physical examination of children with important arrhythmias may be entirely normal. Aim Aim is to study the characteristics of cardiac arrhythmias in paediatric patients in a tertiary paediatric care centre in Chennai, India. Materials and Methods The participants (n=60) were from birth to 12 years of age. Patients with sinus arrhythmias, sinus tachycardia and sinus bradycardia were excluded. Proportions of various parameters of interest like clinical features, age and sex distribution and underlying heart disease of children presenting with cardiac arrhythmias were arrived. Statistical analysis was performed using SPSS version 16.0. Results Ventricular ectopics were the most common type of arrhythmias observed in the present study followed by Sinus Node Dysfunction (SND). The most common type of SND was sino atrial arrest. Supra ventricular tachycardia was the most frequently sustained tachyarrhythmia in the present study. An increased association of WPW (Wolf Parkinson White Syndrome) with specific congenital cardiac defects was noted. Conclusion Cardiac arrhythmias in children can present at anytime from fetal life to adolescence and their recognition requires high index of suspicion. While majority of children with arrhythmias have structurally normal heart, they are frequently encountered in children with underlying heart disease. Treatment of paediatric arrhythmias should be guided by the severity of the patient, the structure and function of the heart. PMID:28208963

  8. Surgical treatment for paediatric patients with moyamoya disease by indirect revascularization procedures (EDAS, EMS, EMAS).

    PubMed

    Matsushima, T; Fujiwara, S; Nagata, S; Fujii, K; Fukui, M; Kitamura, K; Hasuo, K

    1989-01-01

    Surgical results of paediatric patients with Moyamoya disease who were treated by indirect revascularization procedures are reported. Encephalo-duro-arterio-synangiosis (EDAS), encephalomyo-arterio-synangiosis (EMAS), and/or encephalo-myo-synangiosis (EMS) were performed on 47 sides of 29 children with Moyamoya disease. The results of those non-anastomotic EC-IC bypass procedures were evaluated clinically, angiographically, and by computed tomography (CT). Postoperative external carotid angiograms showed a good collateral formation through EDAS, EMAS, or EMS in about 70-80 percent of all surgically treated sides. The symptoms such as TIA, RIND, and/or involuntary movements disappeared in the cases with a good collateral formation but not in those with insufficient development of the collateral circulation. The indirect EC-IC bypass surgery seems effective for most of the children with Moyamoya disease who present with ischaemic signs.

  9. Oral Manifestations of Job’s Syndrome in a Paediatric Dental Patient – A Case Report

    PubMed Central

    Thekkeveetil, Anupam Kumar; Vadakkepurayil, Kannan

    2016-01-01

    Job’s syndrome or Hyperimmunoglobulin E Syndrome (HIES) is a rare primary immunodeficiency with marked increase in serum immunoglobulin E (IgE) levels and eczematous dermatitis. Individuals with HIES share characteristic facial features, with many oral manifestations like retained deciduous teeth, fissured tongue, missing permanent tooth buds, recurrent oral candidiasis, oral mucosal and gingival lesions. Two forms of disease have been identified based on the defective gene as autosomal dominant form and autosomal recessive form. The therapeutic strategies are usually directed towards prevention and management of recurrent infections which are refractory to the conventional strategies. About 200 cases of HIES have been reported so far, in the present case report authors present the oral manifestations of a paediatric dental patient affected with HIES. PMID:28050511

  10. The praxis of clinical knowledge: learning to care for paediatric patients with a congenital heart anomaly.

    PubMed

    Robertson-Malt, Suzi; Chapman, Ysanne B; Smith, Victoria

    2007-06-01

    In Saudi Arabia, the major tertiary care unit for the treatment of cardiovascular disease is the King Faisal Heart Institute (KFHI). Its state of the art technology and patient profile facilitates nurses to become highly knowledgeable in the diversity of treatment modalities and nursing care of a range of paediatric pathology. Like many global nursing organizations, the KFHI is experiencing nursing shortages and nurses coming to work in this highly specialized area are lacking some of the basic understanding and skills development necessary to work efficiently and effectively in the area. This paper describes the work of the cardiovascular education team in developing a praxis-based curriculum that equips nurses to not only function at a high level in the cardiovascular area but also facilitate success in their future careers when they leave Saudi Arabia.

  11. Underweight, overweight and obesity in paediatric dialysis and renal transplant patients.

    PubMed

    Bonthuis, Marjolein; van Stralen, Karlijn J; Verrina, Enrico; Groothoff, Jaap W; Alonso Melgar, Ángel; Edefonti, Alberto; Fischbach, Michel; Mendes, Patricia; Molchanova, Elena A; Paripović, Dušan; Peco-Antic, Amira; Printza, Nikoleta; Rees, Lesley; Rubik, Jacek; Stefanidis, Constantinos J; Sinha, Manish D; Zagożdżon, Ilona; Jager, Kitty J; Schaefer, Franz

    2013-11-01

    The prevalence of childhood overweight is rising worldwide, but in children on renal replacement therapy (RRT) a poor nutritional status is still the primary concern. We aimed to study the prevalence of, and factors associated with, underweight and overweight/obesity in the European paediatric RRT population. Moreover, we assessed the evolution of body mass index (BMI) after the start of RRT. We included 4474 patients younger than 16 years from 25 countries of whom BMI data, obtained between 1995 and 2010, were available within the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry. Prevalence estimates for under- and overweight/obesity were calculated using age and sex-specific criteria of the World Health Organization (WHO, 0-1 year olds) and the International Obesity Task Force cut-offs (2-15 year olds). The prevalence of underweight was 3.5%, whereas 20.8% of the patients were overweight and 12.5% obese. Factors associated with being underweight were receiving dialysis treatment and infant age. Among transplanted recipients, a very short stature (OR: 1.64, 95% CI: 1.40-1.92) and glucocorticoid treatment (OR: 1.23, 95% CI: 1.03-1.47) were associated with a higher risk of being overweight/obese. BMI increased post-transplant, and a lower BMI and a higher age at the start of RRT were associated with greater BMI changes during RRT treatment. Overweight and obesity, rather than underweight, are highly prevalent in European children on RRT. Short stature among graft recipients had a strong association with overweight, while underweight appears to be only a problem in infants. Our findings suggest that nutritional management in children receiving RRT should focus as much on the prevention and treatment of overweight as on preventing malnutrition.

  12. Massive transfusion in paediatric and adolescent trauma patients: incidence, patient profile, and outcomes prior to a massive transfusion protocol.

    PubMed

    Livingston, Michael Hobbs; Singh, Supriya; Merritt, Neil Howard

    2014-09-01

    The purpose of this study was to quantify the incidence, patient profile, and outcomes associated with massive transfusion in paediatric trauma patients prior to establishing a massive transfusion protocol. We performed a retrospective review of paediatric trauma patients treated at London Heath Sciences Centre between January 1, 2006, and December 31, 2011. Inclusion criteria were Injury Severity Score (ISS) greater than 12 and age less than 18 years. 435 patients met the inclusion criteria. Three hundred and fifty-six (82%) did not receive packed red blood cells in the first 24h, 66 (15%) received a non-massive transfusion (<40mL/kg), and 13 (3%) received a massive transfusion (>40mL/kg). Coagulopathy of any kind was more common in massive transfusion (11/13; 85%) than non-massive (32/66; 49%) (p=0.037). Hyperkalemia (18% versus 23%; p=0.98) and hypocalcemia (41% versus 46%; p=1.00) were similar in both groups. Of the 13 massively transfused patients, 9 had multisystem injuries due to a motor vehicle collision, 3 had non-accidental head injuries requiring surgical evacuation, and 1 had multiple stab wounds. In the absence of a massive transfusion protocol, only 8 of the 13 patients received both fresh frozen plasma and platelets in the first 24h. Massive transfusion occurred in patients from across the age spectrum and was associated with severe injuries (mean ISS=33), a higher incidence of severe head injuries (92%), longer hospital stay (mean=36 days), and increased mortality (38%). This study is the first to describe the incidence, complications, and outcomes associated with massive transfusion in paediatric trauma patients prior to a massive transfusion protocol. Massive transfusion occurred in 3% of patients and was associated with coagulopathy and poor outcomes. Protocols are needed to ensure that resuscitation occurs in a coordinated fashion and that patients are given appropriate amounts of fresh frozen plasma, platelets, and cryoprecipitate. Copyright

  13. Negative pressure pulmonary oedema following tracheal tube obstruction in a paediatric patient: a preventable anaesthesia related morbidity.

    PubMed

    Imarengiaye, C O; Ogunsakin, A

    2003-09-01

    The purpose of this study is to describe negative pressure pulmonary oedema due to undetected tracheal tube obstruction in a paediatric patient. A healthy 6 week-old scheduled for release of tongue-tie under general anaesthesia was noticed to be diagnosed at the preparation of the surgical site. The patient was quickly assessed, and ventilation with 100% oxygen was commenced. The heart sounds were still present. Two minutes later, pink frothy secretion was noticed in the lumen of the tracheal tube. Assisted manual ventilation was continued for about 3 hours in the intensive care unit (ICU). Clinical examination after 8 hours of oxygen therapy indicated stable vital signs and was discharged to the ward. Undetected tracheal obstruction due to unsupervised patient positioning may result in negative pressure pulmonary oedema in a paediatric patient. Improved communication between the surgical and the anaesthetic teams may prevent this morbidity.

  14. Advanced oxidation protein product levels as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

    PubMed

    Ozbay, I; Kucur, C; Koçak, F E; Savran, B; Oghan, F

    2016-10-01

    We aimed to determine whether advanced oxidation protein product (AOPP) levels can serve as a marker of oxidative stress in paediatric patients with chronic tonsillitis. Thirty children with chronic tonsillitis and 30 healthy children (control group) were recruited from the Otorhinolaryngology (ORL) and Paediatric Surgery departments, respectively, of Dumlupinar University Hospital. In the patient group, blood samples were collected before tonsillectomy, and tonsil tissue was sampled during the operation. Blood samples were also obtained from the control subjects. AOPP levels in the serum and tonsil tissue were measured by the spectrophotometric method. Serum AOPP levels were significantly higher in the patient group (13.1 ± 3.3 ng/ml) than in the control group (11.6 ± 2.3 ng/ml; P < 0.05). In addition, the mean AOPP level (41.9 ± 13.5 ng/mg protein) in the tonsil tissue in the patient group was significantly higher than the mean serum AOPP levels in the control and patient groups (P < 0.05). AOPP levels are elevated in the tonsil tissue and serum of patients with chronic tonsillitis compared to the serum AOPP levels in healthy controls. AOPPs may represent a novel class of pro-inflammatory molecules that are involved in oxidative stress in chronic tonsillitis. AOPPs may be used as a marker of oxidative stress in paediatric patients with chronic tonsillitis. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  15. Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients.

    PubMed

    Morrow, Brenda; Futter, Merle; Argent, Andrew

    2006-01-01

    Endotracheal suctioning is performed regularly in ventilated infants and children to remove obstructive secretions. The effect of suctioning on respiratory mechanics is not known. This study aimed to determine the immediate effect of endotracheal suctioning on dynamic lung compliance, tidal volume, and airway resistance in mechanically-ventilated paediatric patients by means of a prospective observational clinical study. Lung mechanics were recorded for five minutes before and five minutes after a standardised suctioning procedure in 78 patients intubated with endotracheal tubes < or = 4.0 mm internal diameter. Twenty-four patients with endotracheal tube leaks > or = 20% were excluded from analysis. There was a significant overall decrease in dynamic compliance (p < 0.001) and mechanical expired tidal volume (p = 0.03) following suctioning with no change in the percentage endotracheal tube leak (p = 0.41). The change in dynamic compliance was directly related to both endotracheal tube and catheter sizes. There was no significant change in expiratory or inspiratory airway resistance following suctioning (p > 0.05). Although the majority of patients (68.5%) experienced a drop in dynamic compliance following suctioning, dynamic compliance increased in 31.5% of patients after the procedure. This study demonstrates that endotracheal suctioning frequently causes an immediate drop in dynamic compliance and expired tidal volume in ventilated children with variable lung pathology, intubated with small endotracheal tubes, probably indicating loss of lung volume caused by the suctioning procedure. There is no evidence that suctioning reduces airway resistance.

  16. Assessment of gastric sensorimotor function in paediatric patients with unexplained dyspeptic symptoms and poor weight gain.

    PubMed

    Hoffman, I; Vos, R; Tack, J

    2007-03-01

    Recent studies indicate that impaired meal accommodation or hypersensitivity to distention are highly prevalent in adult functional dyspepsia (FD). Our aim was to investigate whether similar abnormalities also occur in paediatric FD. Sixteen FD patients (15 girls, 10-16 years) were studied. The severity (0-3; 0, absent; 3, severe) of eight dyspeptic symptoms (epigastric pain, fullness, bloating, early satiety, nausea, vomiting, belching and epigastric burning) and the amount of weight loss were determined by questionnaire. All children underwent a gastric barostat study after an overnight fast to determine sensitivity to distention and meal-induced accommodation, which were compared with normal values in young adults (18-22 years). On a separate day, all patients underwent a gastric emptying breath test. A mean weight loss of 4.8 +/- 0.9 kg was present in 14 children. Compared with controls, patients had lower discomfort thresholds to gastric distention (8.8 +/- 1.0 mmHg vs 13.9 +/- 1.9 mmHg, P < 0.02) and gastric accommodation (87 +/- 25 mL vs 154 +/- 20 mL P < 0.04). Hypersensitivity to distention and impaired accommodation were present in respectively nine (56%) and 11 (69%) patients. No relationship was found between barostat and gastric emptying, which was delayed in only three patients. The majority of children with unexplained epigastric symptoms have abnormalities of gastric sensorimotor function.

  17. Knowledge, Attitude and Practice among Dental Practitioners Pertaining to Preventive Measures in Paediatric Patients

    PubMed Central

    Sahu, Amitkumar; Kambalimath, Halaswamy V; Panchakshari, Bharath Kashetty; Jain, Manish

    2016-01-01

    Introduction Prevention at primary level is of great value in Paediatric Dentistry. Since use of preventive measures can prevent future complications, dental professionals share an important responsibility toward early screening, prompt referral and treatment and this knowledge must transfer into the practice of dentistry. Aim To evaluate Knowledge, Attitude and Practice (KAP) among dental practitioners in Bhopal city (central part of India) pertaining to sealants, topical fluorides usage and orthodontic consideration in paediatric patients. Materials and Methods A descriptive cross-sectional survey was conducted using a 20-item self-administered, closed ended, structured questionnaire. A total of 200 available private dental practitioners of Bhopal city made up the sampling frame of study. Results Out of 200 practicing dentists, 147 participated with response rate of 73.5% in which 69.4% were males and 30.6% were females. A total of 83% dentists were less than 35 years of age, while 17% were equal to or more than 35 years of age. Qualification distribution revealed 67.3% dental graduate and 32.6% dental specialist. A highly significant difference in knowledge in relation to age was observed. The mean±SD were found for Knowledge as 8.46±1.82, Attitude as 2.65±0.780, and Practice as 1.66±1.57. Statistically significant correlations were found between attitude and practice (r=0.58, p<0.001). Conclusion Dentists in Bhopal city have vast knowledge towards preventive dentistry. The attitude is highly commendable but underutilized in practice, which needs to be improved. PMID:28209009

  18. A cross-sectional study measuring vanadium and chromium levels in paediatric patients with CKD.

    PubMed

    Filler, Guido; Kobrzynski, Marta; Sidhu, Hargun Kaur; Belostotsky, Vladimir; Huang, Shih-Han S; McIntyre, Chris; Yang, Liju

    2017-06-06

    Although many secondary effects of high levels of vanadium (V) and chromium (Cr) overlap with symptoms seen in paediatric patients with chronic kidney disease (CKD), their plasma V and Cr levels are understudied. Ancillary cross-sectional study to a prospective, longitudinal, randomised controlled trial. Children's Hospital of Western Ontario, London Health Sciences Centre, London, Ontario, Canada. 36 children and adolescents 4-18 years of age with CKD. 1-6 trace element measurements per patient. Cystatin C (CysC) estimated glomerular filtration rate (eGFR) was calculated using the Filler formula. Plasma V and Cr levels were measured using high-resolution sector field inductively coupled mass spectrometry. Anthropomorphic data and blood parameters were collected from our electronic chart programme. Water Cr and V data were obtained from the Ontario Water (Stream) Quality Monitoring Network. Primary outcomes: plasma Cr and V. age, season, CysC, CysC eGFR, and Cr and V levels in environmental water. The median (IQR) eGFR was 51 mL/min/1.73 m(2) (35, 75). The median V level was 0.12 µg/L (0.09, 0.18), which was significantly greater than the 97.5th percentile of the reference interval of 0.088 µg/L; 32 patients had at least one set of V levels above the published reference interval. The median Cr level was 0.43 µg/L (0.36, 0.54), which was also significantly greater than the established reference interval; 34 had at least one set of Cr levels above the published reference interval. V and Cr levels were moderately correlated. Only some patients had high environmental exposure. Our study suggests that paediatric patients with CKD have elevated plasma levels of V and Cr. This may be the result of both environmental exposure and a low eGFR. It may be necessary to monitor V and Cr levels in patients with an eGFR <30 mL/min/1.73 m(2). NCT02126293; HC#172241. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017

  19. Prospective study on dental extractions carried out for paediatric patients under general anaesthetic in a district general hospital.

    PubMed

    Friend, Tom; Allen, Paul

    2016-01-01

    The first line approach to managing healthy anxious children requiring dental extractions should include behavioural management and treatment under local anaesthetic. This can be coupled with conscious sedation. To evaluate alternative methods attempted prior to treatment under general anaesthesia (GA), to establish the incidence of repeat GA procedures. Paediatric cases requiring dental extractions under GA were audited from October 2014 - December 2014 in the Oral and Maxillofacial Department, Great Western Hospital, Swindon. 78 paediatric cases requiring dental extractions were carried out during the study period. 91% of referrals came from local general dental practitioners (GDPs). The indication for the GA was included in 59% of the referral letters. The number of teeth extracted per case ranged from 1 - 14. In 18% of cases treatment under local anaesthetic had been attempted previously. Conscious sedation had not been attempted in any of the cases. There were 5 cases (6.4%) of repeat general anaesthetic procedures. Local guidance regarding appropriate paediatric referrals should be distributed to primary care referrers. Treatment under conscious sedation should be considered for paediatric cases and an improved referral pathway to the community dental service should be developed. Preventative advice should be reinforced to the referrer and to the patient.

  20. A global patient outcomes registry: Cochlear paediatric implanted recipient observational study (Cochlear™ P-IROS)

    PubMed Central

    2014-01-01

    Background Currently, there is a paucity of data concerning the long-term outcomes, educational placement and quality of life of children implanted with hearing devices from large and representative samples of the population. To address this concern, a large, prospective, multicentre, multinational patient-outcomes registry for paediatric recipients of implantable hearing devices was developed. The benefits of this registry, its approach and methodology are described. Methods/Design The Cochlear™ Paediatric Implanted Recipient Observational Study (Cochlear P-IROS) is a prospective international patient-outcomes registry for children who are implanted in routine clinical practice with one or more hearing devices. The study aims to collect data on patient comorbidities, device use, auditory performance, quality of life and health-related utilities, across different types of implantable hearing devices from a range of manufacturers. Patients will be evaluated with a set of standardised and non-standardised questionnaires prior to initial device activation (baseline) and at six-monthly follow-up intervals up to 24 months and annually thereafter. The Cochlear P-IROS utilises a secure web interface to administer electronic case report forms to clinicians and families of implanted children. The web interface is currently available in five languages: English, Japanese, Korean, Mandarin and Russian. The interface also provides printable versions of the case report forms translated into 22 local languages for collection of data prior to entry online; additional languages may be added, as required. Participation in the Cochlear P-IROS registry is investigator-driven and voluntary. To date, the Cochlear P-IROS has recruited implant clinics across Australia, China, India, Indonesia, Turkey and Vietnam. The registry also aims to recruit multiple clinics in Cuba, Israel, Japan, Malaysia, Singapore, South Africa, South Korea and Russia. Discussion The use of a registry such as

  1. Improving patient outcomes with technology and social media in paediatric diabetes.

    PubMed

    Ng, Sze May

    2015-01-01

    The UK has the highest number of children and young people with diagnosed Type 1 diabetes mellitus (T1DM) in Europe, but the lowest numbers attaining good diabetes control (1, 2). Novel strategies and incorporation of digital strategies were identified in the team for development to improve overall patient care and outcomes in our population of children and young people with T1DM. Within a dual-site integrated care organisation, 3 digital initiatives were proposed from 2012-2013 to 1) establish Facebook communications with parents/patients, 2) to implement an electronic diabetes information management system (using Twinkle.Net) and 3) to undertake routine uploading of blood glucose meters and insulin pumps (using DIASEND®) with the aim to improve outcomes in paediatric diabetes care. Key objectives for the three initiatives were aimed to optimise the following outcomes: • Reduce HbA1c levels • Decrease emergency admissions, reduce diabetes-related complications and minimise the length of hospital stays • Improve patient satisfaction and communication • Improve efficiencies with mandatory audit submissions • Empower patients, parents, and the multidisciplicnary team with accurate, real-time information. These digital initiatives showed effective use of technology and social media in achieving significant improvements in all the outcomes within the objectives.

  2. A MONTE-CARLO SIMULATION FRAMEWORK FOR JOINT OPTIMISATION OF IMAGE QUALITY AND PATIENT DOSE IN DIGITAL PAEDIATRIC RADIOGRAPHY.

    PubMed

    Menser, Bernd; Manke, Dirk; Mentrup, Detlef; Neitzel, Ulrich

    2016-06-01

    In paediatric radiography, according to the as low as reasonably achievable (ALARA) principle, the imaging task should be performed with the lowest possible radiation dose. This paper describes a Monte-Carlo simulation framework for dose optimisation of imaging parameters in digital paediatric radiography. Patient models with high spatial resolution and organ segmentation enable the simultaneous evaluation of image quality and patient dose on the same simulated radiographic examination. The accuracy of the image simulation is analysed by comparing simulated and acquired images of technical phantoms. As a first application example, the framework is applied to optimise tube voltage and pre-filtration in newborn chest radiography. At equal patient dose, the highest CNR is obtained with low-kV settings in combination with copper filtration. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients.

    PubMed

    Adebola, Adetokunbo Rafel; Adeleke, Solomon Ibiyemi; Mukhtar, Maryam; Osunde, Otasowie Daniel; Akhiwu, Benjamin Idemudia; Ladeinde, Akinola

    2012-07-01

    The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART. All patients aged 15 years and below attending the Infectious Disease Clinic of Aminu Kano Teaching Hospital with a diagnosis of HIV were consecutively examined in a cross-sectional study over a 2-year period. Information was obtained by history, physical examinations, HIV testing, and enumeration of CD+ T cells. The results are presented. A P-value of <0.05 was considered significant. A total of 105 children comprising 63 males and 42 female who met the inclusion criteria participated in the study, mean age in months was 53.3±42.2, with a mean of 3.4±2.2 for male and 2.8±1.8 for female respectively. Oral lesions occurred in 61.9% of the children Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesion. The most common lesion was oral candidiasis (79.1%). The angular cheilitis (43.8%) variant was most frequent. The mean CD4 counts were 1138 cells/mm(3), 913 cells/mm(3) and 629 cells/mm(3) for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831. Patients on HAART comprised about 61.9% and these were found to have reduced risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56-1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54-0.94; P=0.024) and HIV-gingivitis (OR=0.59; 95% CI=0.46-0.75; P=0.001). HAART had some beneficial but insignificant effect on development of HIV-periodonttitis (OR=0.60; 95% CI=0.51-0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31-5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62-2.06). HIV-related Oral lesions are frequently seen in HIV

  4. The Effect of Nutritional Status on Outcome of Hospitalization in Paediatric Liver Disease Patients

    PubMed Central

    Ghaffar, Shereen Abdel; Sayed, Shaymaa; El-Karaksy, Hanaa

    2016-01-01

    Introduction Liver is an important organ for metabolism. It has a major role in integrating the various biochemical pathways of metabolism. Thus, children with chronic liver disease are at high risk for developing undernutrition, with important prognostic implications. Aim To evaluate the nutritional status of hospitalized paediatric liver disease patients and its effect on outcome. Materials and Methods We prospectively analysed the nutritional status of 59 consecutive patients during their first 24 hours of admission, at the Hepatology Unit, using the following indices: weight/age, height/age, weight/height, Body Mass Index (BMI), arm circumference and triceps skinfold, subcapular skinfold, and mid upper arm circumference. Results According to the measurements: 35.6% were underweight, 49% were stunted, 10% were wasted by weight for length/height percentile and 5% were wasted by body mass index, 49% had percentage of ideal body weight below normal, 27% had head circumference below 3rd percentile, 59.4% had triceps skinfold thickness below 5th percentile, 66% had subscapular skinfold thickness below 5th percentile; 56% had arm circumference below 5th percentile. There was no correlation between these growth parameters and mortality. However, we found a positive correlation between decreased triceps skinfold thickness and prolonged hospital stay. Malnourished patients, according to triceps skinfold thickness, were significantly younger and they were the ones who suffered from cholestatic disorders of infancy. Conclusion Only triceps skinfold thickness was found to be a useful predictor for a prolonged hospital stay. Serial measurements may be more effective. PMID:28208962

  5. Secondary neutron doses received by paediatric patients during intracranial proton therapy treatments.

    PubMed

    Sayah, R; Farah, J; Donadille, L; Hérault, J; Delacroix, S; De Marzi, L; De Oliveira, A; Vabre, I; Stichelbaut, F; Lee, C; Bolch, W E; Clairand, I

    2014-06-01

    This paper's goal is to assess secondary neutron doses received by paediatric patients treated for intracranial tumours using a 178 MeV proton beam. The MCNPX Monte Carlo model of the proton therapy facility, previously validated through experimental measurements for both proton and neutron dosimetry, was used. First, absorbed dose was calculated for organs located outside the clinical target volume using a series of hybrid computational phantoms for different ages and considering a realistic treatment plan. In general, secondary neutron dose was found to decrease as the distance to the treatment field increases and as the patient age increases. In addition, secondary neutron doses were studied as a function of the beam incidence. Next, neutron equivalent dose was assessed using organ-specific energy-dependent radiation weighting factors determined from Monte Carlo simulations of neutron spectra at each organ. The equivalent dose was found to reach a maximum value of ∼155 mSv at the level of the breasts for a delivery of 49 proton Gy to an intracranial tumour of a one-year-old female patient. Finally, a thorough comparison of the calculation results with published data demonstrated the dependence of neutron dose on the treatment configuration and proved the need for facility-specific and treatment-dependent neutron dose calculations.

  6. Effectiveness and Comparison of Various Audio Distraction Aids in Management of Anxious Dental Paediatric Patients

    PubMed Central

    Johri, Nikita; Khan, Suleman Abbas; Singh, Rahul Kumar; Chadha, Dheera; Navit, Pragati; Sharma, Anshul; Bahuguna, Rachana

    2015-01-01

    Background Dental anxiety is a widespread phenomenon and a concern for paediatric dentistry. The inability of children to deal with threatening dental stimuli often manifests as behaviour management problems. Nowadays, the use of non-aversive behaviour management techniques is more advocated, which are more acceptable to parents, patients and practitioners. Therefore, this present study was conducted to find out which audio aid was the most effective in the managing anxious children. Aims and Objectives The aim of the present study was to compare the efficacy of audio-distraction aids in reducing the anxiety of paediatric patients while undergoing various stressful and invasive dental procedures. The objectives were to ascertain whether audio distraction is an effective means of anxiety management and which type of audio aid is the most effective. Materials and Methods A total number of 150 children, aged between 6 to 12 years, randomly selected amongst the patients who came for their first dental check-up, were placed in five groups of 30 each. These groups were the control group, the instrumental music group, the musical nursery rhymes group, the movie songs group and the audio stories group. The control group was treated under normal set-up & audio group listened to various audio presentations during treatment. Each child had four visits. In each visit, after the procedures was completed, the anxiety levels of the children were measured by the Venham’s Picture Test (VPT), Venham’s Clinical Rating Scale (VCRS) and pulse rate measurement with the help of pulse oximeter. Results A significant difference was seen between all the groups for the mean pulse rate, with an increase in subsequent visit. However, no significant difference was seen in the VPT & VCRS scores between all the groups. Audio aids in general reduced anxiety in comparison to the control group, and the most significant reduction in anxiety level was observed in the audio stories group

  7. Stenting the Fontan pathway in paediatric patients with obstructed extracardiac conduits.

    PubMed

    Udink Ten Cate, Floris E A; Trieschmann, Uwe; Germund, Ingo; Hannes, Tobias; Emmel, Mathias; Bennink, Gerardus; Sreeram, Narayanswami

    2017-07-01

    An unobstructed extracardiac conduit (ECC) is essential for optimal Fontan haemodynamics. We aimed to evaluate the feasibility and results of percutaneous transcatheter stenting of the ECC in paediatric patients with a significant Fontan pathway obstruction. Our institutional database was searched to identify all Fontan patients who had a stent placed in their ECC. Medical records, cardiac catheterisation data and echocardiographic investigations were reviewed. Vessel diameters were normalised to account for differences in body surface area. Nineteen Fontan patients (age 6.5±3.2 years; male 78.9%) with a significant stenosis of their Dacron ECC graft were identified. Seven patients presented with protein-losing enteropathy (36.8%). An ECC obstruction was suspected on echocardiography in only 6/19 patients (31.6%). The mean minimum diameter of the ECC was 8.3±2.4 mm. A stenosis of >45% was seen in the majority of patients (n=12, 63.1%). Significant correlations between the severity of the ECC obstruction and Fontan pathway vessel diameters were found (all p<0.05). Stenting was successful in all children. The ECC diameter increased significantly after stenting (p<0.0001). An acute clinical benefit of ECC stenting was observed in 18/19 (94.7%) patients. ECC patency was good during a mean follow-up of 1.8±0.9 years. The feasibility and acute results of percutaneous transcatheter ECC stenting are promising and may provide a good alternative to postpone surgery to a later age. The mechanisms contributing to the development of ECC stenoses are likely multifactorial. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Effect of a multifaceted intervention on documentation of vital signs and staff communication regarding deteriorating paediatric patients.

    PubMed

    McKay, Heather; Mitchell, Imogen A; Sinn, Kam; Mugridge, Heather; Lafferty, Tony; Van Leuvan, Chris; Mamootil, Sarah; Abdel-Latif, Mohamed E

    2013-01-01

    To evaluate the impact of newly designed Paediatric Early Warning Scores and an accompanying education package, COMPASS, on the frequency of documentation of vital signs and communication between health professionals and associated medical review in deteriorating paediatric patients. One thousand fifty-nine patients in the pre-intervention phase and 899 in the post-intervention phase were studied. The daily frequency of documentation of vital sign measurement, incidence of health professional communication and related medical reviews following clinical deterioration of a random subgroup of 262 pre-intervention and 221 post-intervention patients were studied in detail. There were no significant differences in hospital mortality, medical emergency team reviews or unplanned admissions to critical care areas between the pre-intervention and post-intervention groups. There were significant increases in the post-intervention group for the median daily frequency of documentation of respiratory effort (0.0 (0-0) to 7.8 (5.8-12.6), P < 0.001), capillary refill (0 (0-0) to 1.1 (0-3.1), P < 0.001), blood pressure (0 (0-1.1) to 0 (0-1.6), P = 0.007) and level of consciousness (0 (0-0) to 7.8 (5.8-12.0), P < 0.001) and appropriate communication concerning patient deterioration 63 (8.5%) to 216 (40.9%), P < 0.001). There was a significant reduction in the number of children fulfilling the medical emergency team criteria (102 (38.9%) to 45 (20.4), P < 0.001). A multifaceted intervention for the early recognition and response to clinical deterioration in children significantly improved documentation of vital signs, communication and time to medical review. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  9. Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial?

    PubMed

    Silvetti, Massimo Stefano; Drago, Fabrizio; Di Carlo, Duccio; Placidi, Silvia; Brancaccio, Gianluca; Carotti, Adriano

    2013-09-01

    Cardiac pacing is a difficult technique in children, particularly in patients with congenital heart defects (CHDs). Few studies to date have addressed this topic. We performed a retrospective analysis of the results of a single centre. Between 1982 and 2008, 287 patients with CHD, median age of 5 years (25-75%, 1-11) underwent cardiac pacing for sinus node dysfunction (SND) and atrioventricular block (AVB); 97% of patients underwent at least one heart surgery. Endocardial systems (Endo) were implanted in 117 patients, epicardial systems (Epi) in 170, with 595 leads (228 Endo, 367 Epi). Endocardial systems showed a significantly older age group with more frequent SND; Epi a younger age group, with more frequent AVB, greater number of surgical interventions. Perioperative complications were mortality 0.6% (Epi), pericardial effusion 0.6% (Epi), and haemothorax 3.4% (Endo). The median follow-up is 5 (2-10) years: the pacing system failed in 29% of patients, 13% Endo, and 40% Epi (P < 0.0001). Multivariate analysis showed a significantly higher risk of failure for Epi, a lower implant age, greater the number of leads implanted. The risk of malfunction of the leads increases significantly for Epi and the younger age when implanted. The steroid-eluting leads have a lower risk of malfunction (P = 0.05), steroid-eluting Endo leads provide significantly better outcomes than Epi. Cardiac pacing in paediatric patients with CHD shows satisfactory results in the long term. Endocardial systems show significantly better results than Epi systems. A younger age when implanted is a risk factor for complications at follow-up.

  10. Central Telangiectatic Osteosarcoma of the Mandible in a Paediatric Patient: A Rarity

    PubMed Central

    Tomar, Divya; Thayath, Muhamad Nishad; Zaidi, Iram; Singh, Shikha

    2016-01-01

    Osteosarcoma (OS) involving the head and neck region is rare and is a diagnostic challenge due to its aggressive nature and varied presentations. Although OS constitute 40% to 60% of all bone tumours, only 10% of these occur in the head and neck region, most commonly in the maxilla and mandible. OS of the jaw bone has a different pattern and behaviour when compared to OS at other anatomic location. It occurs in a more elderly population, less aggressive and usually spreads locally rather than distant metastases. Telangiectatic Osteosarcoma (TOS) of jaws in a paediatric patient is still a very rare variant and till date only two cases have been reported in literature. Radiographic evaluation plays an important role as the clinical symptoms are not specific to the condition. Conventional radiography should always be supplemented by advanced imaging modalities for the diagnosis, which gives a three dimensional assessment and also prevents superimposition of surrounding structures. Early diagnosis and radical surgery are the keys to high survival rates. Herein, we present a third ever reported case of TOS occurring in mandible of a nine-year-old male patient. PMID:28208989

  11. Creation of two tomographic voxel models of paediatric patients in the first year of life

    NASA Astrophysics Data System (ADS)

    Nipper, J. C.; Williams, J. L.; Bolch, W. E.

    2002-09-01

    Tomographic computational models, based on regional segmentation of CT or MRI medical images, have increasingly been proposed as replacements for current stylized mathematical models of human anatomy used in radiation dosimetry studies. While much effort has been devoted towards the creation of adult models, few research studies have been initiated to address the need for models supporting paediatric radiology dosimetry. In this study, two tomographic models were created using a combination of automatic and manual segmentation via a program created in-house using IDL version 5.5. The first model is of a normal 6 day female newborn, and consists of a 512 × 512 × 485 data array. The CT slices of this model were obtained every 1 mm, and 66 different anatomic regions were defined. The second model is of a patient developmentally equivalent to a 2 month male, and was saved as a 512 × 512 × 438 data array. This subject had severe tissue oedema within the gut, kidneys, liver and spleen. The model is thus considered representative of a critically ill child, from a patient subpopulation expected to receive a larger than normal number of diagnostic x-ray exams. The voxel volumes for the two models are 0.35 mm3 and 0.30 mm3, respectively, thus making these models the most detailed in existence for paediatric dosimetry applications. Ratios of organ masses for the UF newborn model to those within the reference ORNL/MIRD model range from highs of 1.2 to 1.7 for the oesophagus and small intestine/colon, respectively, to lows of 0.18 to 0.27 for the mandible and humeri, respectively. For the UF 2 month model, ratios of organ masses in the UF model to those in the 8 week GSF BABY model ranged from highs of 3.7 to 5.2 for the clavicles and spleen, respectively, to lows of 0.2 to 0.3 for the adrenals and scapulae, respectively.

  12. Obesity and dental caries in paediatric patients. A cross-sectional study.

    PubMed

    Costacurta, M; Di Renzo, L; Bianchi, A; Fabiocchi, F; De Lorenzo, A; Docimo, R

    2011-06-01

    The aim of the present cross-sectional study was to evaluate the relationship between childhood obesity and dental caries, in paediatric subjects, through the use of two methods of diagnosis of overweight-obesity: Body Mass Index (BMI), and Dual energy X-ray Absorptiometry (DXA). A total of 107 healthy patients, aged between 6 and 12 years (53.3% females, 46.7% males) were included in the study. Each patient underwent a nutritional examination and dental check-up. The nutritional examination was performed at the Department of Neuroscience, Human Nutrition Unit, University of Rome Tor Vergata and consisted of anthropometric measurements, BMI calculation, DXA exam, body fat mass (FM) assessment. Dental examinations were performed by a trained dentist of the Paediatric Dentistry Unit of PTV Hospital, University of Rome Tor Vergata. Dental caries was assessed using visual-tactile method and X-rays (bite-wing and panoramic radiography); the dmft/DMFT index was calculated. The subjects were classified as underweight, normal weight, pre-obese, obese, according to different criteria: a) age- and sex-specific BMI according to the Cacciari growth charts and cut-offs, b) body fat mass percentage (FM%) according to the WHO cut-offs, c) body fat mass percentage (FM%) according to the McCarthy growth charts and cut-offs. The statistical analysis was performed with the SPSS software (version 11.01; SPSS Inc., Chicago, IL, USA). The dmft/DMFT index was checked for normality using the Kolmogorov-Smirnov test. Independence of the dmft/DMFT distribution from sex and age was checked by using the Mann Whitney and Kruskal Wallis tests. Differences in the dmft/DMFT values between groups, according to BMI and FM% classifications, were tested using the Mann Whitney test. The minimal level of significance of the differences was fixed at p- value ≤ 0.05 for all procedures. The comparison between BMI and DXA data shows statistically significant differences between BMI-%FM (WHO cut

  13. High weekly doses of liposomal amphotericin B as secondary prophylaxis after cerebral aspergillosis in a paediatric patient.

    PubMed

    Brazzola, Pierluigi; Rossi, Mario R

    2014-01-01

    A paediatric patient treated for acute lymphoblastic leukaemia developed cerebral abscesses caused by Aspergillus fumigatus. After surgical draining voriconazole treatment was started. The patient developed a Steven-Johnson syndrome and treatment was switched to L-AmB. The patient developed no new fungal lesions and L-AmB treatment was continued until the end of the therapy. Complete remission was achieved without neurological consequences. High dose L-AmB represents an alternative for secondary prophylaxis of invasive fungal infections in patients intolerant to azoles.

  14. [Diagnosis of tuberculosis in paediatrics].

    PubMed

    Moreno-Pérez, D; Andrés Martín, A; Altet Gómez, N; Baquero-Artigao, F; Escribano Montaner, A; Gómez-Pastrana Durán, D; González Montero, R; Mellado Peña, M J; Rodrigo-Gonzalo-de-Liria, C; Ruiz Serrano, M J

    2010-04-01

    Tuberculosis is one of the most important health problems worldwide. There are an increasing number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration from highly endemic areas. Measures to optimise early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Paediatric Association (Spanish Society of Paediatric Infectology and Spanish Society of Paediatric Pneumology) have agreed this Consensus Document in order to homogenise diagnostic criteria in paediatric patients.

  15. Enhancement of diuresis with metolazone in infant paediatric cardiac intensive care patients.

    PubMed

    Wise, Russell T; Moffett, Brady S; Akcan-Arikan, Ayse; Galati, Marianne; Afonso, Natasha; Checchia, Paul A

    2017-09-11

    Few data are available regarding the use of metolazone in infants in cardiac intensive care. Researchers need to carry out further evaluation to characterise the effects of this treatment in this population. This is a descriptive, retrospective study carried out in patients less than a year old. These infants had received metolazone over a 2-year period in the paediatric cardiac intensive care unit at our institution. The primary goal was to measure the change in urine output from 24 hours before the start of metolazone therapy to 24 hours after. Patient demographic variables, laboratory data, and fluid-balance data were analysed. The study identified 97 infants with a mean age of 0.32±0.25 years. Their mean weight was 4.9±1.5 kg, and 58% of the participants were male. An overall 63% of them had undergone cardiovascular surgery. The baseline estimated creatinine clearance was 93±37 ml/minute/1.73 m2. Initially, the participants had received a metolazone dose of 0.27±0.10 mg/kg/day, the maximum dose being 0.43 mg/kg/day. They had also received other diuretics during metolazone initiation, such as furosemide (87.6%), spironolactone (58.8%), acetazolamide (11.3%), bumetanide (7.2%), and ethacrynic acid (1%). The median change in urine output after metolazone was 0.9 ml/kg/hour (interquartile range 0.15-1.9). The study categorised a total of 66 patients (68.0%) as responders. Multivariable analysis identified acetazolamide use (p=0.002) and increased fluid input in the 24 hours after metolazone initiation (p0.05). Metolazone increased urine output in a select group of patients. Efficacy can be maximised by strategic selection of patients.

  16. Recombinant factor IX (BAX326) in previously treated paediatric patients with haemophilia B: a prospective clinical trial.

    PubMed

    Urasinski, T; Stasyshyn, O; Andreeva, T; Rusen, L; Perina, F G; Oh, M S; Chapman, M; Pavlova, B G; Valenta-Singer, B; Abbuehl, B E

    2015-03-01

    A newly developed recombinant factor IX (BAX326(1) ) was investigated for prophylactic use in paediatric patients aged <12 years with severe (FIX level <1%) or moderately severe (FIX level 1-2%) haemophilia B. The aim of this prospective clinical trial was to assess the safety, haemostatic efficacy and pharmacokinetic profile of BAX326 in previously treated paediatric patients. BAX326 was administered as prophylaxis twice a week for a period of 6 months, and on demand for treatment of bleeds. Safety was assessed by the occurrence of related AEs, thrombotic events and immunologic assessments. Efficacy was evaluated by annualized bleeding rate (ABR), and by treatment response rating (excellent, good, fair, none). PK was assessed over 72 h. None of the 23 treated paediatric subjects had treatment-related SAEs or AEs. There were no thrombotic events, inhibitory or specific binding antibodies against FIX, rFurin or CHO protein. Twenty-six bleeds (19 non-joint vs. 7 joint bleeds) occurred (mean ABR 2.7 ± 3.14, median 2.0), of which 23 were injury-related. Twenty subjects (87%) did not experience any bleeds of spontaneous aetiology. Haemostatic efficacy of BAX326 was excellent or good for >96% of bleeds (100% of minor, 88.9% of moderate and 100% of major bleeds); the majority (88.5%) resolved after 1-2 infusions. Longer T1/2 and lower IR were observed in younger children (<6 years) compared to those aged 6 to 12 years. BAX326 administered as prophylactic treatment as well as for controlling bleeds is efficacious and safe in paediatric patients aged <12 years with haemophilia B.

  17. Preventing Infections in Cancer Patients

    MedlinePlus

    ... Caregivers Flu Treatment for Cancer Patients and Survivors Flu Publications Stay Informed Cancer Home Information for Patients and Caregivers Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir Cancer patients ...

  18. Discussing patient management online: the impact of roles on knowledge construction for students interning at the paediatric ward.

    PubMed

    De Wever, Bram; Van Winckel, Myriam; Valcke, Martin

    2008-03-01

    The objectives of this study are to explore the use of asynchronous discussion groups during medical students' clinical rotation in paediatrics. In particular, the impact of role assignment on the level of knowledge construction through social negotiation is studied. Case-based asynchronous discussion groups were introduced to enhance reflection and critical thinking on patient management and treatment, and to offer an exercise in evidence-based medical practice. Groups of approximately 4-5 students were asked to discuss 4 authentic cases during clinical rotation in paediatrics. 49 students interning at the paediatric ward participated in this study. With respect to role assignment, differences between groups (1) with a student or an instructor as moderator and (2) with or without a developer of alternatives for patient management were explored. A content analysis was performed to explore the different levels of social construction of knowledge. The results of multilevel logit analyses show a significant difference in knowledge construction through social negotiation between conditions with a student moderator and conditions where the instructor is moderating, but only when a developer of alternatives is involved. No significant difference was revealed between student-moderated and instructor-moderator groups without a developer of alternatives. It can be concluded that when both the moderator and developer role are assigned to students, their contributions are more likely to reflect a high level of knowledge construction.

  19. Transition of gastroenterological patients from paediatric to adult care: A position statement by the Italian Societies of Gastroenterology.

    PubMed

    Elli, Luca; Maieron, Roberto; Martelossi, Stefano; Guariso, Graziella; Buscarini, Elisabetta; Conte, Dario; di Giulio, Emilio; Staiano, Annamaria; Barp, Jacopo; Bassotti, Gabrio; Bianco, Maria Antonia; Buri, Luigi; Carrara, Maurizio; Ghidini, Benedetta; Giannini, Olivia; Knafelz, Daniela; Miele, Erasmo; Peralta, Sergio; Riccio, Elisabetta; Tomba, Carolina; Zilli, Maurizio; Guadagnini, Tiziana

    2015-09-01

    In 2013, four Italian Gastroenterological Societies (the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition, the Italian Society of Hospital Gastroenterologists and Endoscopists, the Italian Society of Endoscopy, and the Italian Society of Gastroenterology) formed a joint panel of experts with the aim of preparing an official statement on transition medicine in Gastroenterology. The transition of adolescents from paediatric to adult care is a crucial moment in managing chronic diseases such as celiac disease, inflammatory bowel disease, liver disease and liver transplantation. Improved medical treatment and availability of new drugs and surgical techniques have improved the prognosis of many paediatric disorders, prolonging survival, thus making the transition to adulthood possible and necessary. An inappropriate transition or the incomplete transmission of data from the paediatrician to the adult Gastroenterologist can dramatically decrease compliance to treatment and prognosis of a young patient, particularly in the case of severe disorders. For these reasons, the Italian gastroenterological societies decided to develop an official shared transition protocol. The resulting document discusses the factors influencing the transition process and highlights the main points to accomplish to optimize compliance and prognosis of gastroenterological patients during the difficult transition from childhood to adolescence and adulthood.

  20. Piloting Psychology Annual Reviews as a Method of Measuring Psychological Distress and Quality of Life in Paediatric Renal Transplant Patients.

    PubMed

    Bamford, Jade; Wirz, Lucy

    2016-01-01

    Psychosocial distress and poorer quality of life after renal transplantation are common in children and young people. This has implications for medication adherence and survival. Posttransplant psychology annual reviews were introduced in one Paediatric Renal Service in the UK as a means of measuring psychological distress and quality of life, as well as facilitating identification of patients and parents/carers who would benefit from psychological intervention. The process of completing posttransplant psychology annual reviews is discussed within this paper. The posttransplant psychology annual review appointments identified patients experiencing depression and/or anxiety and problems in quality of life. These assessments have led to appropriate referrals to, and engagement with, the renal psychology service as well as with community tier 3 child and adolescent mental health services. The posttransplant psychology annual review will continue to be completed at this UK site and discussions will be undertaken with other paediatric renal transplant services to consider whether these could be introduced at a national level to facilitate collection of longitudinal data regarding long-term psychosocial impact of paediatric renal transplantation and its effect on quality of life.

  1. Piloting Psychology Annual Reviews as a Method of Measuring Psychological Distress and Quality of Life in Paediatric Renal Transplant Patients

    PubMed Central

    2016-01-01

    Psychosocial distress and poorer quality of life after renal transplantation are common in children and young people. This has implications for medication adherence and survival. Posttransplant psychology annual reviews were introduced in one Paediatric Renal Service in the UK as a means of measuring psychological distress and quality of life, as well as facilitating identification of patients and parents/carers who would benefit from psychological intervention. The process of completing posttransplant psychology annual reviews is discussed within this paper. The posttransplant psychology annual review appointments identified patients experiencing depression and/or anxiety and problems in quality of life. These assessments have led to appropriate referrals to, and engagement with, the renal psychology service as well as with community tier 3 child and adolescent mental health services. The posttransplant psychology annual review will continue to be completed at this UK site and discussions will be undertaken with other paediatric renal transplant services to consider whether these could be introduced at a national level to facilitate collection of longitudinal data regarding long-term psychosocial impact of paediatric renal transplantation and its effect on quality of life. PMID:27965973

  2. [Carbapenem antibiotics in hospitalised paediatric patients. Adherence to a therapeutic protocol].

    PubMed

    Montesinos-Sanchis, Elena; Moraga-Llop, Fernando A; Soler-Palacín, Pere; Oliveras-Arenas, María; Larrosa Escartín, M Nieves; Martínez Gómez, Xavier; Figueras-Nadal, Concepción

    2014-12-01

    To describe the use of carbapenems in children hospitalised outside intensive care and onco-haematology units, and assess adherence to a therapeutic protocol. A retrospective observational study was conducted on the use of carbapenems between January 2009 and December 2010. The study included children with a community-acquired infectious disease or a health care-associated infectious disease, and who were admitted to paediatric areas of the Vall d'Hebron University Hospital (Barcelona, Spain), other than intensive care, neonatology and onco-haematology units. Clinical data were collected and antibiotic consumption data were provided by the Pharmacy Department. A total of 51 episodes fulfilled the inclusion criteria. Carbapenem as initial empirical treatment was indicated in 31.4%, and applied as rescue therapy in the remainder. The instructions of the protocol were adhered to in 70.6% of the empirical and 87.5% of the targeted prescriptions (77.6% overall). A better match was found for empirical carbapenem in patients with a previous admission or underlying condition. Factors such as diagnosis, age or antibiotic use prior to admission did not affect the empirical indication of carbapenem. The establishment of a treatment protocol with carbapenem indications in our centre since 2007 has yielded significantly better results on the appropriateness of the prescription than those obtained in other studies. Copyright © 2012 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  3. Urinary antibiotic activity in paediatric patients attending an outpatient department in north-western Cambodia.

    PubMed

    Emary, Katherine R W; Carter, Michael J; Pol, Sreymom; Sona, Soeng; Kumar, Varun; Day, Nicholas P J; Parry, Christopher M; Moore, Catrin E

    2015-01-01

    Antibiotic resistance is a prominent public and global health concern. We investigated antibiotic use in children by determining the proportion of unselected children with antibacterial activity in their urine attending a paediatric outpatient department in Siem Reap, Cambodia. Caregiver reports of medication history and presence of possible infection symptoms were collected in addition to urine samples. Urine antibiotic activity was estimated by exposing bacteria to urine specimens, including assessment against multiresistant bacteria previously isolated from patients in the hospital (a methicillin-resistant Staphylococcus aureus (MRSA), a multiresistant Salmonella typhi and an extended-spectrum β-lactamase (ESBL)-producing Escherichia coli isolate). Medication information and urine were collected from 775 children. Caregivers reported medication use in 69.0% of children in the preceding 48 h. 31.7% samples showed antibacterial activity; 16.3% showed activity against a local multiresistant organism. No specimens demonstrated activity against an ESBL-producing E. coli. Antibiotics are widely used in the community setting in Cambodia. Parents are often ill-informed about drugs given to treat their children. Increasing the regulation and training of private pharmacies in Cambodia may be necessary. Regional surveillance of antibiotic use and resistance is also essential in devising preventive strategies against further development of antibiotic resistance, which would have both local and global consequences. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  4. A prospective, multicentre survey on antifungal therapy in neutropenic paediatric haematology patients.

    PubMed

    Cesaro, Simone; Pagano, Livio; Caira, Morena; Carraro, Francesca; Luciani, Matteo; Russo, Delia; Colombini, Antonella; Morello, William; Viale, Pierluigi; Rossi, Giuseppe; Tridello, Gloria; Pegoraro, Anna; Nosari, Annamaria; Aversa, Franco

    2013-01-01

    Invasive fungal infections are a frequent complication after intensive chemotherapy. The aims of this prospective study were to describe the use of antifungal therapy and to report which strategy was routinely adopted to guide the introduction of antifungal therapy. A total of 321 febrile episodes in 160 paediatric patients affected by acute leukaemia or non-Hodgkin-lymphoma were investigated. Antifungal therapy was used in 100 of 321 febrile episodes (31%), and classified as empiric in 73 episodes, diagnostic-driven in 25 episodes and targeted in 2 episodes. Switching to a second-line antifungal therapy was needed in 28 of 100 episodes (28%) and was classified as empiric in 10 episodes (36%), diagnostic-driven in 17 episodes (61%) and targeted in 1 episode (4%). In 9 of 28 episodes (32%), switching to a third-line antifungal therapy was performed and was classified as empiric in 2 episodes (22%), diagnostic-driven in 6 episodes (67%) and targeted in 1 episode (11%). Invasive fungal infections was reported in 23 of 100 episodes: confirmed in 4 episodes, probable in 8 episodes, and possible in 11 episodes. Attributable mortality was 2.8%. Antifungal therapy was still used mostly empirically, whereas as fever persisted, its modification was guided by a diagnostic-driven approach.

  5. Thyroid exposure to scattered radiation and associated second cancer risk from paediatric radiotherapy for extracranial tumours.

    PubMed

    Mazonakis, Michalis; Kourinou, Kalliopi; Lyraraki, Efrossini; Varveris, Haralambos; Damilakis, John

    2012-12-01

    This study was conducted to estimate the scattered thyroid dose and relevant second cancer risk from radiotherapy for extracranial tumours during childhood.  Anteroposeterior and posteronaterior field irradiations employed during the treatment of Hodgkin's disease, neuroblastoma and Wilms' tumour were simulated on two humanoid phantoms representing 5- and 10-y-old patients. Measurements were performed using thermoluminescent dosemeters. Practical thyroid lead shields with thicknesses of 2-10 mm were placed in the phantoms' neck region. The lifetime risk for cancer induction was assessed using sex- and age-specific risk factors. Thyroid dose per monitor unit varied from 28.1 to 492.4 μGy by the primary irradiation site and patient's age. The 10-mm-thick lead shield led to a dose reduction up to 28.9 %. For typical prescribed tumour doses, the total risks for thyroid cancer development after radiotherapy of 5- and 10-y-old male patients were 0.05-0.99  and 0.03-0.48 %, respectively. The corresponding risks for females increased to 0.29-5.51 and 0.17-2.94 %.

  6. Coagulopathy as a complication of kidney biopsies in paediatric systemic lupus erythematosus patients with antiphospholipid syndrome.

    PubMed

    Nagata, Hiroko; Sato, Mai; Ogura, Masao; Yoshikawa, Takahisa; Yamamoto, Kazuna; Matsumura, Sohshi; Kano, Yuji; Saida, Ken; Sako, Mayumi; Kamei, Koichi; Yoshioka, Takako; Ogata, Kentaro; Ito, Shuichi; Ishikura, Kenji

    2017-10-04

    Children with systemic lupus erythematosus (SLE) generally undergo a pretreatment kidney biopsy. However, some of these patients, especially those with antiphospholipid syndrome (APS), may experience serious coagulopathic complications. We report herein two cases of paediatric SLE with APS in which, despite normal blood test results, the disparate coagulopathic complications of haemorrhage and embolism developed following a kidney biopsy. Case 1 was, an 8-year-old male in whom, primary APS was initially diagnosed. Fourteen months later SLE was diagnosed. Based on a percutaneous kidney biopsy, International Society of Nephrology and the Renal Pathology Society (ISN/RPS) class III-A lupus nephritis was histologically diagnosed. On post biopsy Day 9, a giant haematoma in the fascia of the left kidney developed and was accompanied by changes in the vital signs. Case 2, a 13-year-old male, initially received the diagnosis of SLE with APS and underwent two courses of pulse methylprednisolone therapy. His coagulation abnormalities improved, and a percutaneous needle kidney biopsy was performed, leading to the histological diagnosis of ISN/RPS class III-A lupus nephritis. Furthermore, thrombotic microangiopathy was also detected in the renal histopathology. On post biopsy Day 6, the patient experienced right leg pain. A contrast CT and lower extremity ultrasonography detected a massive deep vein thrombosis and partial left pulmonary artery thrombosis. A kidney biopsy in children with SLE and APS can cause lethal coagulopathic complications, and the risks to such patients should be weighed carefully before the procedure is performed. This article is protected by copyright. All rights reserved.

  7. Characterization of Streptococcus pneumoniae clones from paediatric patients with cystic fibrosis.

    PubMed

    Pimentel de Araujo, Fernanda; D'Ambrosio, Fabio; Camilli, Romina; Fiscarelli, Ersilia; Di Bonaventura, Giovanni; Baldassarri, Lucilla; Visca, Paolo; Pantosti, Annalisa; Gherardi, Giovanni

    2014-12-01

    The role of Streptococcus pneumoniae in cystic fibrosis (CF) is poorly understood. The pneumococcal population has changed over time after the introduction of the heptavalent conjugate vaccine (PCV7) and, more recently, the 13-valent conjugate vaccine (PCV13). Although serotypes and clones causing invasive pneumococcal disease or colonizing healthy children have been extensively analysed, little is known so far on the serotypes and clones of pneumococci in CF patients. The aim of this work was to investigate serotypes, antibiotic susceptibilities, genotypes and biofilm production of CF pneumococcal isolates. Overall, 44 S. pneumoniae strains collected from 32 paediatric CF patients from January 2010 to May 2012 in a large Italian CF Centre were tested for antimicrobial susceptibility testing by Etest, serotyped by the Quellung reaction and genotyped by a combination of different molecular typing methods, including pbp gene restriction profiling, pspA restriction profiling and sequencing, PFGE and multilocus sequence typing. Biofilm production by pneumococcal strains was also assessed. Penicillin non-susceptibility was 16 %. High resistance rates (>56 %) were observed for erythromycin, clindamycin and tetracycline. The most frequent serotype recovered was serotype 3 (31.8 %). The coverage of PCV7 and PCV13 was 6.8 and 47.7 %, respectively. More than 80 % of CF strains belonged to Pneumococcal Molecular Epidemiology Network (PMEN) reference clones, the most common being Netherlands(3)-ST180 (28.2 %), and Greece(21)-30/ST193 (15.4 %). All strains produced biofilm in vitro, although with large variability in biofilm formation efficiency. No correlation was found between biofilm levels and serotype, clone or antibiotic resistance. The high isolation rate of antibiotic-resistant serotype 3 pneumococci from CF patients suggests that PCV13 could increase protection from pneumococcal colonization and infection.

  8. Meaningful health outcomes for paediatric neurodisability: Stakeholder prioritisation and appropriateness of patient reported outcome measures.

    PubMed

    Morris, Christopher; Janssens, Astrid; Shilling, Valerie; Allard, Amanda; Fellowes, Andrew; Tomlinson, Richard; Williams, Jane; Thompson Coon, Jo; Rogers, Morwenna; Beresford, Bryony; Green, Colin; Jenkinson, Crispin; Tennant, Alan; Logan, Stuart

    2015-06-25

    Health services are increasingly focused on measuring and monitoring outcomes, particularly those that reflect patients' priorities. To be meaningful, outcomes measured should be valued by patients and carers, be consistent with what health professionals seek to achieve, and be robust in terms of measurement properties. The aim of this study was (i) to seek a shared vision between families and clinicians regarding key aspects of health as outcomes, beyond mortality and morbidity, for children with neurodisability, and (ii) to appraise which multidimensional patient reported outcome measures (PROMs) could be used to assess salient health domains. Relevant outcomes were identified from (i) qualitative research with children and young people with neurodisability and parent carers, (ii) Delphi survey with health professionals, and (iii) systematic review of PROMs. The International Classification of Functioning Disability and Health provided a common language to code aspects of health. A subset of stakeholders participated in a prioritisation meeting incorporating a Q-sorting task to discuss and rank aspects of health. A total of 33 pertinent aspects of health were identified. Fifteen stakeholders from the qualitative and Delphi studies participated in the prioritisation meeting: 3 young people, 5 parent carers, and 7 health professionals. Aspects of health that emerged as more important for families and targets for health professionals were: communication, emotional wellbeing, pain, sleep, mobility, self-care, independence, mental health, community and social life, behaviour, toileting and safety. Whilst available PROMs measure many aspects of health in the ICF, no single PROM captures all the key domains prioritised as for children and young people with neurodisability. The paucity of scales for assessing communication was notable. We propose a core suite of key outcome domains for children with neurodisability that could be used in evaluative research, audit and as

  9. Antimicrobial use in paediatric patients in a teaching hospital in Ethiopia

    PubMed Central

    Kebede, Hafte Kahsay; Gesesew, Hailay Abrha; Woldehaimanot, Tewodros Eyob; Goro, Kabaye Kumela

    2017-01-01

    Background Antibiotics use in in children are different from adults due to a lack of data on pharmacokinetics, pharmacodynamics, efficacy and safety of drugs, different physiological spectrum, pediatrics populations being vulnerable to the majority of the illnesses, and the adverse effect of their irrational use is more serious. However, antibiotic use is not explored much in a paediatric population. The current study focused on antibiotic use among pediatric population using data from a tertiary hospital in Ethiopia. Methods A retrospective cross-sectional study collated data from 614 pediatrics patients admitted in pediatrics ward at Jimma University Teaching Hospital, Southwest Ethiopia. Descriptive analyses were performed to describe the type and pattern of antibiotics. The number of prescriptions per a patient was also compared with the WHO standard. Data analysis was carried out using SPSS version 20 for mackintosh. Results Antimicrobials were prescribed for 407(86.4%) patients of which 85.9% were in the form of injectables. A total of 1241 (90%) medicines were administered parenterally followed by oral 110 (8%). The maximum number of medicines per prescription was eight for all types of drugs in general, and five for antimicrobials in particular. All antimicrobials were prescribed empirically without any microbiological evidence. Pneumonia, sepsis and meningitis were the main reasons for antimicrobial use in the ward. Out of the total of 812 antibiotics prescribed; Penicillin G crystalline was the most (20%) frequently prescribed, followed by gentamicin (19%) and ampicillin (16). Conclusions Majority of the prescribed antibiotics were antimicrobials, and was in the form of injectables. Antimicrobials were over prescribed and the number of drugs per prescription was also far from WHO recommendation. Strict prescribing standard guidelines and treatment habits should be developed in the country, to prevent antimicrobial resistance. PMID:28264021

  10. The efficacy of ventricular pacing with device automaticity in paediatric patients.

    PubMed

    Tomaske, Maren; Harpes, Paul; Woy, Natascha; Bauersfeld, Urs

    2008-07-01

    To compare pacemaker reprogramming and re-intervention rates in children with AutoCapture (AC) and conventionally (Conv) programmed devices, and to assess reliability of device automaticity. Data of children with AC (group AC, n = 49) and conventionally programmed devices (group Conv, n = 41) were analysed. A total of 1106 outpatient visits and 147 Holter recordings were screened for device reprogramming and invasive re-intervention. At 2 and 5 years, freedom from reprogramming differed significantly between groups (AC: 63/35% vs. Conv: 13/4%; P < 0.0001), whereas freedom from re-intervention was not different (AC: 95/90% vs. Conv: 95/85%; P = 0.26). Mean yearly rate of reprogramming was lower in group AC (AC: 0.67 +/- 0.55 vs. Conv: 1.13 +/- 0.82; P = 0.005). Follow-up duration correlated with a decreasing number of reprogramming per year in group Conv (rho = -0.73, P < 0.001). No ventricular output reprogramming was required in group AC. Holter recordings required 0.07 +/- 0.13 reprogramming per year in group Conv, none in group AC (P < 0.001). Holter-detected lead dysfunction prompted re-intervention in one patient of each group. Estimated freedom from as well as total yearly rate of device reprogramming was favourable for AC-programmed devices. No difference was seen for the incidence of invasive re-interventions. AC ventricular output control was effective. Structured device follow-up and Holter recordings in specific patient groups remain mandatory for all devices in paediatric patients.

  11. Frequency of stress lesions of the upper gastrointestinal tract in paediatric patients after cardiac surgery: effects of prophylaxis.

    PubMed Central

    Behrens, R; Hofbeck, M; Singer, H; Scharf, J; Rupprecht, T

    1994-01-01

    BACKGROUND--Stress lesions of the upper gastrointestinal tract are well recognised in adult patients in intensive care. There are no controlled studies of the incidence of these lesions and the effects or side effects of prophylactic treatment in high risk paediatric patients. METHODS--79 paediatric patients in intensive care were studied prospectively after operation for congenital heart disease. All patients had at least one endoscopic examination. The first 36 patients were not given prophylactic medication: later 43 children were treated randomly either with pirenzepine (n = 21) or with famotidine (n = 22). Gastric and tracheal secretions were taken daily for culture in those patients given prophylactic medication. RESULTS--Severe inflammation or ulceration of the upper gastrointestinal tract was less common in those patients who were given prophylactic medication (18% v 44%). Prophylactic treatment did not, however, reduce the total incidence of postoperative stress lesions: it shifted the severity of these changes towards mild lesions and reduced the incidence of ulcerations from 25% to 2%. None of the patients developed a pneumonia caused by an organism previously isolated from the stomach. CONCLUSIONS--The incidence of stress lesions in children after cardiac surgery resembles that in high risk adult patients. Children in intensive care after cardiac surgery should be treated prophylactically with famotidine or pirenzepine until they can be fed by mouth. PMID:7917695

  12. Quality of Life in Swiss Paediatric Inflammatory Bowel Disease Patients: Do Patients and Their Parents Experience Disease in the Same Way?

    PubMed Central

    Mueller, Rebekka; Ziade, Farah; Pittet, Valérie; Fournier, Nicolas; Ezri, Jessica; Schoepfer, Alain; Schibli, Susanne; Spalinger, Johannes; Braegger, Christian

    2016-01-01

    Background and Aims: Inflammatory bowel diseases (IBDs) may impair quality of life (QoL) in paediatric patients. We aimed to evaluate in a nationwide cohort whether patients experience QoL in a different way when compared with their parents. Methods: Sociodemographic and psychosocial characteristics were prospectively acquired from paediatric patients and their parents included in the Swiss IBD Cohort Study. Disease activity was evaluated by the Paediatric Crohn’s Disease Activity Index (PCDAI) and the Paediatric Ulcerative Colitis Activity Index (PUCAI). We assessed QoL using the KIDSCREEN questionnaire. The QoL domains were analysed and compared between children and parents according to type of disease, parents’ age, origin, education and marital status. Results: We included 110 children and parents (59 Crohn’s disease [CD], 45 ulcerative colitis [UC], 6 IBD unclassified [IBDU]). There was no significant difference in QoL between CD and UC/IBDU, whether the disease was active or in remission. Parents perceived overall QoL, as well as ‘mood’, ‘family’ and ‘friends’ domains, lower than the children themselves, independently of their place of birth and education. However, better concordance was found on ‘school performance’ and ‘physical activity’ domains. Marital status and age of parents significantly influenced the evaluation of QoL. Mothers and fathers being married or cohabiting perceived significantly lower mood, family and friends domains than their children, whereas mothers living alone had a lower perception of the friends domain; fathers living alone had a lower perception of family and mood subscores. Conclusion: Parents of Swiss paediatric IBD patients significantly underestimate overall QoL and domains of QoL of their children independently of origin and education. PMID:26519462

  13. Fitness, body composition and vascular health in adolescent and young adult survivors of paediatric brain cancer and cranial radiotherapy.

    PubMed

    Long, Treya M; Rath, Shoshana R; Maroni, Tessa D; Wallman, Karen E; Atkinson, Helen C; Gottardo, Nicholas G; Cole, Catherine H; Choong, Catherine S; Naylor, Louise H

    2017-09-20

    Background Survivors of paediatric brain cancer and/or cranial radiotherapy (CRT) are at an increased risk of developing serious comorbidities. Established risk factors for chronic disease include central obesity, endothelial abnormalities and diminished fitness. Objectives Here we characterised anthropometry, body composition, bone mineral density (BMD), heart rate (HR), blood pressure (BP), endothelial function, muscular strength and endurance and aerobic fitness in adolescent and young adult (AYA) survivors. Methods Twenty survivors (10 male, 10 female; 20 ± 2 years) were compared with 19 matched controls. Muscular strength was assessed using three repetition maximum tests, while muscular endurance was determined as number of repetitions performed per minute. Peak oxygen uptake (VO2 peak) was assessed on a treadmill using a modified chronotropic protocol. Anthropometric measurements, HR and BP were taken using standard clinical protocols, while body composition and BMD were determined using dual X-ray absorptiometry (DXA). Endothelial function was measured using the flow mediated dilation technique. Results Survivors demonstrated deficits in muscular strength (latissimus dorsi pull-down, p = 0.020; bicep curl, p = 0.009), muscular endurance (squats, p = 0.012; sit-ups, p = 0.030; push-ups, p = 0.013), minute ventilation at peak exericse (p = 0.002) and VO2peak (L/min, p = 0.002; mL/kg/min, p = 0.008; mL/kg LBM/min, p = 0.010). Additionally, survivors had greater waist-to-hip ratios (p = 0.032), resting HR (p = 0.048) and higher percentage of total body (p = 0.017), central (p = 0.009) and peripheral (p = 0.032) fat. Lean body mass (p = 0.004) and BMD (p = 0.005) were lower in the survivor group. Conclusion AYA survivors of paediatric brain cancer and/or CRT exhibit altered body composition, increased resting HR and reduced BMD, muscular strength, muscular endurance and cardiorespiratory fitness compared to controls.

  14. Paediatrics in Amsterdam.

    PubMed

    Eber, Ernst; Aurora, Paul; Lødrup Carlsen, Karin C; Lindblad, Anders; Dankert-Roelse, Jeannette E; Ross-Russell, Robert I; Turner, Steve W; Midulla, Fabio; Hedlin, Gunilla

    2012-07-01

    The aim of this update is to describe the paediatric highlights from the 2011 European Respiratory Society (ERS) Annual Congress in Amsterdam, the Netherlands. Abstracts from all seven groups of the ERS Paediatric Assembly (Paediatric Respiratory Physiology, Paediatric Asthma and Allergy, Cystic Fibrosis, Paediatric Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Paediatric Respiratory Epidemiology, and Paediatric Bronchology) are presented in the context of current literature.

  15. Radiation Therapy in Paediatric Orbital Granulocytic Sarcomas: Experience from a Tertiary Cancer Center

    PubMed Central

    Venkatesulu, Bhanu Prasad; Mallick, Supriya; Chander, Subhash

    2016-01-01

    Introduction Orbital Granulocytic Sarcoma (OGS) is an uncommon manifestation associated with haematological malignancies. Chemotherapy remains the cornerstone of the treatment. The role of radiation is not well-defined. Aim To evaluate the effect of radiation in OGS and to define an optimal dose for achieving adequate local control. Materials and Methods This was a retrospective analysis of 11 patients who received radiation therapy to orbit for Granulocytic Sarcoma (GS) between 2007 and 2014 at a tertiary cancer center in India. Radiotherapy was planned by three dimensional conformal (3DCRT) techniques. Demographic and disease characteristics, including clinical, imaging, histopathology and treatment details in this patient cohort were recorded and their response to therapy was assessed. Results The median age was 7 years (Range: 2-16 years). There were 3 female and 8 male patients. Eight patients were diagnosed as Acute Myelogenous Leukemia (AML), two patients had Primary Orbital Granulocytic Sarcoma (POGS) and one had bi-phenotypic leukemia. Median dose was 24.5Gy (Range-15-45 Gy). Two anterior oblique field design were used most commonly. Out of 11 patients, 5 (45.4%) had complete response, 3 (27.27%) had partial response, 1 patient had stable disease (9%) and 2 developed progressive disease (18%). Median follow-up was 24 months (Range 24-84 months). At last follow-up, 7 (63.6%) patients were alive and 4 patients (37.4%) were dead due to progressive disease. Conclusion In patients with residual orbital disease after chemotherapy, low dose radiation can be used to improve local disease control and improve quality of life. Local conformal radiotherapy of 24-30 Gy in conventional fractionation appears optimal with excellent local control and minimal morbidity. PMID:27891440

  16. Organized sports participation and the association with injury in paediatric patients with haemophilia.

    PubMed

    McGee, S; Raffini, L; Witmer, C

    2015-07-01

    With the wide availability of factor and the routine use of prophylaxis boys with haemophilia are now able to participate in regular physical activity, including organized sports. Current guidelines vary regarding specific recommendations for sports participation and concerns remain regarding safety. To determine if participation in organized sports is associated with an increased risk for injury in paediatric subjects with haemophilia. Retrospective single-centre cohort study from January 1, 2008 to December 31, 2010 in male subjects ages 10-18 years with a factor VIII (FVIII) or FIX level <40%. The number of injuries per subject and participation in organized sports was recorded. 48 male subjects with a mean age of 14.3 ± 2.6 years (range: 10-18.8) were included; 64.6% (31/48) FVIII deficiency, 54.2% (26/48) severe haemophilia, 18.8% (9/48) moderate and 27.1% (13/48) mild. The majority [62.5% (30/48)] of subjects participated in at least one season of organized sport. There were 77 injuries in 36/48 (75%) subjects. The mean number of injuries per subject was 1.6 ± 1.5. There was no statistical difference in the mean number of injuries (P = 0.44) or target joint formation (P = 0.52) between the subjects who participated in organized sports compared to those who did not. In this study, participation in organized sports by boys with haemophilia, ages 10-18 years, is common and not associated with an increased number of injuries or the development of a target joint. As injuries occurred equally in both groups, concerted efforts should be directed at reducing injuries in all patients. © 2015 John Wiley & Sons Ltd.

  17. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

    PubMed

    Perrotta, C; Ortiz, Z; Roque, M

    2005-04-18

    Acute bronchiolitis is the leading causes of medical emergencies during winter in children younger than two years of age. Chest physiotherapy is thought to assist infants in the clearance of secretions and decrease ventilatory effort. To determine the efficacy and safety of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2004) which contains the Acute Respiratory Infection Group's specialised register; MEDLINE (January 1966 to June 2004); EMBASE (1990 to June 2004); PASCAL; SCISEARCH; LILACS; and Cumulative Index to the Nursing & Allied Health Literature (CINAHL) (1982 to May 2004). Randomised controlled trails (RCTs) in paediatric patients younger than twenty four months old in which chest physiotherapy was compared against no intervention or against another type of physiotherapy. Two independent reviewers extracted the data. Primary outcome was a severity clinical score. Secondary outcomes were length of hospital stay, duration of oxygen supplementation, and the use of bronchodilators and steroids. Three clinical trials met the inclusion criteria. All evaluated vibration and percussion techniques in postural drainage positions compared to no intervention. The study population were hospitalised infants with a clinical diagnosis of acute bronchiolitis, although one study included only infants who required nasogastric tube feeding or intravenous fluids. None of the other included trails observed any differences in the severity of the clinical score at day five or during each of the five days of the trial or until discharge, length of hospital stay, or oxygen requirements between chest physiotherapy group and control. Based on the results of three RCTs, chest physiotherapy using vibration and percussion techniques does not reduce length of hospital stay, oxygen requirements, or improve the severity clinical score in infants

  18. Menstrual disorders in a Paediatric and Adolescent Gynaecology Clinic: patient presentations and longitudinal outcomes.

    PubMed

    Chung, P W; Chan, Symphorosa S C; Yiu, K W; Lao, Terence T H; Chung, Tony K H

    2011-10-01

    OBJECTIVE. To study the presentations, diagnoses, and outcomes in adolescents with menstrual disorders. DESIGN. Prospective cohort study. SETTING. Paediatric and Adolescent Gynaecology Clinic, Hong Kong. PARTICIPANTS. A total of 577 adolescents aged 14 to 19 years. MAIN OUTCOME MEASURES. The presentations and diagnoses of adolescents with menstrual disorders were reviewed and their menstrual outcomes determined by a telephone survey. RESULTS. In all, 47% presented with menorrhagia, prolonged menstruation, and short menstrual cycles; 27% had secondary amenorrhoea, 12% had dysmenorrhoea, 11% had oligomenorrhoea, and 3% had primary amenorrhoea. Significant diagnoses included congenital genital tract anomalies, premature ovarian failure, anorexia nervosa, and polycystic ovarian syndrome. Polycystic ovarian syndrome was diagnosed in 16% of the cohort. In all, 24% of these 577 patients had abnormal menstrual cycles 4 years later. Direct logistic regression analysis indicated a cycle length of more than 35 days at presentation (adjusted odds ratio=2.8; 95% confidence interval, 1.8-4.5), previous diagnosis of polycystic ovarian syndrome (adjusted odds ratio=2.0; 95% confidence interval, 1.1-3.4), and current body mass index of 23 kg/m(2) or higher (adjusted odds ratio=1.8; 95% confidence interval, 1.0-3.0) were risk factors for persistently long menstrual cycle exceeding 35 days. Adolescents who were screened out with a definitive diagnosis after initial assessment were at low risk of persistently long menstrual cycles at follow-up (adjusted odds ratio=0.3; 95% confidence interval, 0.1-0.8). CONCLUSIONS. Adolescent menstrual disorders should not be ignored. Long cycle, diagnosis of polycystic ovarian syndrome at first consultation, and a current body mass index of 23 kg/m(2) or higher were statistically associated with persistent problems.

  19. Patient safety events in out-of-hospital paediatric airway management: a medical record review by the CSI-EMS

    PubMed Central

    Hansen, Matthew; Meckler, Garth; Lambert, William; Dickinson, Caitlin; Dickinson, Kathryn; Van Otterloo, Joshua

    2016-01-01

    Objective To describe the frequency and characterise the nature of patient safety events in paediatric out-of-hospital airway management. Methods We conducted a retrospective cross-sectional medical record review of all ‘lights and sirens’ emergency medicine services transports from 2008 to 2011 in patients <18 years of age in the Portland Oregon metropolitan area. A chart review tool (see online supplementary appendix) was adapted from landmark patient safety studies and revised after pilot testing. Expert panels of physicians and paramedics performed blinded reviews of each chart, identified safety events and described their nature. The primary outcomes were presence and severity of patient safety events related to airway management including oxygen administration, bag-valve-mask ventilation (BVM), airway adjuncts and endotracheal intubation (ETI). 10.1136/bmjopen-2016-012259.supp1 supplementary appendix Results From the 11 328 paediatric transports during the study period, there were 497 ‘lights and sirens’ (code 3) transports (4.4%). 7 transports were excluded due to missing data. Of the 490 transports included in the analysis, 329 had a total of 338 airway management procedures (some had more than 1 procedure): 61.6% were treated with oxygen, 15.3% with BVM, 8.6% with ETI and 2% with airway adjuncts. The frequency of errors was: 21% (71/338) related to oxygen use, 9.8% (33/338) related to BVM, 9.5% (32/338) related to intubation and 0.9% (3/338) related to airway adjunct use. 58% of intubations required 3 or more attempts or failed altogether. Cardiac arrest was associated with higher odds of a severe error. Conclusions Errors in paediatric out-of-hospital airway management are common, especially in the context of intubations and during cardiac arrest. PMID:27836871

  20. Montelukast in the treatment of perennial allergic rhinitis in paediatric Japanese patients; an open-label clinical trial

    PubMed Central

    Okubo, Kimihiro; Inoue, Yoichi; Numaguchi, Hirotaka; Tanaka, Kumi; Saito, Itori; Oshima, Nobuyuki; Matsumoto, Yuki; Prohn, Marita; Mehta, Anish; Nishida, Chisato; Philip, George

    2016-01-01

    Abstract Background: This study was conducted to evaluate the safety and tolerability, and population pharmacokinetics (PPK) of montelukast as well as efficacy in the treatment of perennial allergic rhinitis (PAR) in paediatric Japanese patients aged between 1 and 15 years. Methods: In this multi-centre, open-label trial, 87 paediatric Japanese patients with PAR received montelukast 4 mg oral granules (OG) for 4 weeks (1–5-year-olds, N = 15), 4 mg OG for 12 weeks (1–5-year-olds, N = 36), 5 mg chewable tablets (CT) for 12 weeks (6–9-year-olds, N = 18), or 5 mg CT for12 weeks (10–15-year-olds, N = 18). Clinical exams and laboratory assessments were conducted at study visits, and adverse events (AE) were monitored throughout the study up to 14 days after the last visit. Population pharmacokinetic approach was used to estimate AUC0–∞, Cmax, Tmax and apparent elimination half-life in each age group. Efficacy was assessed based on global evaluations by the subject’s caregiver. Results: There were no serious AEs and one discontinuation due to an AE. The most common AEs in any of the treatment groups were nasopharyngitis, pharyngitis, and acute sinusitis. Montelukast exposure (AUC0–∞) was similar in the 1–5-year-old group and the 6–9-year-old group, but 19% lower in the 10–15-year-old group. Among all patients, the total proportion of patients whose global evaluation was “very much better” was 5.7% (week 2), 11.5% (week 4), and 16.9% (week 12) reflecting improvement in symptoms over time. Conclusion: Montelukast was generally well tolerated in Japanese children with PAR. AUC0–∞was similar in 1–5 and 6–9-year-olds, while a lower exposure was observed in the 10–15-year-old group likely due to differences in bodyweight. The exposure in Japanese paediatric patients was generally consistent with that in non-Japanese paediatric and adult patients. As assessed by the patients’ caregivers, montelukast also

  1. Systemic exposure to menthol following administration of peppermint oil to paediatric patients

    USDA-ARS?s Scientific Manuscript database

    Peppermint oil (PMO) has been used to treat abdominal ailments dating to ancient Egypt, Greece and Rome. Despite its increasing paediatric use, as in irritable bowel syndrome (IBS) treatment, the pharmacokinetics (PK) of menthol in children given PMO has not been explored. Single-site, exploratory p...

  2. Paediatric musculoskeletal interventional radiology

    PubMed Central

    Paolantonio, Guglielmo; Fruhwirth, Rodolfo; Alvaro, Giuseppe; Parapatt, George K; Toma', Paolo; Rollo, Massimo

    2016-01-01

    Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population. PMID:26235144

  3. Improving timeliness for acute asthma care for paediatric ED patients using a nurse driven intervention: an interrupted time series analysis

    PubMed Central

    Brown, Kathleen; Iqbal, Sabah; Sun, Su-Lin; Fritzeen, Jennifer; Chamberlain, James; C. Mullan, Paul

    2016-01-01

    Asthma is the most common chronic paediatric disease treated in the emergency department (ED). Rapid corticosteroid administration is associated with improved outcomes, but our busy ED setting has made it challenging to achieve this goal. Our primary aim was to decrease the time to corticosteroid administration in a large, academic paediatric ED. We conducted an interrupted time series analysis for moderate to severe asthma exacerbations of one to 18 year old patients. A multidisciplinary team designed the intervention of a bedside nurse initiated administration of oral dexamethasone, to replace the prior system of a physician initiated order for oral prednisone. Our baseline and intervention periods were 12 month intervals. Our primary process measure was the time to corticosteroid administration. Other process measures included ED length of stay, admission rate, and rate of emesis. The balance measures included rate of return visits to the ED or clinic within five days, as well as the proportion of discharged patients who were admitted within five days. No special cause variation occurred in the baseline period. The mean time to corticosteroid administration decreased significantly, from 98 minutes in the baseline period to 59 minutes in the intervention period (p < 0.01), and showed special cause variation improvement within two months after the intervention using statistical process control methodology. We sustained the improvement and demonstrated a stable process. The intervention period had a significantly lower admission rate (p<0.01) and emesis rate (p<0.01), with no unforeseen harm to patients found with any of our balance measures. In summary, the introduction of a nurse initiated, standardized protocol for corticosteroid therapy for asthma exacerbations in a paediatric ED was associated with decreased time to corticosteroid administration, admission rates, and post-corticosteroid emesis. PMID:28090325

  4. Improving timeliness for acute asthma care for paediatric ED patients using a nurse driven intervention: an interrupted time series analysis.

    PubMed

    Brown, Kathleen; Iqbal, Sabah; Sun, Su-Lin; Fritzeen, Jennifer; Chamberlain, James; Mullan, Paul C

    2016-01-01

    Asthma is the most common chronic paediatric disease treated in the emergency department (ED). Rapid corticosteroid administration is associated with improved outcomes, but our busy ED setting has made it challenging to achieve this goal. Our primary aim was to decrease the time to corticosteroid administration in a large, academic paediatric ED. We conducted an interrupted time series analysis for moderate to severe asthma exacerbations of one to 18 year old patients. A multidisciplinary team designed the intervention of a bedside nurse initiated administration of oral dexamethasone, to replace the prior system of a physician initiated order for oral prednisone. Our baseline and intervention periods were 12 month intervals. Our primary process measure was the time to corticosteroid administration. Other process measures included ED length of stay, admission rate, and rate of emesis. The balance measures included rate of return visits to the ED or clinic within five days, as well as the proportion of discharged patients who were admitted within five days. No special cause variation occurred in the baseline period. The mean time to corticosteroid administration decreased significantly, from 98 minutes in the baseline period to 59 minutes in the intervention period (p < 0.01), and showed special cause variation improvement within two months after the intervention using statistical process control methodology. We sustained the improvement and demonstrated a stable process. The intervention period had a significantly lower admission rate (p<0.01) and emesis rate (p<0.01), with no unforeseen harm to patients found with any of our balance measures. In summary, the introduction of a nurse initiated, standardized protocol for corticosteroid therapy for asthma exacerbations in a paediatric ED was associated with decreased time to corticosteroid administration, admission rates, and post-corticosteroid emesis.

  5. [Environment and paediatric cancer in the Region of Murcia (Spain): integrating clinical and environmental history in a geographic information system].

    PubMed

    Ortega-García, J A; López-Hernández, F A; Sobrino-Najul, E; Febo, I; Fuster-Soler, J L

    2011-04-01

    Environment and Paediatric Cancer (PC) in the Region of Murcia (RM) is an on-going research project that has the following aims: to collect a careful paediatric environmental history (PEH) and to use geographical information systems (GIS) to map the incidence and analyze the geographic distribution of the PC incidence in the RM. The objectives are to present the methodology used for the collection and processing of data and disseminate initial results on the spatial and temporal incidence of PC in the RM (Spain). A descriptive and georeference study of all PC cases under 15 years, diagnosed from 1 January 1998 to December 31, 2009. Three postal addresses were assigned to each case, residence during pregnancy, postnatal, and at the time of diagnosis. Other variables such as sex, date of birth, date of diagnosis, and histopathology classification were collected. No increase was observed in the trend of incidence of PC. The crude annual incidence rate was 14.3 cases per 100,000 children under 15 years. The standardised incidence ratio was higher in the north-west of the RM. Before diagnosis, 30% of cases had a different postal address than during the pregnancy. Integrating the spatial and temporal information through the PEH in a GIS should allow the identification and study of space-time clusters through an environmental monitoring system in order to know the importance of associated risk factors. Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  6. Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality?

    PubMed

    Ngoy, B B; Zachariah, R; Hinderaker, S G; Khogali, M; Manzi, M; van Griensven, J; Ayada, L; Jemmy, J P; Maalim, A; Amin, H

    2013-06-21

    A district hospital in conflict-torn Somalia. To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care. Cross-sectional study. Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded. Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage.

  7. [Malnutrition in cancer patients].

    PubMed

    Antoun, Sami; Merad, Mansouriah; Raynard, Bruno; Ruffié, Pierre

    2006-11-30

    Malnutrition is common in cancer patients. Many factors contribute to weight loss: some of them can be related to diminished dietary intake, while others are more associated with metabolic changes induced by systemic inflammatory responses. This is why at a specific phase during the course of development, some cancers will benefit from nutritional support, while in theory, and others will benefit from anti-inflammatory treatment. Parenteral nutrition is indicated for severe malnourished surgical patients and for allogenic stem cell transplant patients. Tube feeding (enteral nutrition) should be considered for patients with a functional gut who are unable to ingest sufficient nutrients orally, for example head and neck cancer patients. The value of dietary counselling and oral nutritional support has not been proven in patients undergoing chemotherapy, which is why it is so difficult to propose recommendations. Some arguments seem to favour parenteral nutrition for patients with bowel obstruction suffering from advanced-stage incurable cancer. As the results of studies following omega-3 fatty acid-enriched oral nutritional support in palliative care patients are inconsistent, these products cannot be recommended.

  8. Paediatric manpower.

    PubMed

    Liberman, M M; Bellman, M H

    1982-09-01

    Two investigations of paediatric manpower in England, Wales, and Northern Ireland were carried out, each using a different method. The first survey located registrars and senior registrars and checked on their occupational status 3 years later in order to see which ones had been promoted. Loss factors--such as emigration, retirement for personal reasons, part-time training, or transfer to general practice, community paediatrics, or other medical specialties--were examined closely. The second survey was a cross-sectional analysis of the entire paediatric establishment. It examined in particular the distribution of consultants and registrars. Using figures from survey 2 and loss factors from survey 1, a model of the paediatric career structure could be constructed. This showed that the present career pyramid would be unable to absorb the current number of registrars in training. There is an urgent need for a comprehensive registration scheme for registrars, especially those with honorary contracts, who are not currently included in official records. Paediatrics is unique in having a high proportion of women for whom there is little opportunity of reconciling career aspirations with family commitments.

  9. Paediatric manpower.

    PubMed Central

    Liberman, M M; Bellman, M H

    1982-01-01

    Two investigations of paediatric manpower in England, Wales, and Northern Ireland were carried out, each using a different method. The first survey located registrars and senior registrars and checked on their occupational status 3 years later in order to see which ones had been promoted. Loss factors--such as emigration, retirement for personal reasons, part-time training, or transfer to general practice, community paediatrics, or other medical specialties--were examined closely. The second survey was a cross-sectional analysis of the entire paediatric establishment. It examined in particular the distribution of consultants and registrars. Using figures from survey 2 and loss factors from survey 1, a model of the paediatric career structure could be constructed. This showed that the present career pyramid would be unable to absorb the current number of registrars in training. There is an urgent need for a comprehensive registration scheme for registrars, especially those with honorary contracts, who are not currently included in official records. Paediatrics is unique in having a high proportion of women for whom there is little opportunity of reconciling career aspirations with family commitments. PMID:7125690

  10. Retrospective cohort analysis of healthcare claims in the United States characterising asthma exacerbations in paediatric patients.

    PubMed

    Suruki, Robert Y; Boudiaf, Nada; Ortega, Hector G

    2016-01-01

    Asthma is the most common chronic disease in childhood and places a significant burden on public and private health systems. This retrospective cohort analysis utilised administrative healthcare claims data (US Clinformatics™ Multiplan database; compliant with the US Department of Health & Human Services Health Insurance Portability and Accountability Act) to characterise asthma exacerbations requiring intervention in a US paediatric patient population. Patients aged > 1-17 years with a recorded asthma diagnosis and receiving treatment were identified in the US Clinformatics™ Multiplan database over a 9-year period (2004-2012). Both incident and prevalent cases of asthma were included, with the most recently recorded asthma diagnosis designated as the index date. The 12-month period following the index date was analysed for asthma exacerbations, defined as an event requiring treatment with systemic corticosteroid or resulting in an asthma-related hospitalisation or emergency department visit. Data from 734,114 children with asthma (41.5 % females, 58.5 % males) were analysed, of this cohort 34.4 % experienced ≥ 1 exacerbation during the follow-up period. The proportion who experienced ≥ 1 exacerbation increased from 28.9 % in 2004 to 36.3 % in 2012, based on the reported index date. Their mean annual exacerbation frequency was 1.4; 85.8 % of exacerbations were defined by systemic corticosteroids use. A consistent trend of increased exacerbation incidence in the fall and early winter was observed, in particular exacerbations defined by systemic corticosteroid use. A greater proportion of asthma-related hospitalisations were associated with younger age. Approximately one-third of children experienced ≥ 1 exacerbation in real-world clinical practice. A targeted treatment approach with a focus on those with a history of recurrent exacerbations is recommended to improve asthma control. This targeted approach could also minimise the

  11. Paediatric intestinal cancer and polyposis due to bi-allelic PMS2 mutations: case series, review and follow-up guidelines.

    PubMed

    Herkert, Johanna C; Niessen, Renée C; Olderode-Berends, Maria J W; Veenstra-Knol, Hermine E; Vos, Yvonne J; van der Klift, Heleen M; Scheenstra, Rene; Tops, Carli M J; Karrenbeld, Arend; Peters, Frans T M; Hofstra, Robert M W; Kleibeuker, Jan H; Sijmons, Rolf H

    2011-05-01

    Bi-allelic germline mutations of one of the DNA mismatch repair genes, so far predominantly found in PMS2, cause constitutional MMR-deficiency syndrome. This rare disorder is characterised by paediatric intestinal cancer and other malignancies. We report the clinical, immunohistochemical and genetic characterisation of four families with bi-allelic germline PMS2 mutations. We present an overview of the published gastrointestinal manifestations of CMMR-D syndrome and propose recommendations for gastro-intestinal screening. The first proband developed a cerebral angiosarcoma at age 2 and two colorectal adenomas at age 7. Genetic testing identified a complete PMS2 gene deletion and a frameshift c.736_741delinsTGTGTGTGAAG (p.Pro246CysfsX3) mutation. In the second family, both the proband and her brother had multiple intestinal adenomas, initially wrongly diagnosed as familial adenomatous polyposis. A splice site c.2174+1G>A, and a missense c.137G>T (p.Ser46Ile) mutation in PMS2 were identified. The third patient was diagnosed with multiple colorectal adenomas at age 11; he developed a high-grade dysplastic colorectal adenocarcinoma at age 21. Two intragenic PMS2 deletions were found. The fourth proband developed a cerebral anaplastic ganglioma at age 9 and a high-grade colerectal dysplastic adenoma at age 10 and carries a homozygous c.2174+1G>A mutation. Tumours of all patients showed microsatellite instability and/or loss of PMS2 expression. Our findings show the association between bi-allelic germline PMS2 mutations and severe childhood-onset gastrointestinal manifestations, and support the notion that patients with early-onset gastrointestinal adenomas and cancer should be investigated for CMMR-D syndrome. We recommend yearly follow-up with colonoscopy from age 6 and simultaneous video-capsule small bowel enteroscopy from age 8. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Nurse perception of Bispectral Index monitoring as an adjunct to sedation scale assessment in the critically ill paediatric patient.

    PubMed

    Hawks, Sharon J; Brandon, Debra; Uhl, Tammy

    2013-02-01

    Reliability of clinical scales and haemodynamic variables for assessing sedation depth in critically children is limited, particularly for those receiving neuromuscular blocking agents (NMBAs). To introduce and integrate the use of Bispectral Index (BIS) monitoring as adjunct to sedation scale assessment in intubated mechanically ventilated Paediatric Intensive Care Unit (PICU) patients. Quality improvement intervention including: BIS education for all PICU nurses; 8-week implementation of BIS monitoring guided by Paediatric BIS Sedation Protocol; evaluation by convenience sample of nurses (n=17). 15-Item survey assessing perceptions of BIS attributes was given to nurses after first 4 BIS encounters; nurse comments and project coordinator observations were recorded. Survey data (intermediate reliability and nurse attitude ratings and low ratings on other attributes; little change over time) revealed nurses' reservations about the usefulness of BIS as an adjunct to sedation scales, but qualitative data indicated that they valued BIS for assessing sedation depth in children receiving NMBAs. Post-intervention, BIS monitoring was adopted in PICU for children receiving NMBAs. One year later, this practice is sustained, and the percentage of BIS-monitored patients has increased. Guidelines addressing the use of BIS in patients not receiving paralytics are needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Respiratory Paradoxical Adverse Drug Reactions Associated with Acetylcysteine and Carbocysteine Systemic Use in Paediatric Patients: A National Survey

    PubMed Central

    Dubus, Jean-Christophe; Bavoux, Françoise; Boyer-Gervoise, Marie-José; Jean-Pastor, Marie-Josèphe; Chalumeau, Martin

    2011-01-01

    Objective To report pediatric cases of paradoxical respiratory adverse drug reactions (ADRs) after exposure to oral mucolytic drugs (carbocysteine, acetylcysteine) that led to the withdrawal of licenses for these drugs for infants in France and then Italy. Design The study followed the recommendations of the European guidelines of pharmacovigilance for medicines used in the paediatric population. Setting Cases voluntarily reported by physicians from 1989 to 2008 were identified in the national French pharmacovigilance public database and in drug company databases. Patients The definition of paradoxical respiratory ADRs was based on the literature. Exposure to mucolytic drugs was arbitrarily defined as having received mucolytic drugs for at least 2 days (>200 mg) and at least until the day before the first signs of the suspected ADR. Results The non-exclusive paradoxical respiratory ADRs reported in 59 paediatric patients (median age 5 months, range 3 weeks to 34 months, 98% younger than 2 years old) were increased bronchorrhea or mucus vomiting (n = 27), worsening of respiratory distress during respiratory tract infection (n = 35), dyspnoea (n = 18), cough aggravation or prolongation (n = 11), and bronchospasm (n = 1). Fifty-one (86%) children required hospitalization or extended hospitalization because of the ADR; one patient died of pulmonary oedema after mucus vomiting. Conclusion Parents, physicians, pharmacists, and drug regulatory agencies should know that the benefit risk ratio of mucolytic drugs is at least null and most probably negative in infants according to available evidence. PMID:21818391

  14. The impact of 12 months treatment with ivacaftor on Scottish paediatric patients with cystic fibrosis with the G551D mutation: a review.

    PubMed

    Dryden, Carol; Wilkinson, Jane; Young, David; Brooker, Richard John

    2016-06-10

    We reviewed the impact of ivacaftor on Scottish paediatric patients with cystic fibrosis ≥6 years of age after 12 months of treatment. Statistically significant improvements in FEV1 and body mass index and a reduction in sweat chloride, all comparable with previously published data were observed. The findings also suggested reduced use of intravenous antibiotics and oral antibiotics. No significant adverse effects were observed but a possible association with cataract formation could not be excluded. This review suggests that, in the short term at least, ivacaftor is effective and safe in paediatric patients ≥6 years of age with G551D.

  15. [Physiotherapy of cancer patients].

    PubMed

    Gomez, Izabella; Szekanecz, Éva; Szekanecz, Zoltán; Bender, Tamás

    2016-07-01

    Physiotherapy of cancer patients is one of the most controversial issues in our country. Malignant diseases are firstly mentioned as a contraindication of physiotherapy. Until now, physiotherapy was not suggested (or only in limited accessibility) for those patients who had malignant disease in medical history. International medical practice was less restrictive in managing this topic. The development of imaging techniques put this question in a new light. On the basis of evidence, the majority of articles have reported beneficial effects of physiotherapy in cancer patients, and only few articles mentioned it as harmful. Of course, each patient requires an individual assessment, however, if we exclude the possibility of tumor recurrence and metastasis, most of physiotherapy procedures can be used safely. One of the aims of this review is to support the physicians' decisions when to prescribe treatments, in such a way, that more patients could receive physiotherapy. Orv. Hetil., 2016, 157(31), 1224-1231.

  16. Upper-lip laser frenectomy without infiltrated anaesthesia in a paediatric patient: a case report.

    PubMed

    Kafas, Panagiotis; Stavrianos, Christos; Jerjes, Waseem; Upile, Tahwinder; Vourvachis, Michael; Theodoridis, Marios; Stavrianou, Irene

    2009-05-20

    Labial frenectomy is a common surgical procedure in the field of oral surgery. Labial frenectomy is a procedure usually done for orthodontic reasons. The role of laser surgery in the oral cavity is well established. The use of diode laser frenectomy without infiltrated anaesthesia is currently under investigation. Needle-less oral surgery, without infiltrated anaesthesia, is a novel situation in paediatrics with paramount importance.

  17. [Community acquired pneumonia in children: Treatment of complicated cases and risk patients. Consensus statement by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Chest Diseases (SENP)].

    PubMed

    Moreno-Pérez, D; Andrés Martín, A; Tagarro García, A; Escribano Montaner, A; Figuerola Mulet, J; García García, J J; Moreno-Galdó, A; Rodrigo Gonzalo de Lliria, C; Saavedra Lozano, J

    2015-09-01

    The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression.

  18. Impact of Prominent Themes in Clinician-Patient Conversations on Caregiver's Perceived Quality of Communication with Paediatric Dental Visits.

    PubMed

    Wong, Hai Ming; Bridges, Susan Margaret; McGrath, Colman Patrick; Yiu, Cynthia Kar Yung; Zayts, Olga A; Au, Terry Kit Fong

    2017-01-01

    Patients' perceived satisfaction is a key performance index of the quality health care service. Good communication has been found to increase patient's perceived satisfaction. The purpose of this study was to examine the impact of the prominent themes arising from clinician-patient conversations on the caregiver's perceived quality of communication during paediatric dental visits. 162 video recordings of clinical dental consultations for 62 cases attending the Paediatric Dentistry Clinic of The Prince Philip Dental Hospital in Hong Kong were captured and transcribed. The patients' demographic information and the caregiver's perceived quality of communication with the clinicians were recorded using the 16-item Dental Patient Feedback on Consultation skills questionnaires. Visual text analytics (Leximancer™) indicated five prominent themes 'disease / treatment', 'treatment procedure related instructions', 'preparation for examination', 'positive reinforcement / reassurance', and 'family / social history' from the clinician-patient conversation of the recorded videos, with 60.2% of the total variance in concept words in this study explained through principal components analysis. Significant variation in perceived quality of communication was noted in five variables regarding the prominent theme 'Positive reinforcement / reassurance': 'number of related words' (p = 0.002), 'number of related utterances' (p = 0.001), 'percentage of the related words in total number of words' (p = 0.005), 'percentage of the related utterances in total number of utterances' (p = 0.035) and 'percentage of time spent in total time duration' (p = 0.023). Clinicians were perceived to be more patient-centered and empathetic if a larger proportion of their conversation showed positive reinforcement and reassurance via using related key words. Care-giver's involvement, such as clinicians' mention of the parent, was also seen as critical to perceptions of quality clinical experience. The study

  19. Sweat testing for the detection of atomoxetine from paediatric patients with attention deficit/ hyperactivity disorder: application to clinical practice.

    PubMed

    Marchei, Emilia; Papaseit, Esther; Garcia-Algar, Oscar; Bilbao, Amaia; Farré, Magí; Pacifici, Roberta; Pichini, Simona

    2013-03-01

    Atomoxetine (ATX) is a selective norepinephrine reuptake inhibitor approved since 2002 for the treatment of attention deficit hyperactivity disorder (ADHD) in children, adolescents, and adults as an alternative treatment to methylphenidate. Within the framework of a project evaluating the use of alternative biological matrices for therapeutic monitoring of psychoactive drugs in paediatric and non-paediatric individuals, the excretion of ATX and its principal metabolites has been recently studied in oral fluid and hair. The aim of this study was to describe the excretion profile of ATX and its metabolites 4-hydroxyatomoxetine (4-OH-ATX) and N-desmethylatomoxetine (N-des-ATX) in sweat following the administration of different dosage regimens (60, 40, 35, and 18 mg/day) of ATX to six paediatric patients. Sweat patches were applied to the back of each participant and removed at timed intervals. ATX and its metabolites were measured in patches using a previously validated liquid chromatography-tandem mass spectrometric (LC-MS/MS) method. Independently from the administered dose, ATX appeared in the sweat patches 1 h post administration and reached its maximum concentration generally at 24 h. Peak ATX concentrations ranged between 2.31 and 40.4 ng/patch and did not correlate with the administered drug dose, or with body surface area. Total ATX excreted in sweat ranged between 0.008 and 0.121 mg, corresponding to 0.02 and 0.3% of the administered drug. Neither 4-OH-ATX, nor N-des-ATX was detected in either of the collected sweat patches. Measuring ATX in sweat patches can provide information on cumulative drug use from patch application until removal.

  20. Respiratory paradoxical adverse drug reactions associated with acetylcysteine and carbocysteine systemic use in paediatric patients: a national survey.

    PubMed

    Mallet, Pauline; Mourdi, Nadjette; Dubus, Jean-Christophe; Bavoux, Françoise; Boyer-Gervoise, Marie-José; Jean-Pastor, Marie-Josèphe; Chalumeau, Martin

    2011-01-01

    To report pediatric cases of paradoxical respiratory adverse drug reactions (ADRs) after exposure to oral mucolytic drugs (carbocysteine, acetylcysteine) that led to the withdrawal of licenses for these drugs for infants in France and then Italy. The study followed the recommendations of the European guidelines of pharmacovigilance for medicines used in the paediatric population. Cases voluntarily reported by physicians from 1989 to 2008 were identified in the national French pharmacovigilance public database and in drug company databases. The definition of paradoxical respiratory ADRs was based on the literature. Exposure to mucolytic drugs was arbitrarily defined as having received mucolytic drugs for at least 2 days (>200 mg) and at least until the day before the first signs of the suspected ADR. The non-exclusive paradoxical respiratory ADRs reported in 59 paediatric patients (median age 5 months, range 3 weeks to 34 months, 98% younger than 2 years old) were increased bronchorrhea or mucus vomiting (n = 27), worsening of respiratory distress during respiratory tract infection (n = 35), dyspnoea (n = 18), cough aggravation or prolongation (n = 11), and bronchospasm (n = 1). Fifty-one (86%) children required hospitalization or extended hospitalization because of the ADR; one patient died of pulmonary oedema after mucus vomiting. Parents, physicians, pharmacists, and drug regulatory agencies should know that the benefit risk ratio of mucolytic drugs is at least null and most probably negative in infants according to available evidence.

  1. Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa.

    PubMed

    Van Eyssen, A; Novitsky, N; De Wit, P; Schlaphoff, T; Thomas, V; Pillay, D; Hendricks, M; Davidson, A

    2017-02-27

    Allogeneic haemopoietic stem cell transplant (Allo-HSCT) is a specialised and costly intervention, associated with significant morbidity and mortality. It is used to treat a broad range of paediatric conditions. South Africa (SA) is an upper middle-income country with limitations on healthcare spending. The role of paediatric Allo-HSCT in this setting is reviewed. To review paediatric patients who underwent Allo-HSCT at the Groote Schuur Hospital/University of Cape Town Private Academic Hospital transplant unit in Cape Town, South Africa, and received post-transplant care at Red Cross War Memorial Children's Hospital, over the period January 2006 - December 2014 in respect of indications for the transplant, donor sources, conditioning regimens, treatment-related morbidity and overall survival (OS). A retrospective analysis of patient records was performed and a database was created in Microsoft Access. Descriptive analyses of relevant demographic, clinical and laboratory data were performed. Summary statistics of demographic and clinical parameters were derived with Excel. OS was calculated from the date of transplant to the date of an event (death) or last follow-up using the Kaplan-Meier method in Statistica. A total of 48 children received Allo-HSCT: 24 for haematological malignancies, 20 for non-oncological haematological conditions, 3 for immune disorders and 1 for adrenoleukodystrophy. There were 28 boys (median age 7.5 years) and 20 girls (8.5 years). There were 31 sibling matched peripheral-blood stem cell (PBSC) transplants and 1 maternal haploidentical PBSC transplant. Stem cells were mobilised from bone marrow into peripheral blood by administering granulocyte-colony stimulating factor to donors. PBSCs were harvested by apheresis. Eight patients received 10/10 HLA-matched grafts from unrelated donors. Six were PBSC grafts and 2 were bone marrow grafts. Three of the unrelated PBSC grafts were from SA donors. Eight transplants used umbilical cord blood

  2. Adenovirus infection and disease in paediatric haematopoietic stem cell transplant patients: clues for antiviral pre-emptive treatment.

    PubMed

    Feghoul, L; Chevret, S; Cuinet, A; Dalle, J-H; Ouachée, M; Yacouben, K; Fahd, M; Guérin-El Khourouj, V; Roupret-Serzec, J; Sterkers, G; Baruchel, A; Simon, F; LeGoff, J

    2015-07-01

    Human adenovirus (HAdV) infections constitute a major cause of morbidity in paediatric haematopoietic stem cell transplant (HSCT) patients. New antiviral treatments offer promising perspectives. However, it remains challenging to identify patients at risk for disseminated infection, and who should receive early antiviral intervention. We conducted a longitudinal study of allogeneic HSCT recipients, including weekly HAdV monitoring, to determine the risks factors associated with HAdV infection and dissemination, and to assess whether HAdV loads in stools may be used as surrogate markers for HAdV dissemination. Between September 2010 and December 2011, out of 72 patients, the cumulative incidence rates at day 100 of HAdV digestive infection, systemic infection and related disease were 35.9%, 24.0%, and 18.3%, respectively. In multivariate analysis, the risk factors for HAdV digestive and systemic infection were cord blood and in vitro T-cell depletion. Graft-versus-host disease (GVHD) grade >2 was also associated with systemic infection. In patients with HAdV digestive shedding, GVHD grade >2 and HAdV load in stools were the only risk factors for systemic infection. The median peak levels of HAdV in stool were 7.9 and 4.0 log10 copies/mL, respectively, in patients with HAdV systemic infection and in those without. HAdV monitoring in stools of paediatric HSCT recipients receiving cord blood or in vitro T-cell depleted transplants helps to predict patients at risk for HAdV systemic infection. Our results provide a rationale for randomized controlled trials to evaluate the benefit of anti-HAdV pre-emptive treatments based on HAdV DNA levels in stools.

  3. The cost effectiveness of treating paediatric cancer in low-income and middle-income countries: a case-study approach using acute lymphocytic leukaemia in Brazil and Burkitt lymphoma in Malawi.

    PubMed

    Bhakta, Nickhill; Martiniuk, Alexandra L C; Gupta, Sumit; Howard, Scott C

    2013-02-01

    Approximately 90% of children with cancer reside in low-income and middle-income countries (LMIC) where healthcare resources are scarce and allocation decisions difficult. The cost effectiveness of treating childhood cancers in these settings is unknown. The objective of the present work was to determine cost-effectiveness thresholds for common paediatric cancers using acute lymphoblastic leukaemia (ALL) in Brazil and Burkitt lymphoma (BL) in Malawi as examples. Disability-adjusted life years (DALYs) prevented by treatment were compared to the gross domestic product (GDP) per capita of each country to define cost-effectiveness thresholds using WHO-CHOICE ('CHOosing Interventions that are Cost-Effective') guidelines. The case examples were selected due to the data available and because ALL and BL both have the potential to yield significant health gains at a low cost per patient treated. The key findings were as follows: the 3:1 cost/DALY prevented to GDP/capita ratio for ALL in Brazil was US $771,225; expenditures below this threshold were cost effective. Costs below US $257,075 (1:1 ratio) were considered very cost effective. Analogous thresholds for BL in Malawi were US $42,729 and US $14,243. Actual costs were far less. In Brazil, US $16,700 was spent to treat each patient while in Malawi total drug costs were less than US $50 per child. In summary, treatment of certain paediatric cancers in LMIC is very cost effective. Future research should evaluate actual treatment and infrastructure expenditures to help guide policymakers.

  4. Psychological wellbeing and quality-of-life among siblings of paediatric CFS/ME patients: A mixed-methods study

    PubMed Central

    Velleman, Sophie; Collin, Simon M; Beasant, Lucy; Crawley, Esther

    2015-01-01

    Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a disabling condition known to have a negative impact on all aspects of a child’s life. However, little is understood about the impact of CFS/ME on siblings. A total of 34 siblings completed questionnaires measuring depression (Hospital Anxiety and Depression Scale (HADS)), anxiety (HADS and Spence Children’s Anxiety Scale (SCAS)) and European Quality-of-life-Youth (EQ-5D-Y). These scores were compared with scores from normative samples. Siblings had higher levels of anxiety on the SCAS than adolescents of the same age recruited from a normative sample; however, depression and quality-of-life were similar. Interviews were undertaken with nine siblings of children with CFS/ME who returned questionnaires. Interview data were analysed using a framework approach to thematic analysis. Siblings identified restrictions on family life, ‘not knowing’ and lack of communication as negative impacts on their family, and change of role/focus, emotional reactions and social stigma as negative impacts on themselves. They also described positive communication, social support and extra activities as protective factors. Paediatric services should be aware of the impact of CFS/ME on the siblings of children with CFS/ME, understand the importance of assessing paediatric CFS/ME patients within the context of their family and consider providing information for siblings about CFS/ME. PMID:26395764

  5. Psychological wellbeing and quality-of-life among siblings of paediatric CFS/ME patients: A mixed-methods study.

    PubMed

    Velleman, Sophie; Collin, Simon M; Beasant, Lucy; Crawley, Esther

    2016-10-01

    Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a disabling condition known to have a negative impact on all aspects of a child's life. However, little is understood about the impact of CFS/ME on siblings. A total of 34 siblings completed questionnaires measuring depression (Hospital Anxiety and Depression Scale (HADS)), anxiety (HADS and Spence Children's Anxiety Scale (SCAS)) and European Quality-of-life-Youth (EQ-5D-Y). These scores were compared with scores from normative samples. Siblings had higher levels of anxiety on the SCAS than adolescents of the same age recruited from a normative sample; however, depression and quality-of-life were similar. Interviews were undertaken with nine siblings of children with CFS/ME who returned questionnaires. Interview data were analysed using a framework approach to thematic analysis. Siblings identified restrictions on family life, 'not knowing' and lack of communication as negative impacts on their family, and change of role/focus, emotional reactions and social stigma as negative impacts on themselves. They also described positive communication, social support and extra activities as protective factors. Paediatric services should be aware of the impact of CFS/ME on the siblings of children with CFS/ME, understand the importance of assessing paediatric CFS/ME patients within the context of their family and consider providing information for siblings about CFS/ME. © The Author(s) 2015.

  6. Comparison of oral dexmedetomidine versus oral midazolam as premedication to prevent emergence agitation after sevoflurane anaesthesia in paediatric patients.

    PubMed

    Prabhu, M Kavya; Mehandale, Sripada G

    2017-02-01

    Sevoflurane is the most often used inhalational agent in paediatric anaesthesia, but emergence agitation (EA) remains a major concern. Oral midazolam and parenteral dexmedetomidine are known to be effective in controlling EA. We attempted to elucidate whether oral dexmedetomidine is better than midazolam in controlling EA. Prospective double-blinded study involving ninety patients aged 1-10 years, undergoing elective surgeries of <2 h of expected duration under sevoflurane general anaesthesia, randomised to receive either midazolam (Group A) or dexmedetomidine (Group B) as oral premedication was carried out to record level of sedation before induction, haemodynamic parameters and recovery time. Incidence and severity of EA, post-operative pain and requirement of rescue analgesic were assessed at 0, 5, 15, 30 and 60 min postoperatively. Data were analysed applying Student's t-test and Chi-square test using SPSS software. Mask acceptance was better in Group B (97.8% vs. 73.4%, P < 0.001). Mean arterial pressure was lower in Group B (P < 0.001) though clinically not significant. More rescue analgesic was required in Group A (5.6% vs. 0%). There was no significant difference in adverse effects. Although there was a higher incidence of EA in Group A (Aono's score 3 and 4; 40% vs. 4.4%), none of them required intervention (paediatric anaesthesia emergence delirium score >10; 0 vs. 0). Premedication with oral dexmedetomidine provides smooth induction and recovery, reduces the EA and provides better analgesia and sedation as compared to oral midazolam.

  7. Impact of magnetic resonance urography and ultrasonography on diagnosis and management of hydronephrosis and megaureter in paediatric patients.

    PubMed

    Wildbrett, Peer; Langner, Sönke; Lode, Holger; Abel, Jürgen; Otto, Sylke; Hosten, Norbert; Barthlen, Winfried

    2012-01-01

    (1) To evaluate the diagnostic value of magnetic resonance urography (MRU) in comparison with ultrasonography (US) to determine the extent of upper urinary tract dilation and (2) to evaluate the impact of MRU on therapy management. From January 2005 to December 2010, paediatric patients with hydronephrosis or megaureter who underwent MRU in addition to standard work-up imaging were included. Data were retrospectively collected and analysed in comparison with the data obtained from results by US. Forty-five patients with upper urinary tract dilatation were included into the study. Twenty-six patients (58%) had a hydronephrosis and 19 patients (42%) presented with a megaureter. Diagnosis was established in all patients by multimodulary imaging work-up including micturating cysto-urethrography, MAG3 renography, US and MRU and could be confirmed in all patients who underwent surgery (n = 28). Hydronephrosis was detected in 26 of 26 patients by US (100% sensitivity) and in 25 of 26 patients (96%) by MRU (Not significant (n.s.)). Megaureter was detected in 17 of 19 patients (sensitivity 89%) by US and in 18 of 19 patients (sensitivity 95%) by MRU (n.s.). In all 45 patients, MRU had no impact on surgical or conservative management of hydronephrosis or megaureter. In our experience, MRU was not superior to US in detecting hydronephrosis or megaureter and had no impact on the surgical or conservative management of upper urinary tract dilation.

  8. Effects of end tidal CO2 and venous CO2 levels on postoperative nausea and vomiting in paediatric patients.

    PubMed

    Altay, N; Yalçın, S; Aydoğan, H; Küçük, A; Yüce, H H

    2015-11-01

    Postoperative nausea and vomiting (PONV) is a common complaint of paediatric surgical patients. The aim of this prospective study was to compare the effects of end tidal CO2 (PeCO2) and venous CO2 (PvCO2) in laryngeal mask (LMA) and face mask (FM) ventilation on the occurrence of PONV in paediatric patients with surgical interventions in the inguinal region. To date, no data regarding these parameters on PONV are available. Ninety children were randomized using the sealed-envelope method. Group 1 consisted of 45 patients whose airway was managed with LMA; Group 2 consisted of 45 patients whose airway was managed with FM. Induction of anaesthesia was performed via administration of 8% sevoflurane in a mixture of air/oxygen in all patients. In both groups, manually controlled ventilation was applied. Five (t1) and fifteen (t2) min after the start of surgery, venous blood samples were obtained and PeCO2 was determined. PeCO2 (t2) and PvCO2 (t2) levels and the occurrence of PONV were significantly increased in Group 2 compared to Group 1 (p < 0.005 for all). In both groups, the occurrence of PONV was positively correlated with BMI, PeCO2 (t2), and PvCO2 (t2) levels (p < 0.05 for all), whereas it was inversely correlated with SpO2 levels (p < 0.05 for all) in a bivariate analysis. We found that the PeCO2 (t2) and PvCO2 (t2) levels were independently associated with the occurrence of PONV in both groups. Our results showed that elevated levels of PeCO2 (t2) and PvCO2 (t2) are independent risk factors for PONV, and these parameters may be used as adjunctive tools to assess the occurrence of PONV.

  9. The use of a reconstituted collagen foil dura mater substitute in paediatric neurosurgical procedures--experience in 47 patients.

    PubMed

    Pettorini, Benedetta Ludovica; Tamburrini, Gianpiero; Massimi, Luca; Paternoster, Giovanna; Caldarelli, Massimo; Di Rocco, Concezio

    2010-02-01

    CSF leakage is a common complication of neurosurgical procedures, with defective dural suture thought to be the most frequent cause. We report our experience with a new collagen foil (TissuDura, Baxter Healthcare SA, Switzerland) utilized as dural substitute in paediatric neurosurgical procedures. TissuDura was used in children consecutively operated on at the department of paediatric neurosurgery, Catholic University, Rome, from March 2004 to August 2007. Children underwent surgical procedures in supratentorial, infratentorial and spinal compartments. In supratentorial and spinal procedures, the dural graft was used according to the overlay technique. In the posterior fossa procedures, the underlay technique was used. Forty-seven patients received TissuDura during surgery. Thirty-one patients underwent surgery for the removal of posterior fossa tumours, nine for supratentorial tumours and seven for spinal dysraphisms. No CSF leakage was observed following the use of TissuDura in supratentorial procedures. Two post-operative CSF leaks occurred in patients who had undergone spinal surgery. No post-operative hydrocephalus was noted in these two surgery groups. Three cases of CSF leakage occurred in patients who had undergone posterior cranial fossa surgery. All 3 cases had an associated supratentorial ventricular dilation present prior to the removal of the tumour (one case) or occurring after the tumour excision (two cases). No clinically evident adverse reactions directly related to TissuDura were observed. The main advantages of TissuDura were its apparent ability to prevent CSF leakage when utilized in a specific subset of patients, and the absence of reactions or postoperative infections.

  10. Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain.

    PubMed

    Malfliet, Anneleen; Leysen, Laurence; Pas, Roselien; Kuppens, Kevin; Nijs, Jo; Van Wilgen, Paul; Huysmans, Eva; Goudman, Lisa; Ickmans, Kelly

    In the last decade, evidence regarding chronic pain has developed exponentially. Numerous studies show that many chronic pain populations show specific neuroplastic changes in the peripheral and central nervous system. These changes are reflected in clinical manifestations, like a generalized hypersensitivity of the somatosensory system. Besides a hypersensitivity of bottom-up nociceptive transmission, there is also evidence for top-down facilitation of pain due to malfunctioning of the endogenous descending nociceptive modulatory systems. These and other aspects of modern pain neuroscience are starting to be applied within daily clinical practice. However, currently the application of this knowledge is mostly limited to the general adult population with musculoskeletal problems, while evidence is getting stronger that also in other chronic pain populations these neuroplastic processes may contribute to the occurrence and persistence of the pain problem. Therefore, this masterclass article aims at giving an overview of the current modern pain neuroscience knowledge and its potential application in post-cancer, paediatric and sports-related pain problems. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  11. Rehabilitation of cancer patients.

    PubMed

    Pandey, M; Thomas, B C

    2001-01-01

    With the developments in cancer treatment, more and more patients are surviving their disease. However, very little emphasis is being placed to rehabilitate these cancer survivors. Ignorance, social structure, stigma attached in seeking psychological help, and poor communication skills of oncology staff all contribute to poor rehabilitative efforts. The priority of governmental agencies and health efforts to fight rampant communicable diseases, malnutrition, maternal health, and the frequent natural calamities, puts rehabilitation movements in the back seat. Treatment and prevention of disability and its rehabilitation requires comprehensive and multidisciplinary approach. There is an urgent need to promote physical and psychological rehabilitation.

  12. Frontal and temporal horn ratio: a valid and reliable index to determine ventricular size in paediatric hydrocephalus patients?

    PubMed

    Antes, Sebastian; Kiefer, Michael; Schmitt, Melanie; Lechtenfeld, Miriam; Geipel, Martina; Eymann, Regina

    2012-01-01

    Because there is currently no sufficient and prevalent parameter for estimating ventricular size in paediatric hydrocephalus patients by using cranial ultrasound, a new measurement index, called the "frontal and temporal horn ratio", is presented in this study. The advantage of the new quotient is that it can be detected in easily obtainable coronal ultrasound planes. A retrospective analysis of 149 MRIs of young hydrocephalus patients proved the new index to be a promising parameter of ventricular size assessment. Statistical comparison between the "frontal and temporal horn ratio" and the already validated "frontal and occipital horn ratio" revealed a strong and linear correlation between the two quotients. Current research is now evaluating the reliability of the new index in the context of an ultrasound study; first results indicate similar positive findings.

  13. Nifedipine capsules may provide a viable alternative to oral powders for paediatric patients.

    PubMed

    Helin-Tanninen, M; Naaranlahti, T; Kontra, K; Savolainen, K

    2007-02-01

    To compare content uniformities between different sizes of extemporaneously compounded nifedipine oral powders and capsules, in order to find out if capsules could be used instead of oral powders as paediatric medications. Actual content and content uniformity of extemporaneously compounded 1-mg nifedipine oral powders and capsules were evaluated by a high performance liquid chromatographic assay. Capsules and powders were prepared by triturating 10-mg nifedipine tablets with different amounts of lactose or microcrystalline cellulose with a mortar and pestle using a standard geometric dilution technique. Oral powders were weighed individually and capsules were filled by a hand-operated capsule-filling machine. Four different sizes of powders (500, 300, 100 and 50 mg) and three different sizes of capsules (numbers 1, 3 and 4) were prepared. Ten oral powders and 10 capsules from each batch were randomly selected and individually assayed for nifedipine amount. The extemporaneously prepared nifedipine oral powders and capsules were within acceptable limits for content uniformity, as defined by the European Pharmacopoeia, but the results indicate that the loss of nifedipine during the preparation process may be considerable for both preparations. The concentration on nifedipine decreased while the total mass of the oral powder decreased. These results demonstrate that nifedipine oral powders can be replaced by capsules, whose contents are emptied for use, in paediatric medications. Compounding small capsules, such as size number 3 or 4, is acceptable when considering the average drug content. The total weight of the oral powder should be at least 300 mg. The preparation of nifedipine in all studied capsule sizes was safe with either lactose monohydrate or microcrystalline cellulose as excipients. Thus, emptied capsules seem to be a good choice for delivering a paediatric medication. The loss of nifedipine was considerable in oral powders with low total weight.

  14. [Fever in Cancer Patients].

    PubMed

    Cornely, Oliver Andreas; Mellinghoff, Sibylle Christiane

    2017-07-01

    Fever in cancer patients is a medical emergency until a severe infection has been ruled out. In case of neutropenia prompt diagnostic work-up should be paralleled by empiric antibiotic treatment. Underlying malignancy as well as treatments may impair immune response and thus pave the way for less virulent pathogens. So the spectrum of infections comprises both pathogens that cause disease in immunocompetent patients and a variety of rarer organisms. After collecting two pairs of blood cultures, broad-spectrum antibiotic treatment should commence within one to two hours. Depending on the individual patient's risk antimicrobial prophylaxis should be considered. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Horner's syndrome in patients admitted to the paediatric intensive care unit: epidemiology, diagnosis and clinical practice.

    PubMed

    Lazar, I; Cavari, Y; Rosenberg, E; Knyazer, B

    2013-01-01

    Horner's syndrome appears when the three-neuron sympathetic pathway is interrupted anywhere from the posterior-lateral nuclei of the hypothalamus through the spinal cord to the eye. In children, Horner's syndrome can be either congenital or acquired, but overall it is a rare finding. There are several causes of Horner's syndrome, some of iatrogenic. Although uncommon in the paediatric population, prompt recognition of the syndrome and immediate treatment may prevent permanent damage to the neuronal pathway. Awareness of the risk of developing iatrogenic Horner's syndrome and early detection of signs are recommended to minimise future disability.

  16. Kingella kingae infections in paediatric patients: 5 cases of septic arthritis, osteomyelitis and bacteraemia.

    PubMed

    Birgisson, H; Steingrimsson, O; Gudnason, T

    1997-01-01

    Kingella kingae is a Gram-negative rod most often recognized as 1 of the organisms causing septic arthritis and osteomyelitis in children. Infection caused by K. kingae had not been diagnosed in Iceland until 5 cases were diagnosed at the Paediatric Department at the University Hospital of Iceland over a 1 year period. In this report we describe these 5 children with invasive infection caused by K. kingae (2 with septic arthritis, 1 with osteomyelitis, 1 with septic arthritis and osteomyelitis, and 1 with bacteraemia) and review the literature. All bacterial isolates were identified by the Bactec culture system.

  17. The CBCL as a screen for psychiatric comorbidity in paediatric patients with ADHD

    PubMed Central

    Biederman, J; Monuteaux, M; Kendrick, E; Klein, K; Faraone, S

    2005-01-01

    Aims: To examine the informativeness of the Child Behavior Checklist (CBCL) as a screening tool to identify comorbid and non-comorbid cases of attention deficit hyperactivity disorder (ADHD) in a paediatrically referred population. It was hypothesised that specific scales of the CBCL would help identify specific comorbidities within ADHD cases in the primary care setting. Methods: The sample consisted of children and adolescents 6–17 years old of both genders with ADHD (n = 121). A receiver operating curve (ROC) approach was used to determine which CBCL scales best differentiated between ADHD cases with and without its comorbidities with conduct, anxiety, and mood disorders. Results: ROC analysis showed that the CBCL Delinquent Behavior and Aggressive Behavior scales predicted the structured interview derived diagnoses of conduct and bipolar disorder, the Anxious/Depressed and Aggressive Behavior scales predicted major depression, and the Anxious/Depressed and Attention problems scales predicted anxiety disorders. Conclusions: These results extend to a paediatrically referred population with previously reported findings in psychiatric samples documenting good convergence between structured interview diagnoses and syndrome congruent CBCL scales. These findings support the utility of the CBCL as a screening tool for the identification of psychiatric comorbidity in ADHD youth in the primary care setting. PMID:16177156

  18. A review of paediatric telehealth for pre- and post-operative surgical patients.

    PubMed

    Smith, Anthony C; Garner, Lisa; Caffery, Liam J; McBride, Craig A

    2014-10-01

    The Queensland Telepaediatric Service (QTS) was established in the year 2000 to deliver a broad range of paediatric specialist health services from the Royal Children's Hospital (RCH) in Brisbane, mainly via videoconference. During a 13-year study period, the QTS facilitated 18,949 video consultations, comprising Mental Health (42%), Medicine (30%), Surgery (21%) and Other (8%). We reviewed the surgical services provided through the QTS. There were 3880 video consultations with a paediatric surgeon. Most of these (91%) used fixed videoconferencing units, 8% were delivered via mobile units (robots) and 1% were delivered using Skype. Surgical consultations were provided by telehealth to 106 sites: 89% in Queensland and the rest to other states. The main surgical specialties were burns (50%), ear, nose and throat (19%), general surgery (21%), orthopaedics (9%) and vascular anomalies (2%). During a 12-month audit period, there were 224 teleconsultations in general surgery; the most common reason for referral was for undescended testes (17%). During the study period there was a significant growth in all surgical telehealth activity: linear regression showed an annual increase of 17 cases per year (P < 0.02). In the last four years of the study, there was a substantial growth in the general surgical component, although there was also a reduction in the burns component. Telehealth has potential for other specialist consultations which require periodic assessment and review.

  19. Screening for depression in adolescent paediatric patients: validity of the new Depression Screener for Teenagers (DesTeen).

    PubMed

    Pietsch, Kathrin; Allgaier, Antje-Kathrin; Frühe, Barbara; Rohde, Sabine; Hosie, Stuart; Heinrich, Martina; Schulte-Körne, Gerd

    2011-09-01

    Depression in adolescents is often hard to detect. In many cases paediatricians are the first point of contact. In order to increase recognition rates, screening instruments may be a helpful support for health care professionals. However, there is a lack of valid and economical screening instruments for primary care patients. Thus, the aim of the study was the development of the new Depression Screener for Teenagers (DesTeen) and its validation in a paediatric sample. 326 patients between 13 and 16 years old completed the DesTeen and a diagnostic interview, serving as gold standard. Prevalence rate for any depressive disorder (minor depression, major depression and dysthymia) was 12.6%. Psychometric properties were calculated. For validity measures, the area under the receiver operating characteristic curves (AUC) for any depressive disorder and the diagnostic subgroups was computed. DesTeen showed a high reliability (Cronbach's α=.87) and a high validity (AUC=.91). For the diagnostic subgroups AUC values did not significantly differ from overall accuracy of any depressive disorder (major depression: AUC=.95, p=.179; dysthymia: AUC=.88, p=.605; minor depression: AUC=.87, p=.327). The optimal cut-off point for any depressive disorder according to the Youden-Index yielded a sensitivity of .90 and a specificity of .80. An abbreviated 5-item version of DesTeen showed no loss in validity (AUC=.90, p=.695). Overall, DesTeen can be regarded as a valid screening instrument for adolescent paediatric patients. For practical use, the 5-item version is even more promising. A replication of these results is essential. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. Evaluation of radiation dose to anthropomorphic paediatric models from positron-emitting labelled tracers

    NASA Astrophysics Data System (ADS)

    Xie, Tianwu; Zaidi, Habib

    2014-03-01

    PET uses specific molecules labelled with positron-emitting radionuclides to provide valuable biochemical and physiological information. However, the administration of radiotracers to patients exposes them to low-dose ionizing radiation, which is a concern in the paediatric population since children are at a higher cancer risk from radiation exposure than adults. Therefore, radiation dosimety calculations for commonly used positron-emitting radiotracers in the paediatric population are highly desired. We evaluate the absorbed dose and effective dose for 19 positron-emitting labelled radiotracers in anthropomorphic paediatric models including the newborn, 1-, 5-, 10- and 15-year-old male and female. This is achieved using pre-calculated S-values of positron-emitting radionuclides of UF-NCI paediatric phantoms and published biokinetic data for various radiotracers. The influence of the type of anthropomorphic model, tissue weight factors and direct human- versus mouse-derived biokinetic data on the effective dose for paediatric phantoms was also evaluated. In the case of 18F-FDG, dosimetry calculations of reference paediatric patients from various dose regimens were also calculated. Among the considered radiotracers, 18F-FBPA and 15O-water resulted in the highest and lowest effective dose in the paediatric phantoms, respectively. The ICRP 103 updated tissue-weighting factors decrease the effective dose in most cases. Substantial differences of radiation dose were observed between direct human- versus mouse-derived biokinetic data. Moreover, the effect of using voxel- versus MIRD-type models on the calculation of the effective dose was also studied. The generated database of absorbed organ dose and effective dose for various positron-emitting labelled radiotracers using new generation computational models and the new ICRP tissue-weighting factors can be used for the assessment of radiation risks to paediatric patients in clinical practice. This work also contributes

  1. Electronic Patient Reported Outcomes in Paediatric Oncology - Applying Mobile and Near Field Communication Technology.

    PubMed

    Duregger, Katharina; Hayn, Dieter; Nitzlnader, Michael; Kropf, Martin; Falgenhauer, Markus; Ladenstein, Ruth; Schreier, Günter

    2016-01-01

    Electronic Patient Reported Outcomes (ePRO) gathered using telemonitoring solutions might be a valuable source of information in rare cancer research. The objective of this paper was to develop a concept and implement a prototype for introducing ePRO into the existing neuroblastoma research network by applying Near Field Communication and mobile technology. For physicians, an application was developed for registering patients within the research network and providing patients with an ID card and a PIN for authentication when transmitting telemonitoring data to the Electronic Data Capture system OpenClinica. For patients, a previously developed telemonitoring system was extended by a Simple Object Access Protocol (SOAP) interface for transmitting nine different health parameters and toxicities. The concept was fully implemented on the front-end side. The developed application for physicians was prototypically implemented and the mobile application of the telemonitoring system was successfully connected to OpenClinica. Future work will focus on the implementation of the back-end features.

  2. Azole-based chemoprophylaxis of invasive fungal infections in paediatric patients with acute leukaemia: an internal audit.

    PubMed

    Yunus, Sara; Pieper, Stephanie; Kolve, Hedwig; Goletz, Grazyna; Jürgens, Heribert; Groll, Andreas H

    2014-03-01

    Children and adolescents with acute myeloid leukaemia (AML) and recurrent acute leukaemias (RALs) are at high risk of life-threatening invasive fungal infections (IFIs). We analysed implementation, safety and efficacy of a standard operating procedure for oral, azole-based, mould-active antifungal prophylaxis. Patients with AML and RALs aged ≥13 years received 200 mg of posaconazole three times daily and patients aged 2-12 years received 200 mg of voriconazole two times daily from the completion of chemotherapy until haematopoietic recovery. Algorithms for fever or focal findings in all patients with haematological malignancies included blood cultures, high-resolution CT and other appropriate imaging, serial serum galactomannan, invasive diagnostics and pre-emptive therapy with change in class if on antifungal medication. From 2006 to 2010, 40 patients (0.8-17 years; 21 males) with newly diagnosed AML (n = 31) or RAL (n = 9) were admitted, of whom 36 received a total of 149 courses of chemotherapy (reasons for exclusion: contraindications and early death ≤3 days). Azole prophylaxis was given in 87.2% (n = 130/149) of episodes. Pre-emptive antifungal therapy for pulmonary infiltrates was initiated in 5/36 (13.9%) patients or 6/130 (4.6%) episodes for a duration of 3-22 days. No proven or probable IFIs occurred. Adverse events (AEs) were common but mostly low grade and reversible. Three courses (2.3%) were discontinued due to AEs. In simultaneously admitted new patients with acute lymphatic leukaemia (ALL; n = 101) and paediatric lymphomas (n = 29) not receiving standard antifungal prophylaxis, proven/probable IFIs occurred in 4 patients with ALL (4.0%) and 7/130 patients (5.4%) received pre-emptive therapy. Azole-based, mould-active antifungal prophylaxis in high-risk paediatric patients with AML and RALs was satisfactorily implemented, well tolerated and effective. The low rate of IFIs in patients with ALL/lymphoma supports the lack of a general indication for

  3. Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality?

    PubMed Central

    Zachariah, R.; Hinderaker, S. G.; Khogali, M.; Manzi, M.; van Griensven, J.; Ayada, L.; Jemmy, J. P.; Maalim, A.; Amin, H.

    2013-01-01

    Setting: A district hospital in conflict-torn Somalia. Objective: To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care. Design: Cross-sectional study. Results: Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded. Conclusion: Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage. PMID:26393014

  4. The outcomes and treatment burden of childhood acute myeloid leukaemia in Australia, 1997-2008: A report from the Australian Paediatric Cancer Registry.

    PubMed

    Foresto, Steven A; Youlden, Danny R; Baade, Peter D; Hallahan, Andrew R; Aitken, Joanne F; Moore, Andrew S

    2015-09-01

    Childhood acute myeloid leukaemia (AML) requires intensive therapy and is associated with survival rates that are substantially inferior to many other childhood malignancies. We undertook a retrospective analysis of Australian Paediatric Cancer Registry data from 1997 to 2008 together with a single-centre audit during the same period assessing burden on service delivery at a tertiary children's hospital (Royal Children's Hospital, Brisbane). Although survival improved from 54.3% (1997-2002) to 69.2% (2003-2008), childhood AML caused a disproportionate number of childhood cancer deaths, accounting for 5.5% of all childhood cancer diagnoses yet 7.9% of all childhood cancer mortality. Furthermore, treatment was associated with significant toxicity requiring intensive use of local health resources. Novel therapeutic strategies aimed at improving survival and reducing toxicity are urgently required. © 2015 Wiley Periodicals, Inc.

  5. Assessment of cardiovascular risk in paediatric peritoneal dialysis patients: a Turkish Pediatric Peritoneal Dialysis Study Group (TUPEPD) report.

    PubMed

    Bakkaloglu, Sevcan A; Saygili, Arda; Sever, Lale; Noyan, Aytul; Akman, Sema; Ekim, Mesiha; Aksu, Nejat; Doganay, Beyza; Yildiz, Nurdan; Duzova, Ali; Soylu, Alper; Alpay, Harika; Sonmez, Ferah; Civilibal, Mahmut; Erdem, Sevcan; Kardelen, Firat

    2009-11-01

    We aimed to clarify arteriosclerotic risk and to document possible relationships between cardiovascular risk factors and echocardiographic parameters in paediatric peritoneal dialysis (PD) patients. M-mode/Doppler/tissue Doppler echocardiographic studies and lipid/lipoproteins, homocysteine, high-sensitivity C-reactive protein (HS-CRP) levels and carotid intima-media thickness (CIMT) were determined in 59 patients (age: 14.2 +/- 4.5 years) and in 36 healthy subjects. Structural and functional cardiac abnormalities were observed in patients on maintenance dialysis. Increased left ventricular mass index (LVMI, P = 0.000), relative wall thickness (P = 0.000), myocardial performance index (MPI, P = 0.000) were documented in the patients. Lipoprotein (a) (P = 0.000), homocysteine (P = 0.001), HS-CRP (P = 0.000) and CIMT (P = 0.000) were significantly elevated in the patients. Left ventricular hypertrophy (LVH) was prevalent in 68% of the patients. Patients with LVH had higher levels of HS-CRP (P = 0.001) and CIMT (P = 0.028) than those without LVH. Haemoglobin was an independent predictor of LVMI (beta: -8.9, P = 0.001), while residual diuresis and CIMT were independent predictors of diastolic dysfunction (beta: -0.45, P = 0.034 and beta: 5.90, P = 0.008, respectively). Albumin (beta: -0.72, P = 0.018) and Kt/V urea (beta: -0.48, P = 0.012) were significant predictors of CIMT. There were positive correlations between LVMI and CIMT. HS-CRP was positively correlated with LVMI as well as CIMT. Elevated levels of atherosclerotic/ inflammatory risk factors, low haemoglobin levels and loss of residual renal function and their negative effects on heart are of remarkable importance in paediatric patients on maintenance peritoneal dialysis. Achieving recommended targets for haemoglobin, blood pressure and Kt/V urea, preserving residual renal function as well as managing inflammation and subsequent arteriosclerosis is obviously essential to improve the patients' prognosis.

  6. Prevalence and severity of patient harm in a sample of UK-hospitalised children detected by the Paediatric Trigger Tool

    PubMed Central

    Chapman, Susan M; Fitzsimons, John; Davey, Nicola; Lachman, Peter

    2014-01-01

    The measurement and examination of adverse events (AEs) that occur in children during hospital admissions is essential if we are to prevent, reduce or ameliorate the harm experienced. The UK Paediatric Trigger Tool (UKPTT) is a method of retrospective case note review that measures harm in hospitalised children. Objectives To examine the harm resulting from the processes of healthcare in hospitalised children from centres providing data to the National Health Service (NHS) Institute UKPTT data portal, to understand the positive predictive values of triggers and to make recommendations for the further development of the trigger tool. Setting 25 hospitals across the UK, including secondary, tertiary and quaternary paediatric centres. Participants Randomly selected children who were admitted to hospital for longer than 24 h. Outcome measures The primary outcome measure was the rate of harm (the percentage of children experiencing one or more AEs during a hospital admission). Secondary measures were the severity of harm and performance of triggers. Results Data from 3992 patient admissions were reviewed across the hospitals and submitted to the trigger tool portal from February 2008 to November 2011. At least one AE was reported for 567 (14.2%) patients, with 211 (5.3%) experiencing more than one event. There were 1001 AEs identified. Where harm occurred, it was considered temporary for 923 (92.2%) AEs; however, 43 (4.3%) AEs resulted in the need for life-sustaining interventions, 18 (1.8%) AEs led to permanent harm and for 17 children (1.7% of AEs) the AE was believed to have contributed to death. Conclusions There is a significant, measurable level of harm experienced by children admitted to hospitals in the UK. While most of this harm is temporary, some of it is serious. The UKPTT offers organisations the means to measure and examine the AEs occurring in their hospital in order to reduce harm. PMID:24993759

  7. Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients.

    PubMed

    Wang, Xue-Qing; Mill, Julie; Kravchuk, Olena; Kimble, Roy M

    2010-12-01

    This study describes the ultrasound assessment of burn scars in paediatric patients and the association of these scar thickness with laser Doppler imaging (LDI) determined burn depth. A total of 60 ultrasound scar assessments were conducted on 33 scars from 21 paediatric burn patients at 3, 6 and 9 months after-burn. The mean of peak scar thickness was 0.39±0.032 cm, with the thickest at 6 months (0.40±0.036 cm). There were 17 scald burn scars (0.34±0.045 cm), 4 contact burn scars (0.61±0.092 cm), and 10 flame burn scars (0.42±0.058 cm). Each group of scars followed normal distributions. Twenty-three scars had original burns successfully scanned by LDI and various depths of burns were presented by different colours according to blood perfusion units (PU), with dark blue <125, light blue 125-250, and green 250-440 PU. The thickness of these scars was significantly different between the predominant colours of burns, with the thinnest scars for green coloured burns and the thickest for dark blue coloured burns. Within light blue burns, grafted burns healed with significantly thinner scars than non-grafted burns. This study indicates that LDI can be used for predicting the risk of hypertrophic scarring and for guiding burn care. To our knowledge, this is the first study to correlate the thickness of burns scars by ultrasound scan with burn depth determined by LDI. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

  8. Improved patient safety through reduced airway infection rates in a paediatric cystic fibrosis programme after a quality improvement effort to enhance infection prevention and control measures.

    PubMed

    Savant, Adrienne P; O'Malley, Catherine; Bichl, Stacy; McColley, Susanna A

    2014-04-01

    To reduce the risk of pathogen transmission between patients with cystic fibrosis (CF) and decrease the rate of acquisition of new CF pathogens in our patients. Using the Model for Improvement, we developed a new process for infection prevention and control in our outpatient CF clinics. Paediatric CF programme at Ann & Robert H. Lurie Children's Hospital of Chicago; approximately 180 paediatric patients aged birth to 21 years. All paediatric patients enrolled in the Cystic Fibrosis Foundation Patient Data Registry at this institution. Implemented contact precautions with all patients, regardless of respiratory tract culture results. Respiratory tract culture rates of specific pathogens by quarter were compared prior to and after implementation. Our percentage of patients with a positive respiratory tract culture for Pseudomonas aeruginosa dropped from 30% to 21% (p<0.0001) and for methicillin-resistant Staphylococcus aureus (MRSA) dropped from 10.8% to 8.7% (p=0.008). Use of contact precautions by all care providers, for all patients, regardless of respiratory tract culture results resulted in decreased P aeruginosa and MRSA infection rates.

  9. Systemic exposure to menthol following administration of peppermint oil to paediatric patients

    PubMed Central

    Kearns, Gregory L; Chumpitazi, Bruno Pedro; Abdel-Rahman, Susan M; Garg, Uttam; Shulman, Robert J

    2015-01-01

    Objective Peppermint oil (PMO) has been used to treat abdominal ailments dating to ancient Egypt, Greece and Rome. Despite its increasing paediatric use, as in irritable bowel syndrome (IBS) treatment, the pharmacokinetics (PK) of menthol in children given PMO has not been explored. Design and setting Single-site, exploratory pilot study of menthol PK following a single 187 mg dose of PMO. Subjects with paediatric Rome II defined (IBS; n=6, male and female, 7–15 years of age) were enrolled. Blood samples were obtained before PMO administration and at 10 discrete time points over a 12 h postdose period. Menthol was quantitated from plasma using a validated gas chromatography mass spectrometry technique. Menthol PK parameters were determined using a standard non-compartmental approach. Results Following a dose of PMO, a substantial lag time (range 1–4 h) was seen in all subjects for the appearance of menthol which in turn, produced a delayed time of peak (Tmax=5.3±2.4 h) plasma concentration (Cmax=698.2±245.4 ng/mL). Tmax and Tlag were significantly more variable than the two exposure parameters; Cmax, mean residence time and total area under the curve (AUC=4039.7±583.8 ng/mL×h) which had a coefficient of variation of <20%. Conclusions Delayed appearance of menthol in plasma after oral PMO administration in children is likely a formulation-specific event which, in IBS, could increase intestinal residence time of the active ingredient. Our data also demonstrate the feasibility of using menthol PK in children with IBS to support definitive studies of PMO dose–effect relationships. PMID:26270949

  10. Systemic exposure to menthol following administration of peppermint oil to paediatric patients.

    PubMed

    Kearns, Gregory L; Chumpitazi, Bruno Pedro; Abdel-Rahman, Susan M; Garg, Uttam; Shulman, Robert J

    2015-08-12

    Peppermint oil (PMO) has been used to treat abdominal ailments dating to ancient Egypt, Greece and Rome. Despite its increasing paediatric use, as in irritable bowel syndrome (IBS) treatment, the pharmacokinetics (PK) of menthol in children given PMO has not been explored. Single-site, exploratory pilot study of menthol PK following a single 187 mg dose of PMO. Subjects with paediatric Rome II defined (IBS; n=6, male and female, 7-15 years of age) were enrolled. Blood samples were obtained before PMO administration and at 10 discrete time points over a 12 h postdose period. Menthol was quantitated from plasma using a validated gas chromatography mass spectrometry technique. Menthol PK parameters were determined using a standard non-compartmental approach. Following a dose of PMO, a substantial lag time (range 1-4 h) was seen in all subjects for the appearance of menthol which in turn, produced a delayed time of peak (Tmax=5.3 ± 2.4 h) plasma concentration (Cmax=698.2 ± 245.4 ng/mL). Tmax and Tlag were significantly more variable than the two exposure parameters; Cmax, mean residence time and total area under the curve (AUC=4039.7 ± 583.8 ng/mL × h) which had a coefficient of variation of <20%. Delayed appearance of menthol in plasma after oral PMO administration in children is likely a formulation-specific event which, in IBS, could increase intestinal residence time of the active ingredient. Our data also demonstrate the feasibility of using menthol PK in children with IBS to support definitive studies of PMO dose-effect relationships. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Antihistamines prescribed off-label among paediatric patients at a tertiary care hospital setting in Malaysia.

    PubMed

    Tan, Rou Wei; Mohamed Shah, Noraida

    2016-10-01

    Background Antihistamines are widely prescribed to children but should be used with caution in young children. Objective To determine the paediatric prescribing pattern of antihistamines with a focus on the off-label prescribing and factors that influence such prescribing. Setting Paediatric wards of a tertiary care hospital setting in Malaysia. Methods The pharmacy-based computer system and medical records were used to collect the required data. Labelling status of each antihistamine was determined based on the information provided in the product leaflets. Main outcome measure Antihistamines prescribed off-label and factors associated with such prescribing. Results Of the 176 hospitalised children aged <18 years prescribed with an antihistamine in the year 2012, 60.8 % received it in an off-label manner. Of 292 antihistamine prescription items, 55.5 % were prescribed off-label. Loratadine (35.3 %) was the most frequently prescribed antihistamine and chlorpheniramine maleate (34.0 %) was the most common antihistamine prescribed off-label. The main reason for the off-label prescribing of antihistamines was prescribing at higher than the recommended dose (30.2 %). Binary logistic regression showed that children aged <2 years (OR 12.65; 95 % CI 2.87-55.67) and the number of medications received (OR 1.14; 95 % CI 1.00-1.29) were significant predictors for the off-label prescribing of antihistamines. Conclusion Prescribing antihistamines for children in an off-label manner was prevalent at the studied locations and warrants further investigation on the consequences of such prescribing.

  12. Population pharmacokinetic analysis of tacrolimus in Mexican paediatric renal transplant patients: role of CYP3A5 genotype and formulation

    PubMed Central

    Jacobo-Cabral, Carlos Orlando; García-Roca, Pilar; Romero-Tejeda, Elba Margarita; Reyes, Herlinda; Medeiros, Mara; Castañeda-Hernández, Gilberto; Trocóniz, Iñaki F

    2015-01-01

    Aims The aims of this study were (i) to develop a population pharmacokinetic (PK) model of tacrolimus in a Mexican renal transplant paediatric population (n = 53) and (ii) to test the influence of different covariates on its PK properties to facilitate dose individualization. Methods Population PK and variability parameters were estimated from whole blood drug concentration profiles obtained at steady-state using the non-linear mixed effect modelling software NONMEM® Version 7.2. Results Tacrolimus PK profiles exhibited high inter-patient variability (IPV). A two compartment model with first order input and elimination described the tacrolimus PK profiles in the studied population. The relationship between CYP3A5 genotype and tacrolimus CL/F was included in the final model. CL/F in CYP3A5*1/*1 and *1/*3 carriers was approximately 2- and 1.5-fold higher than in CYP3A5*3/*3 carriers (non-expressers), respectively, and explained almost the entire IPV in CL/F. Other covariates retained in the final model were the tacrolimus dose and formulation type. Limustin® showed markedly lower concentrations than the rest of the formulations. Conclusions Population PK modelling of tacrolimus in paediatric renal transplant recipients identified the tacrolimus formulation type as a significant covariate affecting the blood concentrations and confirmed the previously reported significant effect of CYP3A5 genotype on CL/F. It allowed the design of a proposed dosage based on the final model that is expected to help to improve tacrolimus dosing. PMID:25846845

  13. Comparison of oral dexmedetomidine versus oral midazolam as premedication to prevent emergence agitation after sevoflurane anaesthesia in paediatric patients

    PubMed Central

    Prabhu, M Kavya; Mehandale, Sripada G

    2017-01-01

    Background and Aims: Sevoflurane is the most often used inhalational agent in paediatric anaesthesia, but emergence agitation (EA) remains a major concern. Oral midazolam and parenteral dexmedetomidine are known to be effective in controlling EA. We attempted to elucidate whether oral dexmedetomidine is better than midazolam in controlling EA. Methods: Prospective double-blinded study involving ninety patients aged 1–10 years, undergoing elective surgeries of <2 h of expected duration under sevoflurane general anaesthesia, randomised to receive either midazolam (Group A) or dexmedetomidine (Group B) as oral premedication was carried out to record level of sedation before induction, haemodynamic parameters and recovery time. Incidence and severity of EA, post-operative pain and requirement of rescue analgesic were assessed at 0, 5, 15, 30 and 60 min postoperatively. Results: Data were analysed applying Student's t-test and Chi-square test using SPSS software. Mask acceptance was better in Group B (97.8% vs. 73.4%, P < 0.001). Mean arterial pressure was lower in Group B (P < 0.001) though clinically not significant. More rescue analgesic was required in Group A (5.6% vs. 0%). There was no significant difference in adverse effects. Although there was a higher incidence of EA in Group A (Aono's score 3 and 4; 40% vs. 4.4%), none of them required intervention (paediatric anaesthesia emergence delirium score >10; 0 vs. 0). Conclusion: Premedication with oral dexmedetomidine provides smooth induction and recovery, reduces the EA and provides better analgesia and sedation as compared to oral midazolam. PMID:28250481

  14. Paediatric Interventional Uroradiology

    SciTech Connect

    Barnacle, Alex M.; Wilkinson, A. Graham; Roebuck, Derek J.

    2011-04-15

    Paediatric interventional uroradiology lies at the intersection of the disciplines of paediatric interventional radiology and paediatric endourology. Interdisciplinary collaboration has led to the development of new techniques and refinement of procedures adopted from adult practice. This article reviews the major procedures used in paediatric interventional uroradiology, with emphasis on nephrostomy, percutaneous nephrolithotomy, balloon-burst pyeloplasty, and antegrade ureteric stenting.

  15. A retrospective analysis of securing autologous split-thickness skin grafts with negative pressure wound therapy in paediatric burn patients.

    PubMed

    Hoeller, Michael; Schintler, Michael Valentin; Pfurtscheller, Klaus; Kamolz, Lars-Peter; Tripolt, Norbert; Trop, Marija

    2014-09-01

    Deep dermal and full-thickness burn wounds are excised and grafted with split-thickness skin grafts. Especially in less compliant patients such as young children, conventional fixing methods can often be ineffective due to high mobility rates in this age group. The aim of this retrospective single-centre study was to give an overview of our experience in the fixation of autologous split-thickness skin grafts (ASTSGs) on burn wounds by negative pressure wound therapy (NPWT) in paediatric patients. A retrospective analysis describing 53 paediatric patients with burns or burn-related injuries who were treated as 60 individual cases were conducted. All patients received ASTSGs secured by NPWT. Of the individual cases, 60 cases with a mean age of 8±6 years (the youngest was 3 months, the eldest was 24 years old) were treated in a single procedure with ASTSG and NPWT. Total burn surface area (TBSA) was, median (med) 4.5% (3.0-12.0%). The TBSA of deep dermal thickness to full-thickness (IIb-III°) burns was med 4.0% (2.0-6.0%). The TBSA treated with ASTSG and NPWT was med 3.5% (2.0-6.0%). Take rate was, med 96% (90-99%) with a total range of 70-100%. The only significant correlation that could be found was between the grafted TBSA and the take rate. The smaller the grafted TBSA the better the take rate resulted, as expected. In three cases, major complications were noted. To sum up our experience, the NPWT system has developed itself to be a constant, well-implemented and useful tool in securing ASTSGs to the wound bed. The main advantage of the technique is a much higher mobility of the patient compared to conventional fixation methods. The high compliance rate of an often challenging group of patients such as children recompenses possible higher costs compared to conventional fixation methods. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  16. Diagnostic workup of paediatric patients with inflammatory bowel disease in Europe: results of a 5-year audit of the EUROKIDS registry.

    PubMed

    de Bie, Charlotte I; Buderus, Stephan; Sandhu, Bhupinder K; de Ridder, Lissy; Paerregaard, Anders; Veres, Gabor; Dias, Jorge Amil; Escher, Johanna C

    2012-03-01

    In 2005, the Inflammatory Bowel Disease (IBD) Working Group of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition published consensus guidelines on the diagnostic workup of paediatric IBD, the Porto criteria. According to these guidelines, children suspected of having IBD should undergo an oesophagogastroduodenoscopy (OGD), ileocolonoscopy, and (except in cases of definitive ulcerative colitis) adequate imaging of the small bowel. To audit and evaluate the diagnostic workup of paediatric patients with IBD in Europe, the Working Group created EUROKIDS, a prospective, Web-based registry of newly diagnosed paediatric patients with IBD. Patients with IBD (ages 0-18 years) were registered in 44 centres in 18 countries. Data on diagnostic workup were analysed according to the year of diagnosis, type of IBD, and centre size. Diagnostic yield of OGD and ileal intubation were evaluated. Between 2004 and 2009, 2087 newly diagnosed patients were correctly registered. Both OGD and ileocolonoscopy had been performed in 64% of all of the patients and increased significantly from year 1 (52 %) to 5 (71%, P  <  0.001). Small-bowel follow-through use decreased during the years (year 1 n = 213, year 5 n = 108; P < 0.001), whereas magnetic resonance imaging use increased (year 1 n  = 25, year 5 n  = 171; P < 0.001). Patients diagnosed as having Crohn disease (CD, 59%) and ulcerative colitis (58%) were more likely to have had a complete diagnostic workup than patients diagnosed as having IBD unclassified (45%). In CD, the diagnostic yield of OGD was 7.5% and the yield of ileal intubation was 13%. The quality of diagnostic workup in paediatric patients with IBD increased steadily between 2004 and 2009. Small-bowel imaging by magnetic resonance imaging superseded the use of small-bowel follow-through. OGD and ileal intubation contributed to a definitive diagnosis of CD.

  17. Population approaches in paediatrics.

    PubMed

    Chatelut, Etienne

    2008-12-01

    Population pharmacokinetic (PK) approach is now often used to evaluate PK characteristics of a new compound during its clinical development. Recently, new legislation governing the development and authorization of medicines for use in children aged 0-17 years was introduced in the European Union. Among the strategies proposed in relation to clinical aspects, use of population PKs is stated. In this manuscript, comparison between standard PK and population PK methods will be briefly addressed to understand why the second is particularly adapted to perform PK studies in paediatrics. Then, specific patients' characteristics (covariates) in paediatrics will be presented. Examples of PK and PK-pharmacodynamic (PK-PD) studies will be finally given. The number of population PK studies published still exceeds largely those of PK-PD.

  18. Will children with cancer benefit from the new European Paediatric Medicines Regulation?

    PubMed

    Vassal, Gilles

    2009-06-01

    In December 2000, the European Parliament voted a resolution addressing the need for better medicines for children in Europe and asking the Commission to prepare a new regulation. Members of the European Parliament considered that there was indeed a health issue to be addressed and resolved at the EU level. Six years later, the EU regulation was published and entered into force on January the 26th, 2007. This European law is going to impact significantly access to new drugs for children with cancer. By considerably changing the landscape of drug development for children, the law will provide an opportunity to make further progress in the cure and quality of cure of children with cancer, at a time when truly innovative and effective anticancer drugs are becoming available. However, there are some risks and pitfalls that need to be anticipated and controlled in order to ensure that children will eventually benefit from the European initiative.

  19. [Early clinical trials in paediatric oncology in Spain: a nationwide perspective].

    PubMed

    Bautista, Francisco; Gallego, Soledad; Cañete, Adela; Mora, Jaume; Díaz de Heredia, Cristina; Cruz, Ofelia; Fernández, José María; Rives, Susana; Berlanga, Pablo; Hladun, Raquel; Juan Ribelles, Antonio; Madero, Luis; Ramírez, Manuel; Fernández Delgado, Rafael; Pérez-Martínez, Antonio; Mata, Cristina; Llort, Anna; Martín Broto, Javier; Cela, María Elena; Ramírez, Gema; Sábado, Constantino; Acha, Tomás; Astigarraga, Itziar; Sastre, Ana; Muñoz, Ascensión; Guibelalde, Mercedes; Moreno, Lucas

    2017-09-01

    Cancer is the leading cause of death between the first year of life and adolescence, and some types of diseases are still a major challenge in terms of cure. There is, therefore, a major need for new drugs. Recent findings in cancer biology open the door to the development of targeted therapies against individual molecular changes, as well as immunotherapy. Promising results in adult anti-cancer drug development have not yet been translated into paediatric clinical practice. A report is presented on the activity in early paediatric oncology trials (phase I-II) in Spain. All members of the Spanish Society of Paediatric Haematology Oncology (SEHOP) were contacted in order to identify early clinical trials in paediatric cancer opened between 2005 and 2015. A total of 30 trials had been opened in this period: 21 (70%) in solid tumours, and 9 (30%) in malignant haemopathies. A total of 212 patients have been enrolled. The majority was industry sponsored (53%). Since 2010, four centres have joined the international consortium of Innovative Therapies for Children with Cancer (ITCC), which has as its aim to develop novel therapies for paediatric tumours. A significant number of new studies have opened since 2010, improving the treatment opportunities for our children. Results of recently closed trials show the contribution of Spanish investigators, the introduction of molecularly targeted agents, and their benefits. The activity in clinical trials has increased in the years analysed. The SEHOP is committed to develop and participate in collaborative academic trials, in order to help in the advancement and optimisation of existing therapies in paediatric cancer. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Cancer Screening Among Patients With Advanced Cancer

    PubMed Central

    Sima, Camelia S.; Panageas, Katherine S.; Schrag, Deborah

    2013-01-01

    Context Cancer screening has been integrated into routine primary care but does not benefit patients with limited life expectancy. Objective To evaluate the extent to which patients with advanced cancer continue to be screened for new cancers. Design, Setting, and Participants Utilization of cancer screening procedures (mammography, Papanicolaou test, prostate-specific antigen [PSA], and lower gastrointestinal [GI] endoscopy) was assessed in 87 736 fee-for-service Medicare enrollees aged 65 years or older diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal, or breast cancer between 1998 and 2005, and reported to one of the Surveillance, Epidemiology, and End Results (SEER) tumor registries. Participants were followed up until death or December 31, 2007, whichever came first. A group of 87 307 Medicare enrollees without cancer were individually matched by age, sex, race, and SEER registry to patients with cancer and observed over the same period to evaluate screening rates in context. Demographic and clinical characteristics associated with screening were also investigated. Main Outcome Measure For each cancer screening test, utilization rates were defined as the percentage of patients who were screened following the diagnosis of an incurable cancer. Results Among women following advanced cancer diagnosis compared with controls, at least 1 screening mammogram was received by 8.9% (95% confidence interval [CI], 8.6%-9.1%) vs 22.0% (95% CI, 21.7%-22.5%); Papanicolaou test screening was received by 5.8% (95% CI, 5.6%-6.1%) vs 12.5% (95% CI, 12.2%-12.8%). Among men following advanced cancer diagnosis compared with controls, PSA test was received by 15.0% (95% CI, 14.7%-15.3%) vs 27.2% (95% CI, 26.8%-27.6%). For all patients following advanced diagnosis compared with controls, lower GI endoscopy was received by 1.7% (95% CI, 1.6%-1.8%) vs 4.7% (95% CI, 4.6%-4.9%). Screening was more frequent among patients with a recent history of screening (16.2% [95

  1. Effect of a pager notification system on Australasian Triage Scale category 2 patients in a paediatric emergency department.

    PubMed

    Cheng, Daryl R; McCartney, Laura E; West, Adam; Craig, Simon S

    2016-08-01

    Australasian EDs have introduced innovative processes to ensure safe and timely management of patients. Our ED introduced a dedicated pager system to provide rapid assessment of Australasian Triage Scale (ATS) category 2 patients in an attempt to expedite ED care. The present paper aims to evaluate the impact of this initiative on time to clinician, ED length of stay (LOS) and clinical outcomes in a tertiary paediatric ED. Retrospective structured chart review on patients presenting in a 2 month period before the intervention (August-September 2009) and the same time 1 year later. Patients were grouped into common ATS category 2 presentations and analysed in these subcategories. Clinical indicators of appropriate and timely performance were selected from best practice performance guidelines. 779 ATS category 2 patients were seen during the two periods: 370 pre-intervention and 409 post-intervention. The overall percentage of ATS category 2 patients seen within the target time increased by 22.3%, although there was no significant change in ED LOS. The median time for patients from triage to being seen by an ED clinician improved from 10 to 6 min (P < 0.01). However, we were unable to demonstrate an impact of the pager system on various clinical quality indicators. The rapid assessment pager system proved beneficial in reducing triage to clinician times for ATS category 2 patients but showed no improvement in overall ED LOS or disease-specific clinical quality indicators. Further research is needed to determine the influence of other components of ED functioning on clinical outcomes, as well as the overall clinical impact a pager system has on other measures of quality such as patient satisfaction and other subgroups of patients. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  2. A global patient outcomes registry: Cochlear paediatric implanted recipient observational study (Cochlear(™) P-IROS).

    PubMed

    Sanderson, Georgina; Ariyaratne, Thathya V; Wyss, Josephine; Looi, Valerie

    2014-01-01

    Currently, there is a paucity of data concerning the long-term outcomes, educational placement and quality of life of children implanted with hearing devices from large and representative samples of the population. To address this concern, a large, prospective, multicentre, multinational patient-outcomes registry for paediatric recipients of implantable hearing devices was developed. The benefits of this registry, its approach and methodology are described. The Cochlear(™) Paediatric Implanted Recipient Observational Study (Cochlear P-IROS) is a prospective international patient-outcomes registry for children who are implanted in routine clinical practice with one or more hearing devices. The study aims to collect data on patient comorbidities, device use, auditory performance, quality of life and health-related utilities, across different types of implantable hearing devices from a range of manufacturers. Patients will be evaluated with a set of standardised and non-standardised questionnaires prior to initial device activation (baseline) and at six-monthly follow-up intervals up to 24 months and annually thereafter. The Cochlear P-IROS utilises a secure web interface to administer electronic case report forms to clinicians and families of implanted children. The web interface is currently available in five languages: English, Japanese, Korean, Mandarin and Russian. The interface also provides printable versions of the case report forms translated into 22 local languages for collection of data prior to entry online; additional languages may be added, as required. Participation in the Cochlear P-IROS registry is investigator-driven and voluntary. To date, the Cochlear P-IROS has recruited implant clinics across Australia, China, India, Indonesia, Turkey and Vietnam. The registry also aims to recruit multiple clinics in Cuba, Israel, Japan, Malaysia, Singapore, South Africa, South Korea and Russia. The use of a registry such as the Cochlear P-IROS will generate

  3. Paediatric celiac patients carrying the HLA-DR7-DQ2 and HLA-DR3-DQ2 haplotypes display small clinical differences.

    PubMed

    Delgado, Juan F; Amengual, María J; Veraguas, Ana; Rodríguez, Encarnación; de Los Santos, Mariela M; Guallarte, María P

    2014-06-01

    The aim of this study was to determine the relevance of HLA-DR7-DQ2 typing in a prospective cohort of paediatric coeliac disease patients from Southern Europe. This cross-sectional study tested 249 paediatric patients with coeliac disease. HLA-DR3-DQ2 was typed in combination with HLA-DR7-DQ2 to screen for the HLA-DQ2 haplotype. The histological, analytical and clinical characteristics of the subjects were recorded. A total of 91 coeliac patients were diagnosed: 96.7% carried HLA-DQ2 and 4.4% carried HLA-DQ8. In percentage terms, 80.2% of patients carried HLA-DR3-DQ2 and 34.1% carried HLA-DR7-DQ2. We did not find significant differences between HLA-DR7-DQ2 and HLA-DR3-DQ2 paediatric patients with respect to histological damage and clinical characteristics, except for irritability and weight loss. These characteristics were more frequent in HLA-DQ2trans than in HLA-DQ2cis (22.2% vs. 0.0% [p = 0.035] and 55.6% vs. 21.4% [p = 0.017], respectively). Coeliac-specific autoantibody levels were higher in HLA-DQ2cis than one half of HLA-DQ2trans patients (105.5 vs. 19.2 U/mL, p = 0.014). Small clinical differences were found between paediatric coeliac patients carrying HLA-DR7-DQ2 and HLA-DR3-DQ2. For a correct screening of HLA-DQ2, at least in our geographical population, the HLA-DR7-DQ2 haplotype should be typed due to its frequency and clinical presentation. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  4. Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

    PubMed

    Bravo-Torres, Sofía; Der-Mussa, Carolina; Fuentes-López, Eduardo

    2017-08-31

    To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™. Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile. All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates. The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables. The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.

  5. General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital.

    PubMed

    Kwok, C-S; Gordon, A C

    2016-09-01

    Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals.

  6. General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital

    PubMed Central

    Gordon, AC

    2016-01-01

    Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals. PMID:27269243

  7. [Pulmonary Rehabilitation for Cancer Patients].

    PubMed

    Yamamoto, Kazuo; Gemma, Akihiko

    2015-07-01

    Dyspnea occurs in most cancer patients and is often associated with severe pain. Pulmonary rehabilitation has become increasingly important to improve ADL and QOL and to relieve pain that results from dyspnea. Although pulmonary rehabilitation is now provided mainly during the perioperative period, it has been recognized as an effective procedure for patients before, during, or after chemotherapy or radiotherapy. It is also useful for patients with advanced or terminal cancer. However, an evidence-based cancer rehabilitation procedure has to be established.

  8. Paediatric palliative care: coming of age in oncology?

    PubMed

    McCulloch, Renée; Comac, Maggie; Craig, Finella

    2008-05-01

    Palliative care in children has been emerging as a clinical subspecialty of paediatrics for many years. It requires the knowledge and experience of a paediatrician, combined with the skills of a palliative care specialist. Both are essential, as a paediatrician may not have advanced knowledge of palliative care and a palliative care specialist is unlikely to be familiar with the complexity of working with families where the child is the patient. This paper reviews recent literature and discusses advances in the development of palliative care services for children and young people with incurable cancer. It highlights key areas where paediatric palliative care differs from that of adults and outlines the barriers to providing palliation and conducting evidence-based research in children and young people dying from cancer.

  9. Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes syndrome with hypothyroidism and focal segmental glomerulosclerosis in a paediatric patient.

    PubMed

    Lau, Keith K; Yang, Samuel P; Haddad, Maha N; Butani, Lavjay; Makker, Sudesh P

    2007-01-01

    Herein, we report on a paediatric patient with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) who was hospitalized for acute on chronic renal insufficiency, seizures and deterioration of the level of consciousness. She also had hypertension, hypothyroidism and nephrotic range proteinuria. Kidney biopsy revealed many sclerotic glomeruli and focal segmental glomerulosclerosis (FSGS). Glomerulopathy is rare in patients with MELAS, and FSGS has been reported only in a few patients. The histopathological features of the renal biopsy suggested that the aetiology of the FSGS may have been secondary to chronic renal injury rather than from a primary immunologic cause. Moreover, our case is unique in that, the coexistence of MELAS, hypothalamic hypothyroidism and FSGS has not been reported in the past. The purpose of this report is to increase the awareness of health-care professionals, especially in the fields of paediatrics, neurology, endocrinology and nephrology, regarding the manifestations and complications of MELAS.

  10. Baseline status of paediatric oncology in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study

    PubMed Central

    Ribeiro, Raul C; Steliarova-Foucher, Eva; Magrath, Ian; Lemerle, Jean; Eden, Tim; Forget, Caty; Mortara, Isabel; Tabah-Fisch, Isabelle; Divino, Jose Julio; Miklavec, Thomas; Howard, Scott; Cavalli, Franco

    2013-01-01

    Summary Background Childhood cancer survival remains dismal in low-income [A4] countries, but initiatives for treating paediatric cancer have substantially improved care in some of these countries. The My Child Matters programme was launched to fund projects for controlling paediatric cancer in low-income and mid-income countries. We aimed to assess the baseline status of paediatric cancer in ten countries that were receiving support (Bangladesh, Egypt, Honduras, Morocco, Philippines, Senegal, Tanzania, Ukraine, Venezuela, and Vietnam). [A5] Methods Qualitative face-to-face interviews with clinicians, hospital managers, health officials, and others were done by a multidisciplinary public-health research company. Estimates of paediatric cancer from population-based data were used to project the number of current and future patients for comparison with survey-based data. 5-year survival was postulated on the basis of interviews with health-care professionals. Field survey data were statistically compared with demographic, health, and socioeconomic data from global health organisations. The main outcome was to assess baseline status of paediatric cancer in the countries. [A6] Findings The baseline status of paediatric oncology varied substantially between the countries. The number of patients reportedly receiving medical care (obtained from survey data [A7]) differed markedly from the number predicted by population-based incidence data. Postulated 5-year survival was directly proportional to several demographic, economic, and health indicators, and most substantially, annual government healthcare expenditure per capita [ADD DATA] [A8]. Interpretation Management of paediatric cancer and access to care are poor or deficient (ie, nonexistent, unavailable, or inconsistent access for most children with cancer [A48]) in seven of the ten countries studied, and accurate baseline data on incidence and outcome are very sparse [A10]. Alliances between public, private, and

  11. Impact of peritoneal transport characteristics on cardiac function in paediatric peritoneal dialysis patients: a Turkish Pediatric Peritoneal Dialysis Study Group (TUPEPD) report.

    PubMed

    Bakkaloglu, Sevcan A; Saygili, Arda; Sever, Lale; Aksu, Nejat; Noyan, Aytul; Akman, Sema; Ekim, Mesiha; Doganay, Beyza; Yildiz, Nurdan; Akalin, Figen; Caliskan, Salim; Kara, Orhan D; Duzova, Ali; Soylu, Alper; Atalay, Semra

    2010-07-01

    The peritoneal equilibration test (PET) is recommended in paediatric peritoneal dialysis (PD) patients to assist prescription management. Despite contradictory reports, high transporter status is associated with reduced survival rate in adults. Since cardiac disease is one of the main causes of mortality in paediatric PD patients, we aimed to evaluate whether transport features have any effect on biochemical data and cardiac function in this group. One hundred and ten PD patients (13 +/- 5 years, PD vintage: 31 +/- 27 months) were enrolled into the study. Four-hour dialysate/plasma creatinine ratio was used for differentiating PET groups. Thirty-eight patients were high transporters, 29 were high-average transporters and 43 were low-average/low transporters. Echocardiography was performed in all subjects. Age, PD vintage, dialysate glucose concentration, ultrafiltration volume, urine volume and blood pressure levels were similar in all PET groups. No biochemical or echocardiographic data (ejection fraction, fractional shortening, left ventricular mass index, myocardial performance index, power Doppler E/tissue Doppler E ratio reflecting diastolic function) were different among PET groups except lower albumin (P = 0.025) levels in high transporters and higher high-sensitivity C-reactive protein (P = 0.026) levels in high and high-average transporters compared to other transport groups. Cardiac structural and functional abnormalities are highly prevalent among paediatric PD patients. Transport rates did not have a significant effect on biochemical parameters or cardiac structural/functional parameters. It might be suggested that being a high transporter does not provide a disadvantage in terms of atherogenic tendency and cardiac disease in paediatric PD patients. Oligoanuria, anaemia and hypertension were independent predictors of cardiac disease.

  12. UK Renal Registry 18th Annual Report: Chapter 4 Demography of Patients Receiving Renal Replacement Therapy in Paediatric Centres in the UK in 2014.

    PubMed

    Hamilton, Alexander J; Braddon, Fiona; Casula, Anna; Inward, Carol; Lewis, Malcolm; Mallett, Tamara; Maxwell, Heather; O'Brien, Catherine; Tse, Yincent; Sinha, Manish D

    2016-01-01

    A total of 917 children and young people under 18 years with established renal failure (ERF) were receiving treatment at paediatric nephrology centres in 2014.At the census date (31st December 2014), 79.3% of prevalent paediatric patients aged ,18 years had a functioning kidney transplant, 11.2% were receiving haemodialysis (HD) and 9.5% were receiving peritoneal dialysis (PD). In patients aged ,16 years, prevalence of ERF was 60.4 per million age related population (pmarp) and the incidence 9.4 pmarp. The most common primary renal diagnosis was renal dysplasia+reflux, present in 32.6% of prevalent paediatric patients aged ,16 years. About a third of patients had one or more reported comorbidity at onset of renal replacement therapy (RRT). The improvement in rates of pre-emptive transplantation for those referred early has been maintained over the last 10 years at 37.5%, compared to 27.4% in 2000–2004. At transfer to adult services, 90.3% of patients had a functioning kidney transplant. Survival during childhood amongst children commencing RRT was the lowest in those aged less than two years compared to those aged 12 to less than 16 years with a hazard ratio of 4.1 (confidence interval 2.2–8.0), and in those receiving dialysis compared to having a functioning transplant with a hazard ratio of 6.3 (confidence interval 3.9–10.2).

  13. Oral bacterial community dynamics in paediatric patients with malignancies in relation to chemotherapy-related oral mucositis: a prospective study

    PubMed Central

    Ye, Y; Carlsson, G; Agholme, M Barr; Wilson, J A L; Roos, A; Henriques-Normark, B; Engstrand, L; Modéer, T; Pütsep, K; Raoult, D

    2013-01-01

    The role of oral bacteria in the development of chemotherapy-related oral mucositis has not been fully elucidated. This study aimed to investigate oral bacterial community diversity and dynamics in paediatric patients with malignancies in relation to the occurrence of oral mucositis. Patients with malignancies (n = 37) and reference individuals without known systemic disorders (n = 38) were recruited. For patients, oral bacterial samples were taken from mucosal surfaces both at the time of malignancy diagnosis and during chemotherapy. If oral mucositis occurred, samples were taken from the surface of the mucositis lesions. Oral mucosal bacterial samples were also taken from reference individuals. All samples were assessed using a 16S ribosomal RNA gene 454 pyrosequencing method. A lower microbial diversity (p < 0.01) and a higher intersubject variability (p < 0.001) were found in patients as compared with reference individuals. At the time of malignancy diagnosis (i.e. before chemotherapy) patients that later developed mucositis showed a higher microbial diversity (p < 0.05) and a higher intersubject variability (p < 0.001) compared with those without mucositis. The change of bacterial composition during chemotherapy was more pronounced in patients who later developed mucositis than those without mucositis (p < 0.01). In conclusion, we found a higher microbial diversity at the time of malignancy diagnosis in patients who later develop oral mucositis and that these patients had a more significant modification of the bacterial community by chemotherapy before the occurrence of mucositis. These findings may possibly be of clinical importance in developing better strategies for personalized preventive management. PMID:23829394

  14. Investigating hepatitis B immunity in patients presenting to a paediatric haematology and oncology unit in South Africa.

    PubMed

    Büchner, Ane; Omar, Fareed Ebrahim; Vermeulen, Johani; Reynders, David T

    2014-06-19

    Hepatitis B is an important public health concern in South Africa (SA). The hepatitis B virus (HBV) vaccine was introduced into the South African Expanded Programme on Immunisation (EPI-SA) in 1995. There is no 'catch-up' programme in place. The duration of protection after hepatitis B vaccination in the SA population is unknown. Waning of vaccine-induced immunity leaves people at risk of acquiring hepatitis B infection in settings where the prevalence of infection is high and horizontal transmission is likely. To assess immunity to HBV in patients at presentation to a paediatric haematology and oncology unit. An audit of hepatitis profiles was done of all new patients seen in the unit from January 2012 to December 2013. Patients were classified as immune (antibody levels to hepatitis B surface antigen (anti-HBs) >100 mIU/ml), low immune (anti-HBs 10 - 100 mIU/ml) and not immune (anti-HBs <10 mIU/ml). Of the 210 patients included (median age 6.5 years), 84 (40.0%) had no immunity to hepatitis B despite presumed vaccination as part of the EPI schedule. Six patients tested positive for hepatitis B core antibody (anti-HBc), consistent with previous infection. No patients had active hepatitis B infection (hepatitis B surface antigen-positive). Most human immunodeficiency virus (HIV)-infected patients were not immune to HBV (80.0%). A significant number of children in SA are not immune to hepatitis B despite vaccination being part of the EPI-SA. Combined passive-active immunisation should be considered for all oncology patients in settings where exposure to HBV is possible. Consideration should also be given to offering booster vaccination to the population as a whole.

  15. Analysis of T2 signal intensity helps in the differentiation between high and low-grade brain tumours in paediatric patients.

    PubMed

    Lescher, Stephanie; Whora, Ketan; Schwabe, Dirk; Kieslich, Matthias; Porto, Luciana

    2016-01-01

    Previous studies hypothesized that the analysis of magnetic resonance intensity of the solid portion in paediatric tumours can provide pre-surgical information about the histopathology. Classically, high signal-intensity in T2weighted (T2w) images identifies low-grade tumours, while anaplasia is characterized by T2 hypointensity. We aimed to investigate if T2w signal intensities can pre-operatively distinguish between low-grade and high-grade brain tumours in paediatric patients. Two raters, blinded to the histological diagnosis, rated the signal intensity of MR images (T2w) from 36 children with newly diagnosed brain tumours, 17 children with low-grade brain tumours and 19 children with high-grade brain tumours were included in this study. Relative T2 values were obtained by dividing the T2w values of the solid portion of the tumour by the T2w values of the vitreous humour. The best cut-off point to distinguish low and high-grade paediatric brain tumours was 0.8. If the signal intensity was less than or equal to 0.8 the tumour was expected to be a high-grade tumour with a sensitivity of 100%. Prediction of a low-grade tumour was more uncertain with a sensitivity of 70.5%. Overall, 86% of the tumours would have been predicted correctly. Our data suggest that T2w signal intensities of the solid portion of brain tumours in paediatrics can pre-operatively differentiate between low-grade and high-grade tumours. In addition, T2 hypointensity may be helpful in targeting stereotactic biopsy. Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  16. Meningitis due to Moraxella nonliquefaciens in a paediatric patient: a case report and review of the literature

    PubMed Central

    Szymczak, Wendy; Munjal, Iona

    2017-01-01

    Introduction. Moraxella nonliquefaciens is an unusual organism to be isolated from cerebral spinal fluid (CSF) and there exists only one case report of M. nonliquefaciens meningitis from a neonate. Moraxella species normally exist as part of the human upper respiratory tract flora and rarely cause invasive human disease. There are only a handful of case reports implicating the organism as a cause of endocarditis, bacteraemia, septic arthritis and endophthalmitis. Identification to the species level based on routine laboratory techniques has been challenging, with final identification often made through 16S rRNA sequencing. With the use of a newer diagnostic tool, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) MS, we were able to rapidly identify the organism and initiate appropriate treatment. Case presentation. We present a rare care of M. nonliquefaciens meningitis in a paediatric patient with an underlying cranial anatomical defect due to Crouzon syndrome. She had been admitted to hospital 3 months previously with Streptococcus pneumoniae meningitis and mastoiditis, and returned to the emergency department with meningismus. CSF culture grew M. nonliquefaciens. She was treated with ceftriaxone with rapid improvement and eventually was taken for endoscopic surgical repair of a right encephalocele defect. Conclusion. The use of MALDI-TOF MS allowed for the rapid identification of the organism. The patient recovered with appropriate antimicrobial therapy and eventual surgical correction. An underlying anatomical defect should be considered in all patients who present with meningitis due to this unusual organism. PMID:28348808

  17. 'Patient satisfaction' in hospitalized cancer patients.

    PubMed

    Skarstein, Jon; Dahl, Alv A; Laading, Jacob; Fosså, Sophie D

    2002-01-01

    Predictors of 'patient satisfaction' with hospitalization at a specialized cancer hospital in Norway are examined in this study. Two weeks after their last hospitalization, 2021 consecutive cancer patients were invited to rate their satisfaction with hospitalization, quality of life, anxiety and depression. Compliance rate was 72% (n = 1453). Cut-off levels separating dissatisfied from satisfied patients were defined. It was found that 92% of the patients were satisfied with their stay in hospital, independent of cancer type and number of previous admissions. Performance of nurses and physicians, level of information perceived, outcome of health status, reception at the hospital and anxiety independently predicted 'patient satisfaction'. The model explained 35% of the variance with an area under the curve of 0.76 of the Receiver Operator Curve. Cancer patients' satisfaction with their hospital stay was high, and predicted by four independently predictive variables related to the performance of caregivers. These suggest areas for further improvement in the healthcare service.

  18. Comparison of injection pain caused by the DentalVibe Injection System versus a traditional syringe for inferior alveolar nerve block anaesthesia in paediatric patients.

    PubMed

    Elbay, M; Şermet Elbay, Ü; Yıldırım, S; Uğurluel, C; Kaya, C; Baydemir, C

    2015-06-01

    To compare paediatric patients' pain during needle insertion and injection in inferior alveoler nerve block (IANB) anaesthesia injected by either a traditional syringe (TS) or the DentalVibe Injection Comfort System (DV). the study was a randomised controlled crossover clinical trial, comprised of 60 children aged 6-12 requiring an operative procedure with IANB anaesthesia on their mandibular molars bilaterally. One of the molar teeth was treated with TS and the contralateral tooth was treated with DV. On each visit, subjective and objective pain was evaluated using the Wond-Baker Faces Pain Rating Scale (PRS) and the Face, Legg, Cry, Consolability Scale (FLACC Scale). Patients were asked which anaesthesia technique they preferred. Data were analysed using Wilcoxon signed rank, Spearman correlation, and Mann-Whitney U tests. There were no statistically significant differences for pain evalution during needle insertion and injection of each injection system. However, a negative correlation was found on the FLACC between age and pain scores during injection after using DV. Paediatric patients experienced similar pain during IANB anaesthesia administered with TS and DV. With increased age, pain values reduced during anaesthetic agent injection with DV according to FLACC. The traditional procedure was preferred to DV in paediatric patients.

  19. Audit of the dietetic care of patients with type 1 diabetes at a large Australian paediatric tertiary hospital and comparison with the International Society for Paediatric and Adolescent Diabetes nutrition guidelines.

    PubMed

    Battersby, Rachel; Sweeney, Annabel; Toome, Sarah; Fairchild, Janice; Miller, Jacqueline

    2017-09-01

    Optimal glycaemic control is important in children and adolescents with type 1 diabetes (T1D) to reduce the risk of developing microvascular complications. Modest reductions in HbA1c translate to significant risk reductions of these complications. Research indicates that targeted dietetic care using evidence-based guidelines improves HbA1c levels. The aim of this study was to audit the dietetic care provided to patients with T1D at the Women's and Children's Hospital (WCH) and compare the service provided to the International Society for Paediatric and Adolescent Diabetes (ISPAD) nutrition guidelines. A retrospective medical records audit of the dietetic service was conducted on 410 (99% of eligible) patients who attended the WCH Diabetes Outpatient Clinic between 1 January 2010 and 30 June 2013. These data were then compared to the ISPAD nutrition guidelines, with a focus on the key service delivery targets. Of the newly diagnosed patients (n = 128), 100% received initial dietary advice by a paediatric diabetes dietitian; 61% of these patients then received a follow-up appointment within one month of diagnosis. Of those who were >1 year post-diagnosis (n = 389), only 6% were seen annually; 79% of patients were identified with a condition requiring more frequent review, of whom 23% were seen more frequently. This large and comprehensive audit, conducted for a 3.5-year period, has shown that the dietetic care of newly diagnosed children and adolescents is mostly in line with ISPAD guidelines, but there is suboptimal follow-up after diagnosis. © 2016 Dietitians Association of Australia.

  20. Accelerating drug development for neuroblastoma - New Drug Development Strategy: an Innovative Therapies for Children with Cancer, European Network for Cancer Research in Children and Adolescents and International Society of Paediatric Oncology Europe Neuroblastoma project.

    PubMed

    Moreno, Lucas; Caron, Hubert; Geoerger, Birgit; Eggert, Angelika; Schleiermacher, Gudrun; Brock, Penelope; Valteau-Couanet, Dominique; Chesler, Louis; Schulte, Johannes H; De Preter, Katleen; Molenaar, Jan; Schramm, Alexander; Eilers, Martin; Van Maerken, Tom; Johnsen, John Inge; Garrett, Michelle; George, Sally L; Tweddle, Deborah A; Kogner, Per; Berthold, Frank; Koster, Jan; Barone, Giuseppe; Tucker, Elizabeth R; Marshall, Lynley; Herold, Ralf; Sterba, Jaroslav; Norga, Koen; Vassal, Gilles; Pearson, Andrew Dj

    2017-08-01

    Neuroblastoma, the commonest paediatric extra-cranial tumour, remains a leading cause of death from cancer in children. There is an urgent need to develop new drugs to improve cure rates and reduce long-term toxicity and to incorporate molecularly targeted therapies into treatment. Many potential drugs are becoming available, but have to be prioritised for clinical trials due to the relatively small numbers of patients. Areas covered: The current drug development model has been slow, associated with significant attrition, and few new drugs have been developed for neuroblastoma. The Neuroblastoma New Drug Development Strategy (NDDS) has: 1) established a group with expertise in drug development; 2) prioritised targets and drugs according to tumour biology (target expression, dependency, pre-clinical data; potential combinations; biomarkers), identifying as priority targets ALK, MEK, CDK4/6, MDM2, MYCN (druggable by BET bromodomain, aurora kinase, mTORC1/2) BIRC5 and checkpoint kinase 1; 3) promoted clinical trials with target-prioritised drugs. Drugs showing activity can be rapidly transitioned via parallel randomised trials into front-line studies. Expert opinion: The Neuroblastoma NDDS is based on the premise that optimal drug development is reliant on knowledge of tumour biology and prioritisation. This approach will accelerate neuroblastoma drug development and other poor prognosis childhood malignancies.

  1. Optimizing treatment in paediatric rheumatology--lessons from oncology.

    PubMed

    Niehues, Tim

    2015-08-01

    Treatment of children with cancer, in particular with acute lymphoblastic leukaemia (ALL), has been highly successful in the past two decades owing to the implementation of treatment optimization studies. Study centres appointed by scientific societies design treatment optimization study protocols (TOSPs) that address an investigator-initiated research question and detail treatment procedures according to these aims. Nearly all children with malignant diseases are treated within TOSPs, whereas children with juvenile idiopathic arthritis (JIA) and other common paediatric rheumatic diseases are mostly treated outside TOSPs and clinical trials. Despite the differences in natural course and prognosis between malignant and inflammatory diseases, aiming for the recruitment of all children with defined rheumatic diseases into TOSPs or similar protocols would enable the longitudinal collection of crucial clinical data and improve evidence-based approaches. Successful research networks already exist in paediatric rheumatology that could facilitate the implementation of this approach. Paediatric rheumatic diseases have a considerable impact on patients and their families; thus, I propose that research networks in paediatric rheumatology should recruit most--if not all--children with rheumatic diseases into study protocols with standardized treatment and outcome measures.

  2. Nutritional Considerations for Cancer Patients

    PubMed Central

    Chen, Angela

    1985-01-01

    Although weight loss is a frequent, though not invariable, component of the cancer syndrome, the associated malnutrition is a poor prognostic sign among both children and adults. This article describes the possible mechanisms of cancer cachexia; reviews the present state of nutritional support in cancer patients; identifies nutritional problems and workable approaches during the pre- and post-treatment periods; discusses the unconventional nutritional practices commonly encountered and lists resource materials for patients and families. PMID:21274086

  3. Negotiating identity at the intersection of paediatric and genetic medicine: the parent as facilitator, narrator and patient.

    PubMed

    Dimond, Rebecca

    2014-01-01

    This article identifies a significant transformation in the role and identity of parents accompanying their child to clinic. This shift is a product of the intersection between paediatric and genetic medicine, where parents play a critical role in providing information about their child, family and ultimately, about themselves. To provide a context for this matrix, two broad areas of sociological inquiry are highlighted. The first is explanations of the role a parent plays in paediatric medicine and the second is the diagnostic process in paediatric genetics and the implications for parent and child identities. Drawing from an ethnographic study of clinical consultations, attention is paid to the changing role of parenthood and the extended role of patienthood in paediatric genetic medicine.

  4. [Delirium in patients with cancer].

    PubMed

    Staniszewska, Agnieszka; Kłoszewska, Iwona

    2007-01-01

    Delirium is a frequent complication of cancer. It is the cause of patients' suffering and due to worsening of communication, the impediment to clinical assessment. It lowers the quality of life of family caregivers as well. Instant diagnosis and therapy of delirium are essential in clinical practice. In this review etiology, prevalence, clinical features and management of delirium in cancer patients are described.

  5. [Paediatric specificities of the concept of therapeutic patient education: review of the literature from 1998 to 2012].

    PubMed

    Colson, Sébastien; Gentile, Stéphanie; Côté, José; Lagouanelle-Simeoni, Marie-Claude

    2014-01-01

    The general concept of therapeutic patient education (TPE), defined by the European Office of the World Health Organization (WHO) in 1998, could be questionable when applied to children due to the many specificities of this population in the field of health and education. To identify the specificities of therapeutic patient education applied to the paediatric population. Concept analysis is based on Rodgers' 5-activities method: 1) Identifying the concept 2) selecting the appropriate realm of literature 3) collecting data from selected publications 4) analysing the results to determine the characteristics of the concept studied 5) discussion of the implications and prospects for development of the concept. Thirty-five publications were included in this concept clarification. Five attributes emerged: relational triad, collaborative partnership, adaptation of learning, gradual and progressive acquisition of skills, and creativity. The results of this first concept analysis shed light on the process of knowledge transfer over time. The five characteristics, consistent with the field of health promotion, could be strengthened by a grounded theory.

  6. Dosimetric Quantities for Computed Tomography Examinations of Paediatric Patients on the Thoracic and Abdominal Regions

    NASA Astrophysics Data System (ADS)

    Flores-M, E.; Buenfil, A. E.; Dies, P.; Gamboa-deBuen, I.; Ruiz-Trejo, C.

    2010-12-01

    Computed Tomography (CT) is a high dose X ray imaging procedure and its use has rapidly increased in the last two decades fueled by the development of helical CT. The aim of this study is to present values of the dosimetric quantities for CT paediatric examinations of thoracic and abdominal regions. The protocols studied were those of chest, lung-mediastine, chest-abdomen, pulmonary high resolution and mediastine-abdomen, which are the more common examinations performed at "Hospital Infantil de México Federico Gómez" in the thoracic-abdominal region. The measurements were performed on a Siemens SOMATOM Sensation 16 CT Scanner and the equipment used was a CT pencil ionization chamber, connected to an electrometer. This system was calibrated for RQT9 CT beam quality. A PMMA head phantom with diameter of 16 cm and length of 15 cm was also used. The dosimetric quantities measured were the weighted air kerma index (Cw), the volumetric dose index (Cvol) and the CT air kerma-length product. It was found that the pulmonary high resolution examination presented the highest values for the Cw (31.1 mGy) and Cvol (11.1 mGy). The examination with the lowest values of these two quantities was the chest-abdomen protocol with 10.5 mGy for Cw and 5.5 mGy for Cvol. However, this protocol presented the highest value for PKL,CT (282.2 mGy cm) when considering the average clinical length of the examinations.

  7. Dosimetric Quantities for Computed Tomography Examinations of Paediatric Patients on the Thoracic and Abdominal Regions

    SciTech Connect

    Flores-M, E.; Gamboa de Buen, I.; Buenfil, A. E.; Ruiz-Trejo, C.; Dies, P.

    2010-12-07

    Computed Tomography (CT) is a high dose X ray imaging procedure and its use has rapidly increased in the last two decades fueled by the development of helical CT. The aim of this study is to present values of the dosimetric quantities for CT paediatric examinations of thoracic and abdominal regions. The protocols studied were those of chest, lung-mediastine, chest-abdomen, pulmonary high resolution and mediastine-abdomen, which are the more common examinations performed at ''Hospital Infantil de Mexico Federico Gomez'' in the thoracic-abdominal region. The measurements were performed on a Siemens SOMATOM Sensation 16 CT Scanner and the equipment used was a CT pencil ionization chamber, connected to an electrometer. This system was calibrated for RQT9 CT beam quality. A PMMA head phantom with diameter of 16 cm and length of 15 cm was also used. The dosimetric quantities measured were the weighted air kerma index (C{sub w}), the volumetric dose index (C{sub vol}) and the CT air kerma-length product. It was found that the pulmonary high resolution examination presented the highest values for the C{sub w}(31.1 mGy) and C{sub vol}(11.1 mGy). The examination with the lowest values of these two quantities was the chest-abdomen protocol with 10.5 mGy for C{sub w} and 5.5 mGy for C{sub vol}. However, this protocol presented the highest value for P{sub KL,CT}(282.2 mGy cm) when considering the average clinical length of the examinations.

  8. Prevalence and identification of Cryptosporidium species in paediatric patients with diarrhoea.

    PubMed

    Sirisena, U M; Iddawela, W M D R; Noordeen, F; Wickramasinghe, S

    2014-09-01

    To determine the prevalence of Cryptosporidium infection in children with diarrhoea, identify associated factors and identify the parasite using Polymerase Chain Reaction (PCR). A total of 138 diarrhoeic faecal samples were collected between August 2011 and February 2013, from children under 12 years of age, admitted to paediatric units of Teaching Hospitals, Kandy and Peradeniya, Sirimawo Bandaranayake Childrens' Hospital, Peradeniya and District General Hospital, Matale. One hundred faecal samples collected from healthy children were used as controls. All control and test samples were screened for the presence of Cryptosporidium oocysts with Modified Ziehl-Neelsen (MZN) method and PCR. Prevalence of Cryptosporidium infection among children with diarrhoea was 5.7%. All the cases positive for Cryptosporidium were below 3 years of age. The majority (7 out of 8) of the positive cases had watery diarrhoea while none of the healthy children excreted Cryptosporidium oocysts in the faeces. Of the 8 positive cases, 6 had a history of animal contact. A large proportion of positive cases used pipe borne municipal water. The majority (66.6%) of positive cases did not consume boiled cooled water. We were able to identify C. parvum from one of the eight cases that had diarrhoea. The current study shows that Cryptosporidium is one of the aetiological agents responsible for childhood watery diarrhoea in Sri Lanka, thus stressing the importance of routine stool examination for Cryptosporidium oocysts. This study recommends boiling water as an important measure to prevent the transmission of Cryptosporidium oocysts. Further molecular studies are needed to determine the other species of Cryptosporidium responsible for cryptosporidiosis in children in Sri Lanka.

  9. Language as a barrier to care for Xhosa-speaking patients at a South African paediatric teaching hospital.

    PubMed

    Levin, M E

    2006-10-01

    Disease is closely linked to the social context in which we live. Difficulty with communication, cultural incompatibility between patients and health care providers and socioeconomic obstacles are important barriers to quality care when doctors and patients come from different backgrounds and speak different languages. Red Cross War Memorial Children's Hospital (RCH) is a paediatric teaching hospital in Cape Town where staff members communicate mainly in English or Afrikaans, while many patients speak Xhosa as their first language. The study aimed to identify barriers to optimal care for Xhosa-speaking parents of patients at RCH. The contribution of language difficulties was assessed as a possible barrier to health care for this group. A questionnaire was developed and administered to 53 Xhosa-speaking parents of children admitted to the short-stay ward at RCH. The questionnaire examined parents' perceptions of barriers to their children's care, using openended questions, closed-ended questions and selection from lists. Parents experienced significant structural and socioeconomic barriers to access of health care for their children. Language and cultural barriers were cited by more parents as a major barrier to health care than structural and socioeconomic barriers. Parents did not have access to same-language practitioners, as only 6% of medical interviews were conducted partly or wholly in the patient's home language. Of the 94% of interviews where no Xhosa was spoken by medical staff, 21% were conducted with the aid of an interpreter (formal or ad hoc) and in 79% no interpreter was used. Parents experienced difficulties with understanding the doctors (64%), making themselves understood (54%) and asking questions (38%). Sixty-nine per cent of parents were dissatisfied with communication between themselves and their doctors and 45% were concerned about negative effects of poor communication on them or their children. Parents tended to blame their own linguistic

  10. Survival of Sami cancer patients.

    PubMed

    Soininen, Leena; Pokhrel, Arun; Dyba, Tadek; Pukkala, Eero; Hakulinen, Timo

    2012-07-02

    The incidence of cancer among the indigenous Sami people of Northern Finland is lower than among the Finnish general population. The survival of Sami cancer patients is not known, and therefore it is the object of this study. The cohort consisted of 2,091 Sami and 4,161 non-Sami who lived on 31 December 1978 in the two Sami municipalities of Inari and Utsjoki, which are located in Northern Finland and are 300-500 km away from the nearest central hospital. The survival experience of Sami and non-Sami cancer patients diagnosed in this cohort during 1979-2009 was compared with that of the Finnish patients outside the cohort. The Sami and non-Sami cancer patients were matched to other Finnish cancer patients for gender, age and year of diagnosis and for the site of cancer. An additional matching was done for the stage at diagnosis. Cancer-specific survival analyses were made using the Kaplan-Meier method and Cox regression modelling. There were 204 Sami and 391 non-Sami cancer cases in the cohort, 20,181 matched controls without matching with stage, and 7,874 stage-matched controls. In the cancer-specific analysis without stage variable, the hazard ratio for Sami was 1.05 (95% confidence interval 0.85-1.30) and for non-Sami 1.02 (0.86-1.20), indicating no difference between the survival of those groups and other patients in Finland. Likewise, when the same was done by also matching the stage, there was no difference in cancer survival. Long distances to medical care or Sami ethnicity have no influence on the cancer patient survival in Northern Finland.

  11. Survival of Sami cancer patients.

    PubMed

    Soininen, Leena; Pokhrel, Arun; Dyba, Tadek; Pukkala, Eero; Hakulinen, Timo

    2012-01-01

    The incidence of cancer among the indigenous Sami people of Northern Finland is lower than among the Finnish general population. The survival of Sami cancer patients is not known, and therefore it is the object of this study. The cohort consisted of 2,091 Sami and 4,161 non-Sami who lived on 31 December 1978 in the two Sami municipalities of Inari and Utsjoki, which are located in Northern Finland and are 300-500 km away from the nearest central hospital. The survival experience of Sami and non-Sami cancer patients diagnosed in this cohort during 1979-2009 was compared with that of the Finnish patients outside the cohort. The Sami and non-Sami cancer patients were matched to other Finnish cancer patients for gender, age and year of diagnosis and for the site of cancer. An additional matching was done for the stage at diagnosis. Cancer-specific survival analyses were made using the Kaplan-Meier method and Cox regression modelling. There were 204 Sami and 391 non-Sami cancer cases in the cohort, 20,181 matched controls without matching with stage, and 7,874 stage-matched controls. In the cancer-specific analysis without stage variable, the hazard ratio for Sami was 1.05 (95% confidence interval 0.85-1.30) and for non-Sami 1.02 (0.86-1.20), indicating no difference between the survival of those groups and other patients in Finland. Likewise, when the same was done by also matching the stage, there was no difference in cancer survival. Long distances to medical care or Sami ethnicity have no influence on the cancer patient survival in Northern Finland.

  12. Sublingual immunotherapy with a latex extract in paediatric patients: a double-blind, placebo-controlled study.

    PubMed

    Bernardini, Roberto; Campodonico, Patrizia; Burastero, Samuele; Azzari, Chiara; Novembre, Elio; Pucci, Neri; Massai, Cristina; De Martino, Maurizio; Vierucci, Alberto

    2006-08-01

    Natural rubber latex (NRL) allergy remains an important allergic disease triggering urticaria, asthma, angioedema and anaphylaxis. Specific immunotherapy can help to solve problems related to NRL allergy. So far, no controlled clinical trials have been performed in children suffering from NRL allergy. To evaluate the safety and efficacy of sublingual immunotherapy (SLIT) with a commercial NRL extract in children with NRL allergy. Randomized, double-blind, placebo-controlled, 12-month trial. Twenty-six children (aged 4-15 years) with NRL allergy, who had cutaneous and/or respiratory symptoms, including oral allergy syndrome to fruits containing cross-reactive allergens, were recruited. Twelve children were randomized to SLIT with a commercial NRL extract and eight to placebo (3:2). An additional six children with NRL allergy served as untreated controls. A glove use test was utilized to monitor skin and systemic symptoms triggered by NRL exposure at baseline and 3, 6, 9 and 12 months later. Oral allergy symptoms were also monitored. No side effects related to treatments were observed in any patient. A significant improvement of symptom score in treated patients in comparison with baseline values was observed at 3 months (p = 0.01) and consolidated after 1 year of treatment (p = 0.0005). In comparison with placebo, significant improvements were observed starting at 9 months from study start (p = 0.015) and at 12 months (p = 0.005). The number of foods triggering oral allergy symptoms increased in placebo and control subjects, but not in active treated patients (p = 0.05). Latex SLIT was safe and efficacious in paediatric patients with NRL allergy.

  13. Patient characteristics associated with treatment initiation among paediatric patients with Attention-Deficit/Hyperactivity Disorder symptoms in a naturalistic setting in Central Europe and East Asia.

    PubMed

    Hong, Jihyung; Novick, Diego; Treuer, Tamás; Montgomery, William; Haynes, Virginia S; Wu, Shenghu; Haro, Josep Maria

    2014-10-30

    Cultural views of Attention-Deficit/Hyperactivity Disorder (ADHD), differing healthcare systems and funding mechanisms, and the availability of mental health services can greatly influence the perceptions, diagnosis, and treatment of ADHD. There is, however, lack of information about treatment practice and the treatment decision-making process for ADHD, particularly in non-Western countries. Our study compared characteristics of paediatric patients newly diagnosed with ADHD symptoms who did and who did not initiate treatment, and also examined whether any differences varied by region in Central Europe and East Asia. Data were taken from a 1-year prospective, observational study that included 1,068 paediatric patients newly diagnosed with ADHD symptoms. Clinical severity was measured using the Clinical Global Impression-ADHD-Severity (CGI-ADHD-S) scale and the Child Symptom Inventory-4 (CSI-4) checklist. Logistic regression was used to explore patient characteristics associated with treatment initiation (pharmacotherapy and/or psychotherapy) at baseline for each region. A total of 74.3% of patients initiated treatment at baseline (78.3% in Central Europe and 69.9% in East Asia). Of these, 48.8% started with both pharmacotherapy and psychotherapy in Central Europe, and only 17.1% did so in East Asia. The level of clinical severity was highest in the combination treatment group in Central Europe, but was highest in the psychotherapy only group in East Asia. In East Asia, treatment initiation was associated with being older, being male, and having a higher CGI-ADHD-S score. In Central Europe, treatment initiation was associated with parental psychological distress, having a higher CSI-4 score, and not being involved in bullying. Although factors associated with treatment initiation differed to some extent between Central Europe and East Asia, clinical severity appeared to be one of the most important determinants of treatment initiation in both regions. However, the

  14. Utility of the Technicon H-1 flags in the detection of peripheral blood blast cells of paediatric acute leukaemia patients.

    PubMed

    Fernández-Castro, M; Viloria, A

    1995-01-01

    This study evaluates the sensitivity and positive predictive value of some of the morphological flags supplied by the Technicon H-1 haematological analyser to detect circulating blasts. A total of 1,269 venous blood samples from 91 paediatric patients diagnosed of acute leukemia were analysed in the Technicon H-1. A conventional microscopic manual method was used for reference. The prevalence was 17.7% for the presence of blasts. The results showed that all samples with more than 5% blasts were detected by some WBC morphological flag: only 5 samples (2.2%) with less than 5% blasts showed no morphological flag. In most cases (86%), the flags observed were either the 'Atyp' flag or the 'Blast' flag or both simultaneously. The positive predictive value obtained by the 'Blast' flag for the true presence of blasts was 66.8%, and for the 'Atyp' flag 34.9%; it was 75.8% when both flags were present simultaneously. False positives were associated with postchemotherapy monocytosis or severe neutropenia.

  15. Evaluation of a tissue-engineered bovine pericardial patch in paediatric patients with congenital cardiac anomalies: initial experience with the ADAPT-treated CardioCel® patch

    PubMed Central

    Neethling, William M.L.; Strange, Geoff; Firth, Laura; Smit, Francis E.

    2013-01-01

    OBJECTIVES This study evaluated the safety, efficacy and clinical performance of the tissue-engineered ADAPT® bovine pericardial patch (ABPP) in paediatric patients with a range of congenital cardiac anomalies. METHODS In this single-centre, prospective, non-randomized clinical study, paediatric patients underwent surgery for insertion of the ABPP. Primary efficacy measures included early (<30 day) morbidity; incidence of device-related complications; haemodynamic performance derived from echocardiography assessment at 6- and 12-month follow-up and magnetic resonance imaging findings in 10 randomly selected patients at 12 months. Secondary measures included device-handling characteristics; shape and sizing characteristics and perioperative implant complications. The Aristotle complexity scoring system was used to score the complexity level of all surgical procedures. Patients completing the 12-month study were eligible to enter a long-term evaluation study. RESULTS Between April 2008 and September 2009, the ABPP was used in 30 paediatric patients. In the 30-day postoperative period, no graft-related morbidity was observed. In total, there were 5 deaths (2 in the 30-day postoperative period and 3 within the first 6 postoperative months). All deaths were deemed due to comorbid non-graft-related events. Echocardiography assessment at 6 and 12 months revealed intact anatomical and haemodynamically stable repairs without any visible calcification of the patch. Magnetic resonance imaging assessment in 10 patients at 12 months revealed no signs of calcification. Fisher's exact test demonstrated that patients undergoing more complex, higher risk surgical repairs (Aristotle complexity score >8) were significantly more likely to die (P = 0.0055, 58% survival compared with 100% survival for less complex surgical repairs). In 19 patients, echocardiographic data were available at 18–36 months with no evidence of device calcification, infection, thromboembolic events or

  16. Use of Anti-TNFα Agents and Time to First-time Surgery in Paediatric Patients with Ulcerative Colitis and Crohn's Disease.

    PubMed

    Larsen, Michael Due; Qvist, Niels; Nielsen, Jan; Kjeldsen, Jens; Nielsen, Rasmus Gaardskær; Nørgård, Bente Mertz

    2016-06-01

    It is debated whether the need for surgery has changed following introduction of anti-TNFα agents in the treatment of paediatric ulcerative colitis [UC] and Crohn's disease [CD]. We aimed to describe the implementation of anti-TNFα agents in paediatric patients, and the need of first-time surgery before and after introduction of anti-TNFα agents. In the Danish National Patient Registry, we identified incident paediatric patients diagnosed from 1998. We calculated the proportion of patients receiving anti-TNFα agents within 5 years from diagnosis, and the cumulative 5 year proportion of surgery, according to calendar periods of diagnosis. At the end of our study period [2007 and 2008], 29-41% of CD children were treated with anti-TNFα agents within 5 years, and for UC children 17-19%. In 1278 CD patients, the 5 year cumulative proportions of surgery were 14.6-15.6% for children diagnosed in 1998-2008 and 9.7% (95% confidence interval [CI]: 6.7-13.7) for those diagnosed in 2009-2013. In 1468 UC patients, the cumulative proportion of surgery suggested a decline in patients diagnosed after mid 2005, and the hazard ratio of surgery was 0.64 [95% CI: 0.47-0.86] after the introduction of anti-TNFα agents compared with before. For UC patients diagnosed in 2009-2013, the 5 year cumulative proportion of surgery was 7.6% [95% CI: 5.2-11.2]. This nationwide study showed an extensive use of anti-TNFα agents at the end of our study period. For UC children, our data suggest a decline in the proportion of surgery in the period of increasing use of anti-TNFα agents. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  17. Sources and magnitude of error in preparing morphine infusions for nurse-patient controlled analgesia in a UK paediatric hospital.

    PubMed

    Rashed, Asia N; Tomlin, Stephen; Aguado, Virginia; Forbes, Ben; Whittlesea, Cate

    2016-10-01

    Background Administering nurse/patient controlled analgesia (N/PCA) to children requires complex dose calculations and multiple manipulations to prepare morphine solutions in 50 mL syringes for administration by continuous infusion with additional boluses. Objective To investigate current practice and accuracy during preparation of morphine N/PCA infusions in hospital theatres and wards at a UK children's hospital. Methods Direct observation of infusion preparation methods and morphine concentration quantification using UV-Vis spectrophotometry. The British Pharmacopoeia specification for morphine sulphate injection drug content (±7.5 %) was used as a reference limit. Results Preparation of 153 morphine infusions for 128 paediatric patients was observed. Differences in preparation method were identified, with selection of inappropriate syringe size noted. Lack of appreciation of the existence of a volume overage (i.e. volume in excess of the nominal volume) in morphine ampoules was identified. Final volume of the infusion was greater than the target (50 mL) in 33.3 % of preparations. Of 78 infusions analysed, 61.5 % had a morphine concentration outside 92.5-107.5 % of label strength. Ten infusions deviated by more than 20 %, with one by 100 %. Conclusions Variation in morphine infusion preparation method was identified. Lack of appreciation of the volume overage in ampoules, volumetric accuracy of different syringe sizes and ability to perform large dilutions of small volumes were sources of inaccuracy in infusion concentration, resulting in patients receiving morphine doses higher or lower than prescribed.

  18. The association between urinary continence and quality of life in paediatric patients with spina bifida and tethered cord

    PubMed Central

    Olesen, Jamie D; Kiddoo, Darcie A; Metcalfe, Peter D

    2013-01-01

    OBJECTIVE: To determine the association between urinary continence and quality of life (QoL) in a paediatric spina bifida population. METHODS: After appropriate ethics approval, a prospective study was initiated using multiple validated QoL instruments that were distributed to patients as they presented for their annual appointment at the Northern Alberta Spina Bifida Clinic (Edmonton, Alberta). General demographic information was collected and validated questionnaires were used. The survey package included two instruments to assess overall QoL: Global Pediatric QoL (PedsQL 4.0) and Health Specific QoL-Spina Bifida (HRQoL-SB). Two instruments were also included to quantify urinary symptoms and assess urinary specific QoL: the Urinary Incontinence Severity Index – Pediatric (ISI-P) and Urinary Specific QoL (PinQ). RESULTS: A total of 71 patients were enrolled in the study. The general QoL (PedsQL 4.0) and health-specific QoL (HRQoL-SB) scores for the population indicated an overall QoL of 66% (n=69) and 83% (n=67), respectively. Approximately 46% (33 of 71) reported >1 episode of urinary incontinence per week. Urinary continence was associated with a significantly higher urinary-specific QoL (PinQ; P<0.001), general QoL (PedsQL 4.0; P<0.05) and health-specific QoL (HRQoL-SB; P<0.05). Furthermore, urinary incontinence and its effect on QoL was not influenced by the presence of a shunt, level of the lesion or manner of dysraphism. CONCLUSION: These data suggest that QoL in patients with spina bifida is related to urinary continence. This effect appears to be independent of the type and level of the spinal dysraphism and the presence or absence of a shunt. PMID:24421717

  19. The role of surgery in the treatment of invasive fungal infection in paediatric haematology patients: a retrospective single-centre survey.

    PubMed

    Cesaro, Simone; Pegoraro, Anna; Tridello, Gloria; Pillon, Marta; Cannata, Elisa; Faggin, Stefano; Cecchetto, Giovanni

    2014-07-01

    Surgery may improve the control of fungal disease and patient survival. The aim of this study was to report a single-centre experience in using surgery for the treatment of paediatric invasive fungal infection (IFI). From 2001 to 2009, 18 paediatric onco-haematology patients underwent 24 surgical procedures as treatment of IFI. At surgery, severe thrombocytopenia and neutropenia were present in four and one episodes respectively. Complications were one pleural effusion, one pleural effusion and surgical wound infection, one pneumothorax with wound dehiscence and one wound dehiscence. None of them required repeat surgery. The median duration of hospitalisation for four complicated procedures was 11 days, range 3-16, and 7 days, range 2-13, for the 20 uncomplicated procedures. No surgery-related deaths occurred. Fourteen patients resumed chemotherapy after a median of 26 days, range 9-77, whereas nine patients underwent hematopoietic stem cell transplantation after a median of 42 days, range 27-110. At 3 months from IFI, 17 patients were alive (94%) and one patient (6%) died from mycosis; the 3-month overall survival (OS) being 94.4%, CI 66.6-99.2. After a median follow-up of 7.1 years (CI 2.8-7.5), the OS was 54.5%, CI 29.2-74.2. Surgery is a feasible and valuable option in paediatric patients because it is associated with a low incidence of complications and an acceptable delay in resuming the chemotherapeutic plan.

  20. Financial Distress in Cancer Patients

    PubMed Central

    de Souza, Jonas A.; Wong, Yu-Ning

    2013-01-01

    Novel diagnostic and therapeutic options offer hope to cancer patients with both localized and advanced disease. However, many of these treatments are often costly and even well-insured patients can face high out-of-pocket costs. Families may also be at risk of financial distress due to lost wages and other treatment-related expenses. Research is needed to measure and characterize financial distress in cancer patients and understand how it affects their quality of life. In addition, health care providers need to be trained to counsel patients and their families so they can make patient-centered treatment decisions that reflect their preferences and values. PMID:24349677

  1. [Neurological complications in cancer patients].

    PubMed

    Hundsberger, Thomas; Roth, Patrick; Roelcke, Ulrich

    2014-08-20

    Neurological symptoms in cancer patients have a great impact on quality of life and need an interdisciplinary approach. They lead to significant impairment in activities of daily living (gait disorders, dizziness), a loss of patients independency (vegetative disturbances, wheel-chair dependency) and interfere with social activities (ban of driving in case of epilepsy). In this article we describe three main and serious neurological problems in the context of oncological patients. These are chemotherapy-induced polyneuropathy, malignant spinal cord compression and epileptic seizures. Our aim is to increase the awareness of neurological complications in cancer patients to improve patients care.

  2. Vitamin E for the treatment of E-antigen-positive chronic hepatitis B in paediatric patients: results of a randomized phase 2 controlled study.

    PubMed

    Fiorino, Sirio; Loggi, Elisabetta; Verucchi, Gabriella; Comparcola, Donatella; Vukotic, Ranka; Pavoni, Michele; Grandini, Elena; Cursaro, Carmela; Maselli, Silvia; Bacchi Reggiani, Maria L; Puggioli, Cristina; Badia, Lorenzo; Galli, Silvia; Viale, Pierluigi; Bernardi, Mauro; Andreone, Pietro

    2017-01-01

    The treatment of chronic hepatitis B infection (CHB) in children is still an area of great uncertainty. Vitamin E is an immunostimulating/antioxidant compound proven to be safe and effective for the treatment of adult CHB. The aim of this phase 2 controlled study was to evaluate the safety and efficacy of vitamin E for the treatment of paediatric HBeAg-positive CHB. Forty-six children were randomized in a 1:1 ratio to receive vitamin E at a dose of 15 mg/kg/day (in galenic preparation) or no treatment for 12 months and were monitored for the subsequent 12 months. Clinical, biochemical, haematological and serovirological evaluations were carried out every 3 months. No significant side effects were associated with the vitamin E treatment. At the end of the study, anti-HBe seroconversion was obtained in 7 of 23 (30.4%) of vitamin E-treated versus 1 of 23 (4.3%) of the control patients (P = 0.05), while a virological response (≥2 log decrease in HBV-DNA from baseline) was observed in 9 of 23 (39.1%) vs. 2 of 23 (8.7%) respectively (P = 0.035). Vitamin E administration for the treatment of paediatric CHB at the tested dosage has no significant side effects and may induce anti-HBe seroconversion. Vitamin E could represent a tool for the treatment of paediatric CHB. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Urotherapy for patients with cancer.

    PubMed

    Eldor, J

    1997-04-01

    Cancer cells release various antigens, some of which appear in the urine. Oral autourotherapy is suggested as a new treatment modality for cancer patients. It will provide the intestinal lymphatic system with the many tumor antigens against which antibodies may be produced. These antibodies may be pierced through the blood stream and attack the tumor and its cells.

  4. Prospective evaluation of cisplatin- and carboplatin-mediated ototoxicity in paediatric and adult soft tissue and osteosarcoma patients

    PubMed Central

    NITZ, ALEXANDRA; KONTOPANTELIS, EVANGELOS; BIELACK, STEFAN; KOSCIELNIAK, EWA; KLINGEBIEL, THOMAS; LANGER, THORSTEN; PAULIDES, MARIOS

    2013-01-01

    Platinum-compound chemotherapy is known to have ototoxic side-effects. However, there is a paucity of literature examining hearing function prospectively and longitudinally in cohorts containing paediatric and adult patients treated within the same cisplatin- or carboplatin-containing treatment trial protocols. In Germany, Austria and Switzerland, late effects of treatment for osteosarcoma and soft tissue sarcoma have been prospectively and longitudinally registered by the Late Effects Surveillance System since 1998. The aim of this study was to analyse cisplatin- and carboplatin-induced ototoxity in a group of 129 osteosarcoma and soft tissue sarcoma patients treated within the COSS-96, CWS-96 and CWS-2002P treatment trials. The cohort consisted of 112 children and 17 adults. The median age at diagnosis was 13.56 (IQR, 10.26–16.27) years. Follow-up was 6.97 (IQR, 0.87–15.63) months. Hearing function was examined by audiometry before and after platinum treatment. A total of 108 patients were treated with cisplatin with a median cumulative dose of 360 mg/m2. Thirteen patients received carboplatin with a median cumulative dose of 1500 mg/m2 and 8 patients were treated with both platinum compounds (median cisplatin dose, 240 mg/m2; IQR, 240–360 mg/m2 and median carboplatin dose: 1200 mg/m2; IQR, 600–3000 mg/m2). Following cessation of therapy, 47.3% of the patients demonstrated a hearing impairment, namely 55 children (49.1%) and 6 adults (42.1%). Out of thirteen children treated with carboplatin with a cumulative dose of 1500 mg/m2, six revealed a significant hearing impairment. Although ototoxicity caused by platinum compounds is considered irreversible, we identified hearing improvements over time in 11 children (9.8%) and 3 adults (17.6%). None of these patients received irradiation to the head. We conclude that hearing loss is frequent in children treated with protocols containing platinum compounds and recommend prospective testing via audiometry. PMID

  5. Protocolized versus non-protocolized weaning for reducing the duration of invasive mechanical ventilation in critically ill paediatric patients.

    PubMed

    Blackwood, Bronagh; Murray, Maeve; Chisakuta, Anthony; Cardwell, Chris R; O'Halloran, Peter

    2013-07-31

    Mechanical ventilation is a critical component of paediatric intensive care therapy. It is indicated when the patient's spontaneous ventilation is inadequate to sustain life. Weaning is the gradual reduction of ventilatory support and the transfer of respiratory control back to the patient. Weaning may represent a large proportion of the ventilatory period. Prolonged ventilation is associated with significant morbidity, hospital cost, psychosocial and physical risks to the child and even death. Timely and effective weaning may reduce the duration of mechanical ventilation and may reduce the morbidity and mortality associated with prolonged ventilation. However, no consensus has been reached on criteria that can be used to identify when patients are ready to wean or the best way to achieve it. To assess the effects of weaning by protocol on invasively ventilated critically ill children. To compare the total duration of invasive mechanical ventilation of critically ill children who are weaned using protocols versus those weaned through usual (non-protocolized) practice. To ascertain any differences between protocolized weaning and usual care in terms of mortality, adverse events, intensive care unit length of stay and quality of life. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 10, 2012), MEDLINE (1966 to October 2012), EMBASE (1988 to October 2012), CINAHL (1982 to October 2012), ISI Web of Science and LILACS. We identified unpublished data in the Web of Science (1990 to October 2012), ISI Conference Proceedings (1990 to October 2012) and Cambridge Scientific Abstracts (earliest to October 2012). We contacted first authors of studies included in the review to obtain further information on unpublished studies or work in progress. We searched reference lists of all identified studies and review papers for further relevant studies. We applied no language or publication restrictions. We included randomized

  6. Paediatric eosinophilic oesophagitis presenting to the otolaryngologist.

    PubMed

    Harris, R; Mitton, S; Chong, S; Daya, H

    2010-01-01

    The prevalence of eosinophilic oesophagitis is increasing. A Pubmed search for 'eosinophilic oesophagitis' and 'eosinophilic esophagitis' yielded 345 publications since 1976. Only seven were in otolaryngology journals.1-7 Patients typically present with dysphagia, vomiting, dyspepsia or food impaction and are therefore usually referred to a paediatric gastroenterologist; otolaryngologists are not usually involved in management. A missed diagnosis may result in oesophageal stricture. Two patients, aged two and four years, were referred to the paediatric otolaryngology department with intermittent upper oesophageal food impaction. A paediatric gastroenterologist was involved in the investigation. Histological examination of oesophageal biopsies demonstrated changes consistent with eosinophilic oesophagitis. Both patients were expediently diagnosed, investigated and managed. A diagnosis of eosinophilic oesophagitis must be considered in patients presenting with food bolus impaction. Early involvement of a paediatric gastroenterology team in the diagnosis is recommended in children presenting with oesophageal symptoms, in order to avoid delayed diagnosis.

  7. Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease--the perspective of critical care.

    PubMed

    LaRovere, Joan M; Jeffries, Howard E; Sachdeva, Ramesh C; Rice, Thomas B; Wetzel, Randall C; Cooper, David S; Bird, Geoffrey L; Ghanayem, Nancy S; Checchia, Paul A; Chang, Anthony C; Wessel, David L

    2008-12-01

    The development of databases to track the outcomes of children with cardiovascular disease has been ongoing for much of the last two decades, paralleled by the rise of databases in the intensive care unit. While the breadth of data available in national, regional and local databases has grown exponentially, the ability to identify meaningful measurements of outcomes for patients with cardiovascular disease is still in its early stages. In the United States of America, the Virtual Pediatric Intensive Care Unit Performance System (VPS) is a clinically based database system for the paediatric intensive care unit that provides standardized high quality, comparative data to its participants [https://portal.myvps.org/]. All participants collect information on multiple parameters: (1) patients and their stay in the hospital, (2) diagnoses, (3) interventions, (4) discharge, (5) various measures of outcome, (6) organ donation, and (7) paediatric severity of illness scores. Because of the standards of quality within the database, through customizable interfaces, the database can also be used for several applications: (1) administrative purposes, such as assessing the utilization of resources and strategic planning, (2) multi-institutional research studies, and (3) additional internal projects of quality improvement or research.In the United Kingdom, The Paediatric Intensive Care Audit Network is a database established in 2002 to record details of the treatment of all critically ill children in paediatric intensive care units of the National Health Service in England, Wales and Scotland. The Paediatric Intensive Care Audit Network was designed to develop and maintain a secure and confidential high quality clinical database of pediatric intensive care activity in order to meet the following objectives: (1) identify best clinical practice, (2) monitor supply and demand, (3) monitor and review outcomes of treatment episodes, (4) facilitate strategic healthcare planning, (5

  8. High incidence of hepatitis B infection after treatment for paediatric cancer at a teaching hospital in Baghdad.

    PubMed

    Al-Jadiry, M F; Al-Khafagi, M; Al-Darraji, A F; Al-Saeed, R M; Al-Badri, S F; Al-Hadad, S A

    2013-02-01

    This study estimated the incidence of viral hepatitis in children treated for cancer, to identify variables that could affect this incidence and to assess the role of hepatitis B virus (HBV) vaccination in preventing infection. Between September 2007 and June 2008, 256 children in the haemato-oncology unit at the Children's Welfare Teaching Hospital, Baghdad, were studied prospectively. Demographic and clinical data and vaccination history were recorded. Patients were tested for HBV at the time of diagnosis (all were negative) and after starting chemotherapy. On admission to the unit, 231 patients (90.2%) were revaccinated. At reassessment after treatment for cancer, HBV infection was found in 70 patients (27.3%). The variables that significantly increased the risk for HBV infection were a diagnosis of leukaemia and receiving more than 3 units of blood. A higher number of HBV vaccinations in hospital reduced the risk for HBV infection. The high rate of acquisition of HBV infection found in this study indicates the need for better screening of blood products and adherence to aseptic techniques in management of this group of patients.

  9. Breast cancer patient stories project.

    PubMed

    Tanna, Nuttan; Buijs, Helene; Pitkin, Joan; Reichert, Robert

    2012-12-01

    It is estimated that there are almost half a million women living with or beyond a breast cancer diagnosis in the UK, often referred to as the breast cancer survivor population. We report on the setting up of a dedicated breast cancer and menopause symptoms service (BCMS), and present results from research undertaken with breast cancer survivors with the aim of obtaining their perspectives on the BCMS service. An action-oriented approach incorporating improvement science methodology has been used to help develop and drive changes to support a high standard of NHS patient care delivery for women with breast cancer within the BCMS setting. Evaluation was undertaken of this innovative service using qualitative methodology, and included discussion within a focus group setting, patient consent to record discussion, followed by thematic analysis of transcription. Women who have survived breast cancer identified a need for specialist support to help improve their quality of life, which is also affected by menopause type symptomology. This support can be provided within the BCMS service setting. Our recommendations are that the BCMS service model is incorporated into any regional or national breast cancer patient pathway and service redesign work in place. Breast cancer survivors would support the setting up of a BCMS service, and would actively help raise awareness and market this service.

  10. Cancer Screening in Older Patients.

    PubMed

    Salzman, Brooke; Beldowski, Kathryn; de la Paz, Amanda

    2016-04-15

    Although cancer is the second leading cause of death among persons 65 years and older, there is a paucity of clinical trial data about the effectiveness and harms of cancer screening in this population. Given the heterogeneous nature of the older population, cancer screening in these patients should not be based on age alone. Studies suggest that a life expectancy of at least 10 years is necessary to derive a survival benefit from screening for breast and colorectal cancers; therefore, screening for these cancers is not recommended in those with a life expectancy of less than 10 years. Prostate cancer screening, if performed at all, should not be performed after 69 years of age. Cervical cancer screening may be stopped after 65 years of age if the patient has an adequate history of negative screening results. An individualized approach to cancer screening decisions involves estimating life expectancy, determining the potential benefits and harms of screenings, and weighing those benefits and harms in relation to the patient's values and preferences.

  11. Neuromuscular conditions associated with malignant hyperthermia in paediatric patients: A 25-year retrospective study.

    PubMed

    Bamaga, Ahmed K; Riazi, Sheila; Amburgey, Kimberly; Ong, Shaun; Halliday, William; Diamandis, Phedias; Guerguerian, Anne-Marie; Dowling, James J; Yoon, Grace

    2016-03-01

    Malignant Hyperthermia (MH) is a rare pharmacogenetic syndrome that can be fatal and the risk of MH in non RYR1-related disorders is unknown. We conducted a retrospective study to determine the prevalence of neuromuscular disorders among patients with MH at our centre. Patients who were admitted to the Hospital for Sick Children during the study period of January 1, 1990 to April 1, 2015 with a CK level > 8000 IU/L, or who received dantrolene, or who had a clinical diagnosis of MH were included. Medical records of 166 patients who met the inclusion criteria were reviewed and 13 patients were identified with MH-like reactions. Nine patients were classified as having true MH after review of the anaesthesia record and genetic testing results were available for 7 patients, 5 of whom had mutations in RYR1. Of the four patients who had severe reactions to anaesthesia but did not meet the criteria for true MH, two had Duchenne muscular dystrophy (DMD). In this retrospective study over 25 years, RYR1 mutations were the most common cause of MH in our cohort, and of these, one third had an underlying neuromuscular diagnosis. Genetic testing of RYR1 is indicated for all patients with MH, and anaesthetic precautions should be considered for any child with symptoms of neuromuscular disease. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. The ketogenic diet in two paediatric patients with refractory myoclonic status epilepticus.

    PubMed

    Caraballo, Roberto Horacio; Valenzuela, Gabriela Reyes; Armeno, Marisa; Fortini, Sebastian; Mestre, Graciela; Cresta, Araceli

    2015-12-01

    We describe two patients with refractory myoclonic status epilepticus treated with the ketogenic diet. Between May 1, 2014 and January 1, 2015, two patients who met the diagnostic criteria for refractory myoclonic status epilepticus, seen at our department, were placed on the ketogenic diet and followed for a minimum of six months. One patient with myoclonic epilepsy of unknown aetiology had a 75-90% seizure reduction, and the other with progressive encephalopathy associated with myoclonic epilepsy had a 50% seizure reduction. Both patients retained good tolerability for the diet. At the last control, one patient had isolated myoclonias and EEG showed occasional generalized spike-and-polyspike waves; the patient is now successfully attending kindergarten. The quality of life of the second patient improved significantly. In both cases, the number of antiepileptic drugs was reduced. The ketogenic diet is an effective and well-tolerated treatment option for patients with refractory myoclonic status epilepticus and should be considered earlier in the course of treatment.

  13. Mutational analysis of paediatric patients with tuberous sclerosis complex in Korea: genotype and epilepsy.

    PubMed

    Lee, Jin Sook; Lim, Byung Chan; Chae, Jong-Hee; Hwang, Yong Seung; Seong, Moon-Woo; Park, Sung Sup; Kim, Ki Joong

    2014-12-01

    To date, only a few studies have reported that, in tuberous sclerosis, TSC2 mutations are more frequently associated with infantile spasms and cognitive impairment compared to TSC1 mutations. We analyzed the mutational spectrum of patients with tuberous sclerosis in Korea and attempted to explore the associations between genotype and seizure type/outcome. We performed mutational analyses on 70 unrelated patients with clinically confirmed tuberous sclerosis by using direct DNA sequencing and/or multiplex ligation-dependent probe amplification. The patients' medical records, including epilepsy type and outcome, were reviewed retrospectively. We identified pathogenic mutations in 55 patients (79%), 25 of which were novel. There were 12 TSC1 mutations and 43 TSC2 mutations. TSC1 mutations included 8 frameshift and 4 nonsense mutations. TSC2 mutations included 12 frameshift, 10 nonsense, 6 splicing, and 6 missense mutations, as well as 4 in-frame deletions and 5 large deletions. Fifty-eight patients had epilepsy (83%), including 19 patients with a history of infantile spasms. Compared to patients with TSC1 mutations, individuals with TSC2 mutations had a significantly higher frequency of epilepsy (p<0.05) and tended to have a higher frequency of infantile spasms (37% vs 17%; p<0.3). Most of the patients with TSC2 mutations who developed infantile spasms exhibited subsequent epilepsy (13/14; 93%). However, the presence/absence of infantile spasms did not influence seizure remission or cognitive outcome.

  14. Paediatric vocal fold paralysis.

    PubMed

    Garcia-Lopez, Isabel; Peñorrocha-Teres, Julio; Perez-Ortin, Magdalena; Cerpa, Mauricio; Rabanal, Ignacio; Gavilan, Javier

    2013-01-01

    Vocal fold paralysis (VFP) is a relatively common cause of stridor and dysphonia in the paediatric population. This report summarises our experience with VFP in the paediatric age group. All patients presenting with vocal fold paralysis over a 12-month period were included. Medical charts were revised retrospectively. The diagnosis was performed by flexible endoscopic examination. The cases were evaluated with respect to aetiology of the paralysis, presenting symptoms, delay in diagnosis, affected side, vocal fold position, need for surgical treatment and outcome. The presenting symptoms were stridor and dysphonia. Iatrogenic causes formed the largest group, followed by idiopathic, neurological and obstetric VFP. Unilateral paralysis was found in most cases. The median value for delay in diagnosis was 1 month and it was significantly higher in the iatrogenic group. Surgical treatment was not necessary in most part of cases. The diagnosis of VFP may be suspected based on the patient's symptoms and confirmed by flexible endoscopy. Infants who develop stridor or dysphonia following a surgical procedure have to be examined without delay. The surgeon has to keep in mind that there is a possibility of late spontaneous recovery or compensation. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  15. Intussusception in children: experience with 105 patients in a department of paediatric surgery, Turkey.

    PubMed

    Sonmez, Kaan; Turkyilmaz, Zafer; Demirogullari, Billur; Karabulut, Ramazan; Kale, Nuri; Basaklar, A Can

    2012-03-29

    The aim of this study was to present our experience in patients with intussusception (IN). One hundred and five cases of IN treated between 1991 and 2007 were analysed. Age, gender, symptoms, signs, diagnostic and treatment methods, types of IN including leading point, and postoperative complications were evaluated. The mean age of the patients was 2.5 years (range 1 month - 15 years). Fifty-nine per cent (62/105) were under 1 year of age, and of these 28% were receiving therapy for upper respiratory tract infection. The most common symptom was colicky abdominal pain. Rectal bleeding was present in all patients under 2 years of age. In 23 children (21.9%) leading points were detected. Thirty per cent of the patients were older than 4 years, and 76.6% of these had leading points. Ultrasonography demonstrated the invaginated segment in 93 patients. Hydrostatic reduction was attempted in 71.4% (75) of the patients and was successful in 48% (36), 70% of whom were under 1 year of age. Of the patients with unsuccessful hydrostatic reduction, 11 required intestinal resection and primary anastomosis and 35 manual reduction. Twenty-four patients were diagnosed by means of ultrasonography and were operated on immediately. Ten of these patients had signs of peritonitis on admission and were treated by resection-primary anastomosis. In patients with IN under 2 years of age, hydrostatic or pneumatic reduction may be successful. Considering the high incidence of leading points in older children, one should not persist with reduction but should rather design a treatment plan accordingly, i.e. laparotomy with manual reduction or resection.

  16. Disconnective surgery in posterior quadrantic epilepsy: a series of 12 paediatric patients.

    PubMed

    Yang, Peng-Fan; Mei, Zhen; Lin, Qiao; Pei, Jia-Sheng; Zhang, Hui-Jian; Zhong, Zhong-Hui; Tian, Jun; Jia, Yan-Zeng; Chen, Zi-Qian; Zheng, Zhi-Yong

    2014-09-01

    To assess the surgical outcomes of temporo-parieto-occipital (TPO) and parieto-occipital (PO) disconnection surgery for children with intractable posterior quadrantic epilepsy and a unilateral posterior quadrant lesion based on MRI and functional imaging abnormality in the TPO region on one side. A retrospective review of data of 12 children who underwent TPO or PO disconnective surgery was carried out from September 2009 to September 2012. Three-dimensional surface reconstructions of MRI scans and intraoperative electrophysiological monitoring were used during surgery. Drugs were not discontinued after surgery in any patient. The affected hemisphere was the left in seven patients and the right in five patients. The mean ages at seizure onset and at surgery were four years and 12.3 years, respectively. At the time of surgery, 3 children had atonic seizures, 4 had symptomatic epilepsy with focal seizures and alteration of conscioussness, 4 had secondarily generalised seizures, and 1 child had spasms and tonic seizures. All patients had developmental delay. A pure TPO disconnection was performed in 11 patients and a PO disconnection was performed in the remaining patient. On pathological examination, 3 patients were shown to have focal cortical dysplasia (FCD) Ib, 2 with FCD IIa, 5 with FCD IIb, 1 with gliosis, and 1 with gliosis plus FCD IIa. Following surgery, 2 patients had oedema; 1 required another operation to resect the occipital lobe. At a mean follow-up of 34.5 months, 9 patients (75%) were classified as Engel class I, 2 as Engel Class II, and 1 as Engel class III. All 12 children had contralateral hemianopia postoperatively and improvement in median IQ (p=0.04) was reported three months postoperatively. With respect to the limits of a retrospective and relatively small sample size series TPO and PO disconnection are safe and effective motor-sparing epilepsy surgical procedures in selected patients with the epileptiform zone located in the posterior quadrant

  17. A STUDY OF THE EFFECT OF HYPOTONIC HYPER-HYDRATION FLUIDS ON SODIUM BALANCE IN PAEDIATRIC HAEMATOLOGY/ONCOLOGY PATIENTS RECEIVING CHEMOTHERAPY.

    PubMed

    Keane, Sinead; Butler, Eileen

    2016-09-01

    To determine the effect, if any, that hyper-hydration with hypotonic fluids has on sodium balance in paediatric haematology/oncology patients receiving cytotoxic chemotherapy treatment for malignancies. A literature review was carried out and a snapshot of current practice across paediatric haematology/oncology centres in the UK was obtained. A prospective study was carried out in a tertiary paediatric haematology/oncology centre. A total of 98 patient episodes involved hyper-hydration with isotonic 0.9% NaCl, almost isotonic 0.45% NaCl+2.5% glucose with added sodium bicarbonate or hypotonic 0.45% NaCl+2.5% glucose. Serum sodium was monitored before and during hyper-hydration. Results were analysed according to whether children experienced a drop in serum sodium. Patients who were hyper-hydrated with hypotonic 0.45% NaCl & 2.5% Glucose experienced the greatest mean drop in serum sodium. The mean drop in sodium was 2.11 mmol/L in the group receiving the hypotonic 0.45% NaCl & 2.5% Glucose compared to 0.47 mmol/L in the group who received isotonic 0.9% NaCl or 0.45% NaCl & 2.5% Glucose with added sodium bicarbonate. During the course of the study five patients who received 0.45% NaCl & 2.5% Glucose dropped their sodium to 130 mmol/L or less constituting hyponatraemia. No patient dropped their serum sodium to 130 mmol/L or less in the other two groups. During the course of the study no patient experienced clinical manifestations of hyponatraemia. No child became hypernatraemic. In paediatric haematology/oncology patients receiving hyper-hydration with concurrent chemotherapy isotonic fluids are preferable. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Assessing and addressing the problem of pain and distress during wound care procedures in paediatric patients with burns.

    PubMed

    van der Heijden, Marianne J E; de Jong, Alette; Rode, Heinz; Martinez, Roux; van Dijk, Monique

    2017-08-08

    While the prevalence of burns in children is highest in low and middle-income countries, most research on burn-related pain intensity and distress is carried out in high-income countries. In this study we assessed pain intensity and distress in paediatric patients with burns undergoing wound care procedures without distraction and parental presence in a South-African children's hospital and sought to identify predictors for the outcomes. This observational study, carried out as part of a randomized controlled trial, took place at a burns unit in Cape Town, South Africa and included patients between the ages of 0 and 13 years undergoing their first or second wound care procedure. We measured pain intensity and distress using the COMFORT Behavioural scale (COMFORT-B) across four distinct phases of wound care procedures: removal of bandage; washing the wound; administering wound care; putting on new dressings. COMFORT-B scores ≥21 indicate severe pain intensity and distress. 124 patients were included, median age 21.2 months (IQR 14.9-39.5 months), 90% suffered scalds, and median total body surface 8% (IQR 5-14%). Assessment scores for the majority of patients were indicative of severe pain intensity and distress during wound care procedures. Median COMFORT-B scores across the four phases were 24, 25, 25 and 22 respectively. Across the four phases respectively 76%; 89%; 81% and 62% of the patients were indicated with severe pain intensity and distress. Age was a predictor for pain intensity and distress as younger children were assigned higher scores than older children (Unstandardized B -.052; 95% CI -.071 to -.032 p<0.001). In this study children received wound care procedures without distraction or parental presence and were assessed to have high pain intensity and distress. There is a correlation between age and COMFORT-B scores: younger children show higher distress, indicating a great need for better pain and distress control during wound care procedures. It

  19. Adult and paediatric patients with minimal change nephrotic syndrome show no major alterations in glomerular expression of sulphated heparan sulphate domains.

    PubMed

    Wijnhoven, Tessa J M; Geelen, Joyce M; Bakker, Marinka; Lensen, Joost F M; Rops, Angelique L W M M; Kramer, Andrea B; Navis, Gerjan; van den Hoven, Mabel J W; van der Vlag, Johan; Berden, Jo H M; Wetzels, Jack F M; van den Heuvel, Lambert P W J; Monnens, Leo A H; van Kuppevelt, Toin H

    2007-10-01

    Minimal change nephrotic syndrome (MCNS) is the most frequent form of nephrotic syndrome in childhood. In the glomerular basement membrane (GBM) of adult patients with MCNS, a reduced expression of a specific heparan sulphate (HS) domain has been reported. In children with MCNS, urinary activity of the HS-degrading enzyme heparanase was increased. It is, therefore, possible that a decreased GBM HS expression is associated with the pathogenesis of proteinuria in patients with MCNS. In this study, HS in glomeruli of five adult and six paediatric patients with MCNS were analysed by immunofluorescence staining using four different antibodies, each defining a specific sulphated HS domain. The pediatric patients were subdivided into three groups depending on the presence or absence of podocyte foot process effacement, the level of proteinuria and prednisone administration at the time of the biopsy. In addition, kidneys of rats with adriamycin nephropathy (ADRN), a model for MCNS, were included in the study. Expression of sulphated HS domains was not aberrant in adult or paediatric patients compared with control subjects. Children with and without proteinuria had the same HS content. In contrast, rats with ADRN showed a decreased glomerular expression of sulphated HS domains. These results suggest that in patients with MCNS proteinuria is not associated with major changes in glomerular expression of sulphated HS domains.

  20. Prevalence of malnutrition at the time of admission among patients admitted to a Canadian tertiary-care paediatric hospital

    PubMed Central

    Baxter, Jo-Anna B; Al-Madhaki, Fatma Ibrahim; Zlotkin, Stanley H

    2014-01-01

    BACKGROUND: Malnutrition among hospitalized children is known to negatively influence their response to therapy and to prolong their admission. It also has short- and long-term consequences for growth, development and well-being. It is commonly regarded as a condition affecting children in low-income countries; however, malnutrition has been found to be variably prevalent among hospitalized children in higher-income countries. At the time the present study was conducted, it had been >30 years since the nutritional status of Canadian hospitalized children was last published. OBJECTIVES: To determine and communicate the prevalence of malnutrition among children in a Canadian tertiary-care paediatric hospital at the time of their admission. METHODS: In the present cross-sectional study, anthropometric measures were obtained from 322 children admitted to The Hospital for Sick Children in Toronto, Ontario. Nutritional indexes (BMI for age, weight for age, weight for length/height and length/height for age) were generated from anthropometric measures using the WHO igrowup software, and summarized according to WHO definitions. RESULTS: The overall prevalence of malnutrition using BMI for age was 39.6% (95% CI 33% to 46%), of which 8.8% and 30.8% of participants were under- and overnourished, respectively. Furthermore, 6.9% (95% CI 3% to 13%) were determined to be acutely malnourished (weight for length/height <−2 SD) and 13.4% (95% CI 10% to 18%) chronically malnourished (length/height for age <−2 SD). CONCLUSION: The high prevalence of overall malnutrition observed among study participants suggests that initial screening using simple anthropometric measures should be conducted on hospital admission so that patients can receive appropriate nutrition-specific care. PMID:25382997

  1. Medication Errors in Ambulatory Paediatric Patient Setting--How Close, or Far, are we from an Error Free Process?

    PubMed

    Elashwah, Mohamed

    2014-01-01

    The medication management pathway (MMP) outlines the medication journey from the decision to prescribe through to monitoring the outcomes. Medication errors (MEs) can occur at any point of the pathway. MEs in children may result in poor health outcomes; and as children are more vulnerable to dose calculation and administration errors especially in the ambulatory setting, this cohort may be at a higher risk of adverse outcomes. This review aimed to identify MEs in children and attribute them to the steps within the MMP for paediatric ambulatory patients. A systematic search of studies related to MEs in children was performed using MEDLINE, EMBASE and International Pharmaceutical Abstracts in the period from Jan 1991 to June 2011, using keywords pertaining to children, medication errors and ambulatory settings. Thirty articles met the review inclusion criteria and the findings of these studies were reported. Based on the MMP, 26 studies reported prescribing errors, 7 dispensing errors, and 12 administration errors. Twelve studies reported errors at more than one time point within the MMP; four studies at 2 stages and 8 studies at 3 stages. The most common types of the errors identified were dose errors which commonly occurred during prescribing, dispensing, or administration. Studies have highlighted that MEs occurring in children, with most of the errors reported at the prescribing stage. This could be a reflection of the studies' focus, and further work is needed to review errors occurring at other time points during the medication management cycle. Identifying where errors occur will contribute to the development of novel strategies to detect and prevent these errors in ambulatory settings.

  2. Febrile neutropaenia in cancer patients.

    PubMed

    Walwyn, M; Nicholson, A; Lee, M G; Wharfe, G; Frankson, M A

    2010-03-01

    Febrile neutropaenia is a common complication of chemotherapy in cancer patients. Empirical antibiotic regimes are based on the epidemiological characteristics of bacterial isolates globally and locally. This study retrospectively reviewed all cases of febrile neutropaenia in patients with confirmed cancer admitted at the University Hospital of the West Indies in the four-year period between, January 1, 2003 and December 31, 2006 and who received chemotherapy. Cases were identified from blood culture records and hospital charts which were reviewed to determine the aetiological agents causing bacteraemia, their antimicrobial susceptibilities and clinicalfeatures. These cases were compared with non-neutropaenic cancer patients admitted with fever. A total of 197 febrile episodes in cancer patients were reviewed. Thirty-seven per cent had febrile neutropaenia while 62% were non-neutropaenic. Acute myeloid leukaemia was the most common haematological malignancy and the most common solid tumour was breast cancer. Twenty-six per cent of patients had a positive blood culture. In febrile neutropaenic patients, Escherichia coli was the most common organism isolated followed by coagulase-negative staphylococci while in non-neutropaenic patients, coagulase-negative staphylococci was most common. Acinetobacter infections was prominent in non-neutropaenic patients but absent in neutropaenic patients. More than one organism was cultured in 9 neutropaenic and 18 non-neutropaenic patients. Mortality was 10.8% in neutropaenic and 24.4% in non-neutropaenic patients. Gram-negative organisms are the predominant isolates in febrile neutropaenic episodes in this cohort of patients. Non-neutropaenic patients had an increased mortality with an increase in Acinetobacter infections and multiple isolates.

  3. Essentials of paediatric infection control

    PubMed Central

    Moore, Dorothy L

    2001-01-01

    Young children readily transmit and acquire nosocomial infections. Children are also vulnerable to endogenous infections as a result of the breakdown of their normal defences by disease, invasive procedures or therapy. The increasing acuity of illness in hospitalized children and therapeutic advances have resulted in a patient population that is increasingly at higher risk for nosocomial infections. Antibiotic resistance has emerged as a problem in some paediatric hospitals, usually in intensive care and oncology units. Infection rates are the highest in neonatal and paediatric intensive care units (where bloodstream infections are the most frequent), and are usually associated with intravascular devices. On general paediatric wards, respiratory and gastrointestinal infections predominate, reflecting the occurrence in the community. The surveillance of nosocomial infections identifies priorities for infection control activities and permits evaluation of interventions. The prevention of transmission between patients and to personnel requires that certain measures be taken with all patients, and that additional precautions be taken with some infections, based on the route of transmission. The prevention of transmission from personnel involves ensuring that personnel are appropriately immunized and counselled about working with infections. The prevention of nosocomial infection also involves control of visitors, appropriate management of invasive procedures and devices, sterilization and disinfection of equipment, provision of a clean environment and adequate staffing. Severely immunocompromised children require extra protection, including ventilation systems that reduce the risk of exposure to filamentous fungi. Infection control in paediatrics is an evolving field that must adapt to changes in the paediatric patient population and in health care technology. PMID:20084127

  4. Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery.

    PubMed

    Larson, Grace E; McKeever, Stephen

    2017-03-08

    Pain and sedation protocols are suggested to improve the outcomes of patients within paediatric intensive care. However, it is not clear how protocols will influence practice within individual units. Evaluate a nurse led pain and sedation protocols impact on pain scoring and analgesic and sedative administration for post-operative cardiac patients within a paediatric intensive care unit. A retrospective chart review was performed on 100 patients admitted to a tertiary paediatric intensive care unit pre and post introduction of an analgesic and sedative protocol. Stata12 was used to perform Chi 2 or student t tests to compare data between the groups. Post protocol introduction documentation of pain assessments increased (pre protocol 3/24h vs post protocol 5/24h, p=0.006). Along with a reduction in administration of midazolam (57.6mcg/kg/min pre protocol vs 24.5mcg/kg/min post protocol, p=0.0001). Children's pain scores remained unchanged despite this change, with a trend towards more scores in the optimal range in the post protocol group (5 pre protocol vs 12 post protocol, p=0.06). Introducing a pain and sedation protocol changed bedside nurse practice in pain and sedation management. The protocol has enabled nurses to provide pain and sedation management in a consistent and timely manner and reduced the dose of midazolam required to maintain comfort according to the patients COMFORT B scores. Individual evaluation of practice change is recommended to units who implement nurse led analgesic and sedative protocols to monitor changes in practice. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.

  5. Paediatric workload of an adult retrieval service in Scotland.

    PubMed

    Harry, Christina L; Mccormack, Jon; Donald, Michael; Corfield, Alasdair R

    2017-02-01

    The Emergency Medical Retrieval Service (EMRS) provides adults with life-threatening conditions in remote areas with timely interventions and rapid access to definitive medical care, including a primary response service. Paediatric patients are managed under a separate network. Despite this, there has been an increase in paediatric retrievals by EMRS. We aim to inform future service development and ascertain how EMRS can serve the needs of this cohort. This is a retrospective, observational study. Raw data were retrieved from the database of paediatric patients retrieved by EMRS for 9 years. A total of 112 paediatric patients were retrieved; 46% were primary retrievals. The most common injuries were head injuries (n=29) and orthopaedic injuries (n=16). Common interventions include fluid resuscitation (n=34), ventilation (n=22) and sedation/paralysis (n=22).This study describes the evolution of an adult retrieval service to cover paediatric patients in Scotland outside the remit of the paediatric retrieval service.

  6. Dentists' use of behavioural management techniques and their attitudes towards treating paediatric patients with dental anxiety.

    PubMed

    Strøm, Kjetil; Rønneberg, Anne; Skaare, Anne B; Espelid, Ivar; Willumsen, Tiril

    2015-08-01

    The purpose of this study was to explore the relationship between dentists' education in treatment of dental anxiety (DA), dentists' attitudes towards patients with DA and dentists' use of BMT. An anonymous questionnaire was sent electronically to 611 dentists in the Public Dental Service in Norway. Statistical evaluation was done using cross tabulation with Chi square and logistic regression analyses. The response rate was 65 % (n = 391). About half of the respondents (53 %, n = 208) had followed postgraduate courses in treating patients with DA. The following were the most common attitudes towards treating young patients with DA: it feels like making a contribution (72 %, n = 286), it is difficult or tiresome (54 %, n = 215) and it is a positive challenge (51 %, n = 203). Dentists who had taken postgraduate courses in DA more often reported anxious patients as a positive challenge (60 vs. 42 %, p < 0.001) and were less reluctant to treat these patients (5 vs. 15 %, p = 0.002). The most frequently used BMT was tell-show-do (87 %, n = 340), followed by relaxation (35 %, n = 132), distraction (25 %, n = 94), systematic cognitive behaviour therapy (22 %, n = 84) and conscious sedation (18 %, n = 69). Dentists without postgraduate courses in DA used fewer techniques when treating these patients (OR 2.1, 95 % CI 1.3-3.3, p = 0.001) compared with dentists who had taken these courses. Country of graduation and postgraduate courses in DA had a strong relationship with dentists' use of BMT and dentists' attitudes towards young patients with DA.

  7. Discussing Patient Management Online: The Impact of Roles on Knowledge Construction for Students Interning at the Paediatric Ward

    ERIC Educational Resources Information Center

    De Wever, Bram; Van Winckel, Myriam; Valcke, Martin

    2008-01-01

    The objectives of this study are to explore the use of asynchronous discussion groups during medical students' clinical rotation in paediatrics. In particular, the impact of role assignment on the level of knowledge construction through social negotiation is studied. Case-based asynchronous discussion groups were introduced to enhance reflection…

  8. Photographing wheelchair-bound patients with neuromuscular scoliosis in a paediatric hospital.

    PubMed

    Wright, Julie; Tsirikos, Athanasios I

    2005-06-01

    This is an investigation of the photography services offered to children and adolescents with neuromuscular scoliosis at the spinal inpatient and outpatient clinic of Great Ormond Street Hospital. The spine service, in cooperation with the medical photography department, sought to identify what clinicians required in the content of photographs as part of the patients' routine clinical assessment, and also what equipment was available on the market to meet these requirements. Current techniques for obtaining medical photographs of this specific group of severely disabled children were also evaluated, and compared to a proposed method of obtaining photographs using the Mangar chair. The authors sought to develop a safe, reliable, patient-friendly and parent-friendly, and easily reproducible technique, which would provide accurate and consistent photographs, and adequately supplement the clinicians' evaluation of patients' conditions.

  9. Radiological protection in paediatric computed tomography.

    PubMed

    Khong, P-L; Frush, D; Ringertz, H

    2012-01-01

    It is well known that paediatric patients are generally at greater risk for the development of cancer per unit of radiation dose compared with adults, due both to the longer life expectancy for any harmful effects of radiation to manifest, and the fact that developing organs and tissues are more sensitive to the effects of radiation. Multiple computed tomography (CT) examinations may cumulatively involve absorbed doses to organs and tissues that can sometimes approach or exceed the levels known from epidemiological studies to significantly increase the probability of cancer development. Radiation protection strategies include rigorous justification of CT examinations and the use of imaging techniques that are non-ionising, followed by optimisation of radiation dose exposure (according to the 'as low as reasonably achievable' principle). Special consideration should be given to the availability of dose reduction technology when acquiring CT scanners. Dose reduction should be optimised by adjustment of scan parameters (such as mAs, kVp, and pitch) according to patient weight or age, region scanned, and study indication (e.g. images with greater noise should be accepted if they are of sufficient diagnostic quality). Other strategies include restricting multiphase examination protocols, avoiding overlapping of scan regions, and only scanning the area in question. Newer technologies such as tube current modulation, organ-based dose modulation, and iterative reconstruction should be used when appropriate. Attention should also be paid to optimising study quality (e.g. by image post-processing to facilitate radiological diagnoses and interpretation). Finally, improving awareness through education and advocacy, and further research in paediatric radiological protection are important to help reduce patient dose. Copyright © 2012. Published by Elsevier Ltd.

  10. Assessment of Radiation doses to Paediatric Patients in Computed Tomography Procedures

    PubMed Central

    Alzimami, Khalid

    2014-01-01

    Summary Background The use of pediatric CT that had recently emerged as a valuable imaging tool has increased rapidly with an annual growth estimated at about 10% per year. Worldwide, there is a remarkable increase in the number of CT examinations performed. The purposes of this study are to: (i) to measure the radiation dose and estimate the effective doses to pediatric patients during CT for chest, abdomen and brain. Material/Methods A total of 182 patients were investigated. CT scanners that participated in this study are helical CT scanners (64 slices, 16 slices and dual slices). Organ and surface dose to specific radiosensitive organs were estimated by using software from National Radiological Protection Board (NRPB). Results For all patients, the age was ranged between 1.12 month–10.0 years while the weight was ranged between 5.0 kg to 29.0 kg. The DLP was 320.58 mGy·cm, 79.93 mGy·cm, 66.63 mGy·cm for brain, abdomen and chest respectively. The effective dose was, 2.05, 1.8, 1.08 mSv for brain, abdomen and chest respectively. Conclusions The patient dose is independent of CT modality and depends on operator experience and CT protocol. The study has shown a great need for referring criteria, continuous training of staff in radiation protection concepts. Further studies are required in order to establish a reference level in Sudan. PMID:25289112

  11. Bordetella bronchiseptica in a paediatric cystic fibrosis patient: possible transmission from a household cat

    USDA-ARS?s Scientific Manuscript database

    Bordetella bronchiseptica was isolated from the sputum of a cystic fibrosis patient recently exposed to a kitten with an acute respiratory disease. Genetic characterization of the isolate and comparison with other isolates of human or feline origin strongly implicate the kitten as the source of infe...

  12. Eye lens dose correlations with personal dose equivalent and patient exposure in paediatric interventional cardiology performed with a fluoroscopic biplane system.

    PubMed

    Alejo, L; Koren, C; Corredoira, E; Sánchez, F; Bayón, J; Serrada, A; Guibelalde, E

    2017-04-01

    To analyse the correlations between the eye lens dose estimates performed with dosimeters placed next to the eyes of paediatric interventional cardiologists working with a biplane system, the personal dose equivalent measured on the thorax and the patient dose. The eye lens dose was estimated in terms of Hp(0.07) on a monthly basis, placing optically stimulated luminescence dosimeters (OSLDs) on goggles. The Hp(0.07) personal dose equivalent was measured over aprons with whole-body OSLDs. Data on patient dose as recorded by the kerma-area product (PKA) were collected using an automatic dose management system. The 2 paediatric cardiologists working in the facility were involved in the study, and 222 interventions in a 1-year period were evaluated. The ceiling-suspended screen was often disregarded during interventions. The annual eye lens doses estimated on goggles were 4.13±0.93 and 4.98±1.28mSv. Over the aprons, the doses obtained were 10.83±0.99 and 11.97±1.44mSv. The correlation between the goggles and the apron dose was R(2)=0.89, with a ratio of 0.38. The correlation with the patient dose was R(2)=0.40, with a ratio of 1.79μSvGy(-1)cm(-2). The dose per procedure obtained over the aprons was 102±16μSv, and on goggles 40±9μSv. The eye lens dose normalized to PKA was 2.21±0.58μSvGy(-1)cm(-2). Measurements of personal dose equivalent over the paediatric cardiologist's apron are useful to estimate eye lens dose levels if no radiation protection devices are typically used. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  13. CD38+ CD58- is an independent adverse prognostic factor in paediatric Philadelphia chromosome negative B cell acute lymphoblastic leukaemia patients.

    PubMed

    Li, Xu-Mian; Zhang, Le-Ping; Wang, Ya-Zhe; Lu, Ai-Dong; Chang, Yan; Zhu, Hong-Hu; Qin, Ya-Zhen; Lai, Yue-Yun; Kong, Yuan; Huang, Xiao-Jun; Liu, Yan-Rong

    2016-04-01

    To explore new risk predictors for a high risk of relapse in Philadelphia chromosome negative (Ph-) B cell acute lymphoblastic leukaemia (B-ALL) patients, 196 paediatric Ph- B-ALL patients (≤ 18 years) were retrospectively analysed. We mainly focus on investigating the prognostic value of CD38 and CD58 expression in leukemic blasts in these patients by four colour flow cytometry. The CD38+ CD58- group (n=16) had a higher relapse rate, a shorter 3-year event-free survival (EFS) and overall survival (OS) than the CD38+ CD58+ group (n=157; 31.3% vs 10.2%, P=0.04; 52.4% vs 92.3%, P<0.01; 32.5% vs 91.0%, P=0.01); CD38+ CD58- was an independent adverse prognostic predictor for relapse (hazard ratio [HR], 0.203; 95%CI, 0.063-0.656; P=0.01), 3-year EFS (HR, 0.091; 95%CI, 0.023-0.355; P<0.01) and OS (HR, 0.102; 95%CI, 0.026-0.3971; P<0.01) in this cohort, as determined by Cox multivariate analysis. We identified, for the first time, a higher risk population of paediatric Ph- B-ALL patients with CD38+ CD58- who had a higher relapse risk and a shorter survival. Our results may allow better risk stratification and individualized treatment.

  14. The readability of paediatric patient information materials: Are families satisfied with our handouts and brochures?

    PubMed

    Swartz, Erik Nathan

    2010-10-01

    To determine the grade reading level of eight easily available patient handouts for parents of children with otitis media, to calculate the internal reliability and consistency of seven readability tests, and to explore the relationship between the grade reading level of a handout and parent satisfaction. Eight patient handouts developed for the parents of children with otitis media were collected, stripped of all formatting and analyzed using seven different readability formulas. Cronbach's alpha and intraclass correlation coefficients (ICC) were calculated to determine the internal reliability and consistency of the seven formulas. Parents were surveyed on their satisfaction with three of the handouts, and their responses were compared with the handouts' reading grade levels using ANOVA. Only four of the eight handouts had a mean grade 8 or less reading level. None of the handouts had a grade 5 or less reading level. Cronbach's alpha was calculated to be 0.990, single measures ICC 0.931 and average class ICC 0.990, indicating extremely high internal reliability/consistency among the different readability tests. One-way ANOVA showed no evidence of a significant difference in parental satisfaction with the three handouts tested, despite their different grade reading levels (grades 7, 10 and 14) (P=0.24). While many readability formulas are available, the high internal reliability/consistency among them indicates that only one formula needs to be used to assess readability (eg, the Flesch-Kincaid Grade Level formula). Because there was no difference in parental satisfaction among three patient handouts that had widely different grade reading levels, studies should explore whether writing patient information materials explicitly to achieve low grade reading level scores is a worthwhile strategy.

  15. Orofacial and dental injuries associated with seizures in paediatric patients in Lagos University Teaching Hospital.

    PubMed

    Adeyemo, W L; Fajolu, I B; Temiye, E O; Adeyemi, M O; Adepoju, A A

    2011-05-01

    To determine the prevalence and pattern of presentation of orofacial and dental injuries in children with seizures at the Children's Emergency Unit of the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. This was a prospective study of children with febrile or non-febrile convulsion who presented at the Children's Emergency Unit of LUTH between July 2008 and August 2009. The age, gender, type of convulsion and the presence/absence of orofacial and other bodily injuries were recorded in a proforma. Mechanism, type and classification of injury were recorded for patients with orofacial injuries. A total of 257 children (148 males and 109 females) with febrile/non-febrile convulsion were included in the analysis. The mean age (SD) of patients was 32.8 ± 40.5 months. There were 223 (86.8%) cases of febrile convulsion and 34 (13.3%) cases of non-febrile convulsion. Thirteen children sustained orofacial injuries giving a prevalence of 5.1%. There was no significant difference in the prevalence of orofacial injury between patients with febrile convulsion (4.5%) and those with non-febrile convulsion (8.8%) (P=0.282). The most common cause of orofacial injuries was forceful insertion of hard object into the mouth during convulsive episodes. Twelve (92.3%) patients sustained soft tissue injury, while one sustained both soft and hard tissue injuries. The most common site of injury was the lip. Oro-facial and dental injuries may occur in children with seizures. It is therefore important that these injuries be looked for by the paediatrician and the dentist/oral and maxillofacial surgeons should be involved in managing these children. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  16. Efficacy of Deferasirox as an Oral Iron Chelator in Paediatric Thalassaemia Patients

    PubMed Central

    Hishikar, Rajesh; Khandwal, Onkar; Agarwal, Manju; Joshi, Usha; Halwai, Ajay; Maheshwari, Basant; Sheohare, Raka

    2017-01-01

    Introduction Thalassaemia Major patients require frequent blood transfusion leading to iron overload. Excessive iron gets deposited in vital organs and leads to dysfunction of the heart, liver, anterior pituitary, pancreas, and joints. Our body has limited mechanism to excrete iron, so patients with iron overload and its complications need safe and effective iron chelation therapy. Aim To assess the efficacy of Deferasirox (DFX) as an iron chelator, with specific reference to reduction in serum ferritin level. Materials and Methods This is a prospective; observational study done in 45 multitransfused Thalassaemia Major Children receiving DFX therapy at registered Thalassaemia society Raipur Chhattisgarh. DFX was given in an initial dose of 20 mg/kg/day and according to response increased to a maximum of 40 mg/kg/day. Serum ferritin level was estimated at time of registration and at every three monthly intervals (four times during study period). The primary end point of the study was change in serum ferritin level after 12 months of DFX therapy. Results The mean serum ferritin before DFX therapy of all cases was 3727.02 ng/mL. After 12 months of mean dose of 38 mg/kg/day of DFX, the mean decline in serum ferritin was 1207.11 ng/mL (drop by 32.38%, p-value <0.001). Conclusion DFX monotherapy has a good safety profile and effectively chelates total body iron in Thalassaemia major patients. PMID:28384880

  17. Steady-state pharmacokinetics and pharmacodynamics of cysteamine bitartrate in paediatric nephropathic cystinosis patients

    PubMed Central

    Belldina, Eric B; Huang, Mei Y; Schneider, Jerry A; Brundage, Richard C; Tracy, Timothy S

    2003-01-01

    Aims Cysteamine is used to reduce tissue cystine content in patients suffering from nephropathic cystinosis. The objectives of the current study were to investigate pharmacokinetics and pharmacodynamics of cysteamine bitartrate in children and young adults with nephropathic cystinosis. Methods Cysteamine bitartrate was administered to 11 cystinosis patients at their regular dose level in a single-dose, open-label, steady-state study. Blood samples were collected and analysed for plasma cysteamine and white blood cell cystine content and pharmacokinetic and pharmacodynamic parameters estimated by NONMEM analysis using a linked pharmacokinetic–pharmacodynamic model. Results Cysteamine was rapidly cleared from the plasma (mean CL/F = 32.3 ml min−1 kg−1, range = 17.3–52.2), appeared to be extensively distributed (mean V ss/F = 15.1 l, range 2.7–32.3) and exhibited a mean Tmax of 1.4 h. White blood cell cystine content post-dosing was significantly decreased compared with pre- and post-dose values (average decrement approximately 47%). A counter-clockwise hysteresis was noted in all patients, suggestive of a lag time (mean Tlag = 0.44 h, range 0.22–0.92) between drug concentration and effect. Conclusions The results of this study establish that cysteamine is rapidly cleared from the plasma but that an every 6 h dosing interval adequately maintains white blood cell cystine content below the target of 1 nmol cystine per mg protein. PMID:14651726

  18. [Anaesthetic management in a paediatric patient with a difficult airway due to epidermolysis bullosa dystrophica].

    PubMed

    Blázquez Gómez, E; Garcés Aletá, A; Monclus Diaz, E; Manen Berga, F; García-Aparicio, L; Ontanilla López, A

    2015-05-01

    Dystrophic epidermolysis bullosa (DEB) is a rare inherited disorder characterized by blistering after minimal trauma. These blisters tend to form dystrophic scars, leading to limiting and life-threatening sequelae. The anaesthetic management of patients with DEB is a challenge, even for the most experienced anaesthesiologists, but basic principles can help us prepare the plan of care. The main goals are to prevent trauma/infection of skin/mucous, and to establish a secure airway without causing bullae. Patient positioning and the instruments used to monitor vital signs and administering anaesthetic agents can cause new lesions. It is advisable to lubricate the instruments and to avoid adhesive material and shearing forces on the skin. Besides the implications of the comorbidities, there is a potential difficult intubation and difficult vascular access. Acute airway obstruction can occur due to airway instrumentation. We report the case of a patient diagnosed with EBD difficult airway and undergoing correction of syndactylyl and dental extractions. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Paediatric recurrent herpetic whitlow.

    PubMed

    Patel, Ramnik; Kumar, Hemant; More, Bharat; Patricolo, Mario

    2013-07-31

    We present a case of recurrent painful blisters of middle phalanx of the left ring finger of a 15-month-old previously healthy and immunocompetent female child. These lesions initially were confused with infective bacterial whitlow, treated with incision and drainage, and later with cigarette burns which led to referral to child protection team. Paediatric dermatologist finally diagnosed after scrapping and virology culture. The patient had recovery following full treatment with topical and systemic acyclovir. She presented again at the age of 4 with recurrence which required topical and systemic acyclovir therapy with good recovery. It is important to be aware of the danger of incorrect diagnosis, raising child protection concerns and management leading to danger of cross infection and serious illness especially in the immunocompromised patients.

  20. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

    PubMed

    Roqué i Figuls, Marta; Giné-Garriga, Maria; Granados Rugeles, Claudia; Perrotta, Carla; Vilaró, Jordi

    2016-02-01

    This Cochrane review was first published in 2005 and updated in 2007, 2012 and now 2015. Acute bronchiolitis is the leading cause of medical emergencies during winter in children younger than two years of age. Chest physiotherapy is sometimes used to assist infants in the clearance of secretions in order to decrease ventilatory effort. To determine the efficacy of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. A secondary objective was to determine the efficacy of different techniques of chest physiotherapy (for example, vibration and percussion and passive forced exhalation). We searched CENTRAL (2015, Issue 9) (accessed 8 July 2015), MEDLINE (1966 to July 2015), MEDLINE in-process and other non-indexed citations (July 2015), EMBASE (1990 to July 2015), CINAHL (1982 to July 2015), LILACS (1985 to July 2015), Web of Science (1985 to July 2015) and Pedro (1929 to July 2015). Randomised controlled trials (RCTs) in which chest physiotherapy was compared against no intervention or against another type of physiotherapy in bronchiolitis patients younger than 24 months of age. Two review authors independently extracted data. Primary outcomes were change in the severity status of bronchiolitis and time to recovery. Secondary outcomes were respiratory parameters, duration of oxygen supplementation, length of hospital stay, use of bronchodilators and steroids, adverse events and parents' impression of physiotherapy benefit. No pooling of data was possible. We included 12 RCTs (1249 participants), three more than the previous Cochrane review, comparing physiotherapy with no intervention. Five trials (246 participants) evaluated conventional techniques (vibration and percussion plus postural drainage), and seven trials (1003 participants) evaluated passive flow-oriented expiratory techniques: slow passive expiratory techniques in four trials, and forced passive expiratory techniques in three trials.Conventional techniques failed to show a

  1. [The treatment of cancer patients].

    PubMed

    Pretorius, H L; Falkson, G

    1986-04-12

    Advances in the field of medical oncology were spurred by the development of cytostatic drugs, and cancer is today one of the most treatable (and most curable) of the chronic diseases. Because of the diversity of neoplastic diseases, classification, staging and the important individual patient discriminants must be taken into account more than ever before because of the availability of drugs that can cure or palliate many forms of cancer. The results obtained in advanced disease acted as an impetus to start chemotherapy at an earlier stage. In highly malignant neoplasms and especially in children with cancer, drug treatment has become of increasing importance, and when given appropriately complements surgery and radiotherapy.

  2. Paediatric nuclear medicine imaging.

    PubMed

    Biassoni, Lorenzo; Easty, Marina

    2017-09-01

    Nuclear medicine imaging explores tissue viability and function by using radiotracers that are taken up at cellular level with different mechanism. This imaging technique can also be used to assess blood flow and transit through tubular organs. Nuclear medicine imaging has been used in paediatrics for decades and this field is continuously evolving. The data presented comes from clinical experience and some milestone papers on the subject. Nuclear medicine imaging is well-established in paediatric nephro-urology in the context of urinary tract infection, ante-natally diagnosed hydronephrosis and other congenital renal anomalies. Also, in paediatric oncology, I-123-meta-iodobenzyl-guanidine has a key role in the management of children with neuroblastic tumours. Bone scintigraphy is still highly valuable to localize the source of symptoms in children and adolescents with bone pain when other imaging techniques have failed. Thyroid scintigraphy in neonates with congenital hypothyroidism is the most accurate imaging technique to confirm the presence of ectopic functioning thyroid tissue. Radionuclide transit studies of the gastro-intestinal tract are potentially useful in suspected gastroparesis or small bowel or colonic dysmotility. However, until now a standardized protocol and a validated normal range have not been agreed, and more work is necessary. Research is ongoing on whether magnetic resonance imaging (MRI), with its great advantage of great anatomical detail and no ionizing radiations, can replace nuclear medicine imaging in some clinical context. On the other hand, access to MRI is often difficult in many district general hospitals and general anaesthesia is frequently required, thus adding to the complexity of the examination. Patients with bone pain and no cause for it demonstrated on MRI can benefit from bone scintigraphy with single photon emission tomography and low-dose computed tomography. This technique can identify areas of mechanical stress at

  3. Diaphragm plication following phrenic nerve injury: a comparison of paediatric and adult patients

    PubMed Central

    Simansky, D; Paley, M; Refaely, Y; Yellin, A

    2002-01-01

    Background: A study was undertaken to evaluate whether adults differ from children in the indications and outcome of diaphragmatic plication following phrenic nerve injury. Methods: A retrospective study was performed of 21 patients, 10 below the age of 5 and 11 older than 37 years. The indication for surgery for all the children was failure to wean from ventilatory support. The indications for surgery in the adult group were ventilator dependency (n=4) and symptomatic dyspnoea (n=7). All patients had at least one imaging study confirming diaphragmatic paralysis. The American Thoracic Society (ATS) dyspnoea scale, pulmonary function tests, and quantitative pulmonary perfusion scans were used as evaluation parameters. At surgery the diaphragm was centrally plicated. Results: One child died immediately after surgery due to irreversible heart failure and two children died within 2 months of surgery from ongoing complications of their original condition. These three patients were considered as selection failures. Seven children were weaned from ventilatory support within a median of 4 days (range 2–140). Only one of four ventilated adults was successfully weaned. Seven adults who underwent surgery for chronic symptoms had a marked subjective improvement of 2–3 levels in the ATS dyspnoea scale. Pulmonary function studies in the seven symptomatic adults showed a 40% improvement above baseline. Severely asymmetrical perfusion scans reverted to a normal pattern after plication. Conclusions: Diaphragmatic plication offers a significant benefit to children with diaphragmatic paralysis and should be performed early to facilitate weaning from mechanical ventilation. While plication is of limited benefit in weaning ventilated adults, it results in significant subjective and objective lifetime improvement in non-ventilated symptomatic adults. PMID:12096205

  4. Rehabilitation of older cancer patients.

    PubMed

    Balducci, Lodovico; Fossa, Sophia Dorothe

    2013-02-01

    Cancer is a disease of aging. With the aging of the population and the improved survival of cancer patients, rehabilitation of older cancer survival is an increasingly common problem. Age may be constructed as a progressive reduction in functional reserve of multiple organ systems leading to decreased life expectancy and reduced stress tolerance. Physiologic age may be different from chronologic age and is best assessed with a comprehensive geriatric assessment (CGA). The goals of cancer treatment in the older aged person include prolongation of active life expectancy that is prevention of functional dependence. Cancer and cancer treatment may accelerate physiologic aging. Rehabilitation is especially necessary in the case of curable malignancies or malignancies for which a prolonged survival is likely. Long-term complications of cancer treatment that may compromise life expectancy and functional independence include fatigue cognitive decline and peripheral neuropathy. This paper reviews the risk factors and the management of these complications. The number of older cancer survivors is expected to increase with the aging of the population. Prevention and management of fatigue, cognitive decline and peripheral neuropathy appear as the most important issue to prolong the active life expectancies of these individuals.

  5. Incidence, treatment and survival of paediatric patients with bone sarcomas in Finland from 1991 to 2005.

    PubMed

    Serlo, Joni; Tarkkanen, Maija; Sampo, Mika; Vettenranta, Kim; Riikonen, Pekka; Helenius, Ilkka

    2015-07-01

    Our aims were to establish the 10-year overall and event-free survival rates among children and adolescents with bone sarcomas in Finland, estimate their respective incidences, evaluate the treatment given and describe the key prognostic factors. We included 88 patients of <18 years of age diagnosed with a bone sarcoma during 1991-2005 in this retrospective, nationwide and population-based study. Median follow-up time was 12.2 years (range 5.8-20.3 years) for surviving patients. The overall incidence among children and adolescents was 5.1 per million: 3.6 for osteosarcoma, 1.2 for Ewing's sarcoma and 0.3 for chondrosarcoma. The 10-year event-free and overall survival of those with a localised disease at diagnosis was 69% and 82%, respectively. The overall 10-year survival of those with a metastatic disease at diagnosis was 47%. Prognostic factors for localised disease included an axial versus peripheral primary tumour site in Ewing's sarcoma (p = 0.022) and age at diagnosis in osteosarcoma (p = 0.027). The 10-year overall survival of children and adolescents diagnosed with a bone sarcoma in Finland during 1991 to 2005 was very good, at 82% if the disease was localised at diagnosis and 47% if it was metastatic at diagnosis. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  6. Careers in paediatrics: Community paediatrics revisited

    PubMed Central

    Tonkin, Roger Sherriff

    2012-01-01

    The concept of ‘community paediatrics’, as enunciated by Robert Haggerty in 1968, has informed and shaped many paediatric careers. The principle tenets of inclusiveness: attention to unmet needs; addressing common health problems of children and youth; using and applying preventive and harm-reduction strategies; and securing community input and control, were part of the Haggerty model. The present article revisits Haggerty’s model and describes how the concepts have shaped contemporary paediatrics in North America. PMID:23277752

  7. Ray resection in paediatric population.

    PubMed

    Martínez-Álvarez, S; Maldonado-Morillo, A; Vara-Patudo, I; Martínez-González, C; Miranda-Gorozarri, C

    Evaluation of clinical and functional outcome of ray resection in paediatric population and description of key aspects of surgical technique. We performed a retrospective review of all patients undergoing surgery between 2010-2015. one or more ray resections of the hand and a minimum of one year follow-up. Evaluation of clinical characteristics, functional and cosmetic results, complications, need for psychological support and patient or family satisfaction. Four patients met the inclusion criteria. The mean age at surgery was 5 years (range, 1-14 years). Aetiology was: fibrolipomatous hamartoma, traumatic amputation, radial deficiency and complex syndactyly. Second ray was resected in three patients and third and fourth ray in one. No finger transfer was performed. No immediate post-operative complications were found at the final evaluation. None of them needed psychological support. All the patients showed excellent clinical and functional results with a high grade of satisfaction. Ray resection of the hand has been used as salvage procedure in patients with vascular lesions, tumours, trauma, infections or congenital malformations. There are only a few published studies including small samples in adults or case reports, with no references in the paediatric population. Ray resection of the hand is a useful and safe technique in paediatric population, obtaining excellent cosmetic and functional results in those cases in which it is impossible to preserve one or more fingers. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Antibiotic resistance in cancer patients.

    PubMed

    Gudiol, Carlota; Carratalà, Jordi

    2014-08-01

    Bacterial infection is one of the most frequent complications in cancer patients and hematopoietic stem cell transplant recipients. In recent years, the emergence of antimicrobial resistance has become a significant problem worldwide, and cancer patients are among those affected. Treatment of infections due to multidrug-resistant (MDR) bacteria represents a clinical challenge, especially in the case of Gram-negative bacilli, since the therapeutic options are often very limited. As the antibiotics active against MDR bacteria present several disadvantages (limited clinical experience, higher incidence of adverse effects, and less knowledge of the pharmacokinetics of the drug), a thorough acquaintance with the main characteristics of these drugs is mandatory in order to provide safe treatment to cancer patients with MDR bacterial infections. Nevertheless, the implementation of antibiotic stewardship programs and infection control measures is the cornerstone for controlling the development and spread of these MDR pathogens.

  9. Neurodevelopmental and behavioural paediatrics.

    PubMed

    McDowell, Michael

    2015-01-01

    One of the notable shifts in Paediatrics across the last 50 years has been towards disorders that are chronic and qualitative in nature. In addition to physical health, these impact on childhood development, behaviour and wellbeing. Understanding and management of these problems extends the traditional biological toolkit of paediatrics into the complexities of uncertainties of psychological and social context. In Australasia, the profession has responded with the development of Community Paediatrics as a recognised sub-specialty, of which Neurodevelopmental and Behavioural Paediatrics is an important component. These developments are reviewed along with consideration of future challenges for this field of health care. © 2015 The Author. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  10. [Fertility in testicular cancer patients].

    PubMed

    Shin, Takeshi; Miyata, Akane; Arai, Gaku; Okada, Hiroshi

    2015-03-01

    Testicular cancer(TC)is the most common and curable cancer affecting men of reproductive age. Successful treatment approaches have resulted in longer life expectancy in TC survivors. The most frequently used treatment for TC is a combination of inguinal orchiectomy, and either radiotherapy or cisplatin-based chemotherapy. In many TC patients, sperm quality is already abnormal and there may even be a lack of viable spermatozoa at the time of diagnosis. Therefore, the effect of cancer treatment on fertility is a potentially significant issue. Fertility preservation in these men has become essential and needs to be discussed prior to the start of cancer treatment. The only currently established fertility preservation method is the cryopreservation of sperm before therapy. For most patients seeking cryopreservation, the semen sample is collected via masturbation. If the patient is unable to ejaculate for any reason, other techniques such as vibratory stimulation and electroejaculation can be performed. In azoospermic or severely oligozoospermic patients, testicular sperm extraction at the time of the inguinal orchiectomy is a useful technique for obtaining spermatozoa before cytotoxic therapy. We herein present an overview of the current topics on fertility in TC patients, including the effects of surgery, chemotherapy, and radiation therapy. We also describe the strategy for fertility preservation in these patients.

  11. Cancer patient satisfaction with care.

    PubMed

    Wiggers, J H; Donovan, K O; Redman, S; Sanson-Fisher, R W

    1990-08-01

    A diagnosis of cancer places considerable stress on patients and requires them to make major adjustments in many areas of their lives. As a consequence, considerable demands are placed on health care providers to satisfy the complex care needs of cancer patients. Currently, there is little available information to indicate the extent to which cancer patients are satisfied with the quality of care they receive. The present study assessed the perceptions of 232 ambulatory cancer patients about the importance of and satisfaction with the following aspects of care: doctors technical competence and interpersonal and communication skills, accessibility and continuity of care, hospital and clinic care, nonmedical care, family care, and finances. The results indicate that all 60 questionnaire items used were considered to reflect important aspects of care, but that greater importance was given to the technical quality of medical care, the interpersonal and communication skills of doctors, and the accessibility of care. Most patients were satisfied with the opportunities provided to discuss their needs with doctors, the interpersonal support of doctors, and the technical competence of doctors. However, few patients were satisfied with the provision of information concerning their disease, treatment, and symptom control and the provision of care in the home and to family and friends.

  12. Disseminated histoplasmosis by Histoplasma capsulatum var. duboisii in a paediatric patient from the Chad Republic, Africa.

    PubMed

    Garcia-Guiñon, A; Torres-Rodríguez, J M; Ndidongarte, D Torangar; Cortadellas, F; Labrín, L

    2009-06-01

    Histoplasmosis caused by Histoplasma capsulatum var. duboisii is an endemic mycosis of sub-Saharan Africa that usually affects the skin, subcutaneous tissue, lymph nodes and bones. We present a case of a 10-year-old immunocompetent girl with severe cutaneous and subcutaneous abscesses affecting the head and upper body. Microscopic examination showed polar budding yeasts and short mycelium compatible with H. capsulatum var. duboisii. Cultures were not possible but serology showed antibodies against both H. capsulatum var. duboisii and H. capsulatum var. capsulatum antigens. Presumptive diagnosis of histoplasmosis was done but treatment with itraconazole was inefficacious. After 15 days of treatment with Amphotericin B i/v, improvement was evident and, three months later, the patient was discharged with only residual lesions. Seven months later, no relapses were observed.

  13. Hypertension in Patients with Cancer

    PubMed Central

    de Souza, Vinicius Barbosa; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade

    2015-01-01

    There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality. PMID:25742420

  14. Paediatrics in Barcelona.

    PubMed

    Midulla, Fabio; Lombardi, Enrico; Rottier, Bart; Lindblad, Anders; Grigg, Jonathan; Bohlin, Kajsa; Rusconi, Franca; Pohunek, Petr; Eber, Ernst

    2014-08-01

    This update will describe the paediatric highlights from the 2013 European Respiratory Society (ERS) annual congress in Barcelona, Spain. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology) have been chosen by group officers and are presented in the context of current literature. ©ERS 2014.

  15. Paediatrics: messages from Munich

    PubMed Central

    Midulla, Fabio; Lombardi, Enrico; Pijnenburg, Marielle; Balfour-Lynn, Ian M.; Grigg, Jonathan; Bohlin, Kajsa; Rusconi, Franca; Pohunek, Petr

    2015-01-01

    The aim of this article is to describe paediatric highlights from the 2014 European Respiratory Society (ERS) International Congress in Munich, Germany. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology) are presented in the context of the current literature. PMID:27730136

  16. Effectiveness of Two Topical Anaesthetic Agents used along with Audio Visual Aids in Paediatric Dental Patients

    PubMed Central

    Dhawan, Jayata; Kumar, Dipanshu; Anand, Ashish; Tangri, Karan

    2017-01-01

    Abstract Introduction Topical anaesthetic agents enable pain free intraoral procedures, symptomatic pain relief for toothache, superficial mucosal lesions and pain related to post extraction time. Most common anxiety provoking and fearful experience for children in dental operatory is administration of local anaesthesia because on seeing the needle, children usually become uncooperative. One of recent trend of behaviour management technique is using non-aversive techniques out of which audiovisual distraction has emerged as a very successful technique for managing children in dental settings. Audio visual distraction could decrease the procedure related anxiety of patients undergoing dental treatment and can be very relaxing for highly anxious patients. Aim The aim of the present study was to compare the efficacy of topical anaesthetics EMLA (Eutectic Mixture of Local Anaesthetics) cream and benzocaine (20%) gel in reducing the pain during the needle insertion with and without the use of Audio Visual (AV) aids. Materials and Methods The study was conducted on 120 children, the age range of 3-14 years attending the outpatient department for their treatment. EMLA and benzocaine gel (20%) were assessed for their effectiveness in reducing the pain on needle insertion during local anaesthesia administration. Based on the inclusion and the exclusion criteria, children requiring local anaesthesia for the dental treatment were randomly divided into four equal groups of 30 children based upon whether AV aids were used or not. AV aids were given using Sony Vaio laptop with earphones with nursery rhymes and cartoon movies DVD. The pain assessment was done by using the Visual Analogue Scale (VAS) scale and measurement of the physiological responses of pulse rate and oxygen saturation were done by pulse oximeter. Results There was a statistically significant difference in the mean pain score, pulse rate and mean oxygen saturation rate when it was compared between the four

  17. Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy.

    PubMed

    Oremule, B; Johnson, M; Sanderson, L; Lutz, J; Dodd, J; Hans, P

    2015-12-01

    The withdrawal of codeine for use in children following tonsillectomy enforced a change in our practice of providing regular paracetamol and ibuprofen, with codeine for breakthrough pain relief. Our objectives were to; examine the effectiveness of paracetamol and ibuprofen; examine the effectiveness of the addition of rescue (PRN) morphine to regular paracetamol and ibuprofen. A 2 cycle prospective audit was conducted on our unit. Telephone consultations were conducted with parents of 74 children undergoing tonsillectomy and adenotonsillectomy. Cycle 1 (C1, without morphine) contained 24 consecutive patients and cycle 2 (C2, with morphine) contained 50 consecutive patients. Postoperative health service contact and outcome was recorded: worst pain scores on days 4 and 7 were obtained using validated pain assessment tools scoring 0-10. Cycle 2 results underwent subgroup analysis by method of surgery i.e. coblation (C2C) and cold steel dissection (C2D) groups. More than half of parents felt simple analgesia was not effective enough in both cycles, this number was significantly higher in both 2nd cycle groups (C1=54%, C2C=74%, p=0.003, C2D=84%, p=0.0001). Mean worst pain reported at day 4 was similar for all groups, but the morphine groups reported higher pain at day 7 (C1 1.6, C2C 3.59, p=0.017, C2D 3.90, p=0.002). Antibiotic prescribing for children contacting a GP after surgery was significantly lower in the morphine groups (C1 24%, C2C 7%, p=0.0014, C2D 5%, p=0.0002). There was no difference in measured outcomes between the 2nd cycle groups. This service evaluation found that postoperative morphine on an as-required basis, in addition to regular paracetamol and ibuprofen, did not significantly alter initial pain profile, worst pain scores or rate of health service contact when compared to regular paracetamol and ibuprofen alone. The majority of children in this study felt additional analgesia required. Children in the morphine groups experienced significantly less

  18. [Weight loss in cancer patients].

    PubMed

    Lordick, Florian; Hacker, Ulrich

    2016-02-01

    Cancer patients are regularly affected by malnutrition which often leads to a worsened quality of life and activity in daily living, more side effects and complications during anticancer treatment and shorter survival times. The early diagnosis and treatment of malnutrition are therefore relevant components of oncological treatment. The assessment of the nutritional status and determination of the body-mass-index should be done in every patient with cancer. The clinical examination delivers important findings and indications for malnutrition. Bioimpedance analysis can deliver additional objective information. The treatment of malnutrition should start early and follows a step-wise escalation reaching from nutritional counseling to enteral nutritional support to parenteral nutrition.

  19. Therapeutic drug monitoring of posaconazole oral suspension in paediatric patients younger than 13 years of age: a retrospective analysis and literature review.

    PubMed

    Jancel, T; Shaw, P A; Hallahan, C W; Kim, T; Freeman, A F; Holland, S M; Penzak, S R

    2017-02-01

    Posaconazole is an extended-spectrum triazole antifungal with activity against a variety of clinically significant yeasts and moulds. Posaconazole is not currently approved by the U.S. Food and Drug Administration for use in children younger than 13 years of age. Our primary objective was to describe the dosing and observed trough concentrations with posaconazole oral suspension in paediatric patients at the National Institutes of Health Clinical Center (Bethesda, MD). This retrospective single-centre study reviewed paediatric patients younger than 13 years of age initiated on posaconazole oral suspension. Patients were included if they were initiated on posaconazole for prophylaxis or treatment for fungal infections from September 2006 through March 2013 with at least one trough concentration collected after at least 7 days of therapy. A total of 20 male patients were included, of whom 15 (75%) had chronic granulomatous disease. The median age of patients was 6·5 years (range: 2·8-10·7). A total of 79 posaconazole trough concentrations were measured in patients receiving posaconazole as prophylaxis (n = 8) or treatment (n = 12). Posaconazole dose referenced to total body weight ranged from 10·0 to 49·2 mg/kg/day. Posaconazole trough concentrations ranged from undetectable (<50 ng/mL) up to 3620 ng/mL and were ≥500, ≥700 and ≥1250 ng/mL in 95%, 60% and 25% of patients, respectively. Patients younger than 13 years of age had highly variable trough concentrations, and recommendations for the appropriate dosing of posaconazole oral suspension remain challenging. Until studies are conducted to determine the appropriate dosing of posaconazole in this patient population, therapeutic drug monitoring should be considered to ensure adequate posaconazole exposure. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  20. [Confusion as a presentation symptom of pseudomigraine with pleocytosis in a paediatric patient].

    PubMed

    Soto-Insuga, V; López-Villanueva, L; Rodrigo, M; Mois Aroyo, I; Losada, R; Soriano-Guillén, L

    2014-06-01

    Transient headache and neurological deficits with cerebrospinal fluid lymphocytic pleocytosis (Handl) syndrome is a rare condition of unknown origin that is characterized by episodes of severe headache, transient neurological deficits that recur over less than 3 months, and lymphocytic pleocytosis in CSF. We report the case of a 14 year-old girl who presented with headache and vomiting that lasted 4 days, later combined with a clinical presentation of confusion, with a decrease in the level of consciousness, aphasia, peripheral facial paralysis, ataxia and fever for 24 hours. CSF analysis showed pleocytosis (110 cells/ml) and proteinorrachia (87 mg/dl). Electroencephalogram in the acute time showed generalized slowing, and later a focal slowing in the left hemisphere. She suffered 7 episodes of migraine (severe headache and vomiting) in the following two months, remaining asymptomatic thereafter. This is the first pediatric case published in the literature that presents with an agitated and/or confused state. This condition must be considered in the differential diagnosis of patients with headache and acute altered level of consciousness, in order to avoid prolonged treatments or unnecessary invasive testing. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  1. [The Development of Quality Indicators for Management of Patients with ADHD in Social Paediatrics].

    PubMed

    Skrundz, M; Borusiak, P; Hameister, K A; Geraedts, M

    2015-12-01

    Attention deficit/hyperactivity disorder (ADHD) with an estimated prevalence of 5% and its increased risk for comorbidities is of significant relevance for the health care system and is as well of socio-political significance. There is a lack of established methods for the evaluation of the diagnostic and therapeutic treatment of the patients. In this study, we have developed a set of evidence- and consensus-based meaningful indicators for the treatment of children with ADHD. Following a thorough examination of the literature and published Guidelines, a first set of 90 quality indicators was created after redundancy reduction and addition of newly developed indicators. The further development of the indicator set was based on a modified version of the 2-step RAND/UCLA expert evaluation method. After assessment in 2 rounds of ratings, a set of 39 homogeneously positively rated indicators was established. 28 indicators apply to the quality of the diagnostic and therapeutic process, 4 to structural conditions and 3 rely on outcome. This is the first study covering the aspect of quality measurement in children with developmental disorders, especially ADHD. For the next step a pilot evaluation is necessary to complete the evaluation of the quality indicators. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Single daily dose amikacin in paediatric patients with severe gram-negative infections.

    PubMed

    Trujillo, H; Robledo, J; Robledo, C; Espinal, D; Garces, G; Mejia, J; Restrepo, C; Restrepo, F; Mejia de Rodriguez, G I; Tamayo de Guitierrez, M C

    1991-05-01

    Twenty-five children with serious Gram-negative infections were treated in a prospective study with amikacin 20 mg/kg administered in a single daily dose as a 30 min iv infusion for 4 to 12 days. In nine cases the amikacin was combined with beta-lactam antibiotics. Escherichia coli were the most frequent bacteria isolated followed by K. pneumoniae, Providencia and Enterobacter spp. and Pseudomonas aeruginosa with MICs ranging from 1 to 16 mg/l. Mean (+/- S.D.) peak and trough concentrations of days 1 and 4 of therapy ranged from 49 +/- 13.5 to 53.6 +/- 13.4 mg/l and 6 + 1.4 to 7.7 +/- 4.1 mg/l respectively. All patients were clinically and bacteriologically cured. No significant adverse reactions were observed. The results suggest that administration of a single daily dose of 20 mg/kg amikacin should be considered practical and safe in children. Further studies are needed.

  3. Spirometer-controlled cine magnetic resonance imaging used to diagnose tracheobronchomalacia in paediatric patients.

    PubMed

    Ciet, Pierluigi; Wielopolski, Piotr; Manniesing, Rashindra; Lever, Sandra; de Bruijne, Marleen; Morana, Giovanni; Muzzio, Pier Carlo; Lequin, Maarten H; Tiddens, Harm A W M

    2014-01-01

    Tracheobronchomalacia (TBM) is defined as an excessive collapse of the intrathoracic trachea. Bronchoscopy is the gold standard for diagnosing TBM; however it has major disadvantages, such as general anaesthesia. Cine computed tomography (CT) is a noninvasive alternative used to diagnose TBM, but its use in children is restricted by ionising radiation. Our aim was to evaluate the feasibility of spirometer-controlled cine magnetic resonance imaging (MRI) as an alternative to cine-CT in a retrospective study. 12 children with a mean age (range) of 12 years (7-17 years), suspected of having TBM, underwent cine-MRI. Static scans were acquired at end-inspiration and expiration covering the thorax using a three-dimensional spoiled gradient echo sequence. Three-dimensional dynamic scans were performed covering only the central airways. TBM was defined as a decrease of the trachea or bronchi diameter >50% at end-expiration in the static and dynamic scans. The success rate of the cine-MRI protocol was 92%. Cine-MRI was compared with bronchoscopy or chest CT in seven subjects. TBM was diagnosed by cine-MRI in seven (58%) out of 12 children and was confirmed by bronchoscopy or CT. In four patients, cine-MRI demonstrated tracheal narrowing that was not present in the static scans. Spirometer controlled cine-MRI is a promising technique to assess TBM in children and has the potential to replace bronchoscopy.

  4. Family Support and the Cancer Patient.

    ERIC Educational Resources Information Center

    Dakof, Gayle A.; And Others

    Research has shown that social support is psychologically beneficial to cancer patients, with support from families being especially important. A survey of the social support needs of 407 cancer patients and an in-depth interview study of 55 of those patients were conducted to examine issues concerning family support and cancer patients. Results…

  5. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease.

    PubMed

    Chalumeau, Martin; Duijvestijn, Yvonne C M

    2013-05-31

    Acetylcysteine and carbocysteine are the most commonly prescribed mucolytic drugs in Brazil and many European and African countries. To our knowledge, no systematic review has been published on their efficacy and safety for acute upper and lower respiratory tract infections (RTIs) in children without chronic broncho-pulmonary disease. The objective was to assess the efficacy and safety and to establish a benefit-risk ratio of acetylcysteine and carbocysteine as symptomatic treatments for acute upper and lower RTIs in paediatric patients without chronic broncho-pulmonary disease. We searched CENTRAL (2013, Issue 2), MEDLINE (1966 to February week 3, 2013), EMBASE (1980 to March 2013), Micromedex (2010), Pascal (1987 to 2004) and Science Citation Index (1974 to March 2013). To study efficacy, we used randomised controlled trials (RCTs) comparing the use of acetylcysteine or carbocysteine versus placebo, either alone or as an add-on therapy. To study safety, we used trials comparing acetylcysteine or carbocysteine versus active treatment or no treatment and case reports. In this review update two review authors (YD, MC), with help from a colleague, extracted data and assessed trial quality. We performed a subgroup analysis of children younger than two years of age. We included six trials involving 497 participants to study efficacy. They showed some benefit (e.g. reduction of cough at day seven) from mucolytic agents, although differences were of little clinical relevance. No conclusion was drawn about the subgroup of infants younger than two years because data were unavailable. Thirty-four studies, including the previous six trials involving 2064 children, were eligible to study safety. Overall safety was good but very few data were available to evaluate safety in infants younger than two years. However, 59 cases of paradoxically increased bronchorrhoea observed in infants were reported to the French pharmacovigilance system. The results have to be interpreted with

  6. Paediatric Post-Traumatic Bladder Neck Distraction Injury: Case Series

    PubMed Central

    Sawant, Ajit S.; Kumar, Vikash; Pawar, Prakash; Tamhankar, Ashwin S.

    2017-01-01

    The bladder neck distraction is a rare posterior urethral injury in paediatric age group. It mostly occurs secondary to road traffic accidents. We report three cases of paediatric bladder neck distraction injury. Three paediatric patients aged between 4 to 7 years (mean 5 year), who presented with post traumatic bladder neck distraction injury but no other major injury, they were treated with early urethro-vesical anastomosis. Postoperatively all patients were continent and with good urine flow rates. In paediatric bladder neck distraction injury, immediate urethro-vesical anastomosis gives good results. PMID:28384935

  7. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    PubMed

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

    2010-10-01

    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.

  8. [Evaluation and diagnosis of patients with developmental delay: standardised protocols from the paediatric point of view].

    PubMed

    Poch-Olivé, M L

    2006-01-07

    The identification of the causes of mental retardation (MR) is of great importance because of the consequences it has in the intervention, prognosis, knowledge of risk of recurrence and its prevention. The purpose of this review is to provide a global evaluation of the child with developmental delay or with MR in day-to-day clinical praxis of the neuropaediatrician who has to put aetiological diagnosis in practice. To this end we conduct a review of the evidence-based guidelines published by the leading groups of experts that assess the weight of diagnostic tests in the initial evaluation of children with MR and propose an algorithm that helps the clinician to make decisions. A good patient record including the familial and personal history, the examination and observation of behaviour is essential before starting the laboratory and imaging tests in a rational manner. At the outset, cytogenetic and molecular genetic studies are indicated to study fragile X syndrome and neuroimaging, preferably magnetic resonance, should be employed above all when anomalies are observed in the examination. Ophthalmologic and auditory evaluation is recommended in all cases. Routine metabolic screening is not indicated at the outset; studies to investigate thyroid (T4 and TSH) and other metabolic pathologies can be considered when the child has not been subject to neonatal metabolic screening or when there is clinical evidence of it. Routine electroencephalogram studies are not recommended, but can be considered if suggested by the clinical history. Likewise, the clinician may consider a study for toxins, if the clinical history suggests it, and a genetic study of Rett syndrome, in the case of girls with MR that cannot be accounted for by other causes.

  9. RGS5 gene and therapeutic response to short acting bronchodilators in paediatric asthma patients.

    PubMed

    Labuda, Malgorzata; Laberge, Sophie; Brière, Julie; Bérubé, Denis; Krajinovic, Maja

    2013-10-01

    Short-acting β2-adrenergic receptor agonists are commonly used bronchodilators for symptom relief in asthmatics. Recent evidence demonstrated that prolonged exposure of cultured airway smooth muscle cells to β2 agonists directly augments procontractile signaling pathways with the change in expression of regulator of G protein signaling 5 (RGS5). The aim of this study was to test whether genetic variants in RGS5 gene affect the response to short acting β2-agonists. Bronchodilator responsiveness was assessed in 137 asthmatic children by % change in baseline forced expiratory volume in 1 sec (FEV1 ) after administration of albuterol. The analyses were performed in patients with FEV1 /FVC ratio below 0.9 (FVC-forced vital capacity, n = 99). FEV1 % change adjusted for baseline FEV1 values was significantly different between genotypes of rs10917696 C/T polymorphism (P = 0.008). The association remained significant with inclusion of age, sex, atopy, parental smoking, and controller medications into multivariate model (P = 0.005). We also identified additive effect on the treatment outcome with previously published genetic variant G/A rs1544791 in phosphodiesterase 4 (PDE4D) gene. Carriers of two risk alleles (C and G) had adjusted mean % FEV1 change value 4.6 ± 1.3, while carriers of one and none of the risk alleles had 8.1 ± 0.7% and 13.5 ± 2.4%, respectively, P = 0.001. Our work identifies a new genetic variant in RGS5 demonstrating additive effect with PDE4D, both implicated in modulation of asthma treatment. © 2012 Wiley Periodicals, Inc.

  10. [Urodynamic changes after bladder augmentation surgery in paediatric patients with myelomeningocele due to neurogenic bladder].

    PubMed

    Zaragoza Torres, Raúl Ignacio; Galarza-Flores, Mario Eduardo; Gómez-Castellanos, Julio Cesar; Barrera-de León, Juan Carlos

    2016-01-01

    Augmentation cystoplasty is a successful surgical procedure for the management of neurogenic bladder in children in order to improve urodynamic parameters. The aim of this article is to describe urodynamic changes after augmentation cystoplasty in children with myelomeningocele. A descriptive cross-sectional study including children aged 8-16 years with a myelomeningocele operated on for augmentation cystoplasty surgery with sigmoid colon segments due to a neurogenic bladder from the years 2003-2013. A urodynamic study was conducted before and after the surgical procedure. Non-probabilistic sample of consecutive cases. Descriptive statistics with frequencies and percentages, medians, and ranges. Inferential intra-group comparison with the Wilcoxon test and inter-group with Mann-Whitney U. SPSS 20.0 statistical package. The study included 50 patients, of whom 25 were male and 25 were female, with a median age of 12 years (range, 6-15 years). Bladder capacity improved from 52.8% to 95.9% (p<0.001), uninhibited contractions 1.4-1.8, contraction intensity 47-8.5 (p<0.001), mean pre-surgical and post-surgical filling pressure 40.8cm H2O and 11.0cm H2O, respectively (p<0.001), mean emptying pressure 48.5 vs. 3.6cm H2O (p<0.001), and bladder accommodation 4.6 vs. 41.3cm H2O (p<0.001). Augmentation cystoplasty with sigmoid colon significantly improved urodynamic parameters, such as bladder accommodation and filling pressure in children with myelomeningocele-associated neurogenic bladder. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  11. Paediatric trauma patients and attention deficit hyperactivity disorder: correlation and significance.

    PubMed

    Ertan, Cem; Özcan, Özlem Özel; Pepele, Mustafa Safa

    2012-11-01

    Trauma is one of the leading reasons for emergency department (ED) visits in children. Hyperactivity, inattentiveness and impulsiveness may contribute to injury proneness. The aim of this study was to evaluate the prevalence and role of attention deficit hyperactivity disorder (ADHD) in children with trauma. Trauma patients aged 3-17 attending the ED were included in the study group. Parents were informed after medical care had been given to their children, and demographic data and information about the trauma were collected. Later, parents were asked to complete the Conners' Parent Rating Scales-Revised questionnaire for ADHD symptoms. The control group consisted of children of similar age and sociocultural characteristics who attended the hospital for reasons other than trauma. Cases in which the child apparently had no active role in the trauma or where the parents did not complete the Conners' Parent Rating Scales-Revised questionnaire were excluded from the study. Fifty-five children were included in the study group (mean age 7.49 (range 3-14; SD 3.3); 33 (60%) were male). The control group was statistically similar to the study group. The most common trauma mechanism was falls (n=31, 56.4%). All the subscale scores were significantly higher in the study group, and previous trauma-related ED visits were associated with significantly higher subscale scores. The data suggest that children who make repeated trauma-related ED visits have a predisposition to ADHD, and they may benefit from screening for this disorder while in the ED.

  12. Ambulatory paediatrics: does it work?

    PubMed

    Macleod, C; McElroy, G; O'Loan, D; Kennedy, F; Kerr, R M; Jenkins, J; Lim, J

    2002-02-01

    To determine whether a paediatric ambulatory assessment service is an effective and acceptable replacement for an inpatient unit. Analysis of hospital paediatric medical admissions. Postal questionnaire survey of local general practitioners. Telephone survey of parents of children who had attended the ambulatory service. Rural General Hospital in Northern Ireland. General practitioners. Parents of children referred to assessment service. Number of paediatric medical hospital admissions from the local area before and after the introduction of an ambulatory assessment service. General practitioner satisfaction levels. Parental satisfaction levels. Since the introduction of the new service in April 1996 there has been a marked progressive reduction in paediatric medical hospital admissions from the local area. By the third year of operation of the ambulatory service (1998/99), a 47% reduction in admissions was recorded, compared to the 1995/96 baseline year. The response rate to the general practitioner questionnaire was 65% (37 of 57) of whom most (31, 84%) found the service beneficial. Of the 37 respondents, 31 had referred patients to the service. The majority of these general practitioners (30, 97%) reported that the service was easy to access, and the same proportion felt that requests for consultation were met promptly. Most felt that feedback was appropriate (29, 94%). A telephone survey of 50 parents showed that most were either very satisfied (38, 76%), or satisfied (11, 22%) with the service. Most parents (41, 82%) felt their child had benefited by not being admitted to hospital. Most (46, 92%) felt they had received adequate information regarding their child's illness. A paediatric ambulatory assessment unit can reduce the number of children admitted to hospital and meet the needs of children, their families and general practitioners.

  13. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

    PubMed

    Roqué i Figuls, Marta; Giné-Garriga, Maria; Granados Rugeles, Claudia; Perrotta, Carla

    2012-02-15

    This is an update of the original Cochrane review published in 2005 and updated in 2007. Acute bronchiolitis is the leading cause of medical emergencies during winter in children younger than two years of age. Chest physiotherapy is thought to assist infants in the clearance of secretions and to decrease ventilatory effort. The main objective was to determine the efficacy of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. A secondary objective was to determine the efficacy of different techniques of chest physiotherapy (for example, vibration and percussion and passive forced exhalation). We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to November week 3, 2011), MEDLINE in-process and other non-indexed citations (8 December 2011), EMBASE.com (1990 to December 2011), CINAHL (1982 to December 2011), LILACS (1985 to December 2011) and Web of Science (1985 to December 2011). Randomised controlled trials (RCTs) in which chest physiotherapy was compared against no intervention or against another type of physiotherapy in bronchiolitis patients younger than 24 months of age. Two review authors independently extracted data. Primary outcomes were respiratory parameters and improvement in severity of disease. Secondary outcomes were length of hospital stay, duration of oxygen supplementation and the use of bronchodilators and steroids. No pooling of data was possible. Nine clinical trials including 891 participants were included comparing physiotherapy with no intervention. Five trials (246 participants) evaluated vibration and percussion techniques and four trials (645 participants) evaluated passive expiratory techniques. We observed no significant differences in the severity of disease (eight trials, 867 participants). Results were negative for both types of physiotherapy. We

  14. Hearing the voices of children and young people to develop and test a patient-reported experience measure in a specialist paediatric setting.

    PubMed

    Wray, Jo; Hobden, Sylvie; Knibbs, Sarah; Oldham, Geralyn

    2017-09-13

    To develop and test patient-reported experience measures (PREMs) for children and young people in a specialist paediatric hospital setting. Six PREMs were developed and tested by children and young people for children and young people aged 8-11, 12-13 and 14-16 years in inpatient and outpatient settings. A week-long pilot was implemented across inpatient wards and outpatient clinics to identify facilitators and barriers to the routine use of PREMs in a real-time setting across our organisation. Tertiary paediatric hospital. Final PREMs; identified facilitators and barriers to implementation. 543 children and young people aged 8-16 years attending outpatient clinics or inpatient wards across a range of specialties. Three key themes about hospital experience were identified during focus groups: facilities, treatment and tests and people working at the hospital, and these provided the structure for the questionnaires. During cognitive testing the questionnaires were generally understood but some revisions to language and length of the questionnaires were required. Two designs were selected for the final PREMs. During acceptability and feasibility testing it was evident that children and young people liked the PREMs and wanted to give feedback on their hospital experience. Particular challenges for routine use of the PREMs focused on sustainability and resources. The new PREMs will provide children and young people receiving care in specialist paediatric hospitals with the opportunity to provide feedback on their experience. Sustainability and ensuring that feedback results in improvements need to be addressed in future work. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Dissociative symptomatology in cancer patients

    PubMed Central

    Civilotti, Cristina; Castelli, Lorys; Binaschi, Luca; Cussino, Martina; Tesio, Valentina; Di Fini, Giulia; Veglia, Fabio; Torta, Riccardo

    2015-01-01

    Introduction: The utilization of the post-traumatic stress disorder (PTSD) diagnostic spectrum is currently being debated to categorize psychological adjustment in cancer patients. The aims of this study were to: (1) evaluate the presence of cancer-related traumatic dissociative symptomatology in a sample of cancer patients; (2) examine the correlation of cancer-related dissociation and sociodemographic and medical variables, anxiety, depression, and post-traumatic stress symptomatology; (3) investigate the predictors of cancer-related dissociation. Methods: Ninety-two mixed cancer patients (mean age: 58.94, ds = 10.13) recruited from two hospitals in northern Italy were administered a questionnaire on sociodemographic and medical characteristics, the Karnofsky Scale to measure the level of patient activity and medical care requirements, the Hospital Anxiety and Depression Scale (HADS) to evaluate the presence of anxiety and depression, the Impact of Event Scale Revised (IES-R) to assess the severity of intrusion, avoidance, and hypervigilance, and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) to quantify the traumatic dissociative symptomatology. Results: 31.5% of participants report a PDEQ score above the cutoff. The results indicated that dissociative symptomatology was positively correlated with HADS scores (HADS-Anxiety: r = 0.476, p < 0.001; HADS-Depression: r = 0.364, p < 0.001) and with IES-R scores (IES-R-Intrusion: r = 0.698, p < 0.001; IES-R-Avoidance: r = 0.619, p < 0.001; IES-R- Hypervigilance: r = 0.681, p < 0.001). A stepwise regression analysis was performed in order to find the predictors of cancer-related traumatic dissociative symptomatology. The results converged on a three predictor model revealing that IES-R-Intrusion, IES-R-Avoidance, and IES-R-Hyperarousal accounted for 53.9% of the explained variance. Conclusion: These findings allow us to hypothesize a specific psychological reaction which may be ascribed to the traumatic

  16. Diagnostic paediatric imaging

    SciTech Connect

    Hall, C.M.; Lingam, S.

    1986-01-01

    This book is a case study teaching manual presenting radiographs and examples of other imaging modalities from 100 paediatric patients. The material comes from the radiological teaching collection at the Hospital for Sick Children at Great Ormond Street in London and was compiled over a ten year period. With each case a short clinical history is given and a series of questions posed, similar to those encountered in postgraduate medical examinations. Sample answers with comments and more illustrations are presented on the following page. The last decade has seen a rapid expansion in the range and sophistication of diagnostic imaging modalities which are available to clinicians. Since it is impossible to achieve comprehensive coverage in a book of this size, the authors have selected examples of cases which illustrate the range of imaging modalities currently available and which may be encountered in both clinical practice and in examinations.

  17. [Toxicology screening in paediatrics].

    PubMed

    Garcia-Algar, Óscar; Cuadrado González, Ainoha; Falcon, María

    2016-09-01

    The prevalence of acute or chronic exposure to substances of abuse in paediatric patients, from the neonatal period to adolescence, is not well established as most cases go unnoticed. Regardless of clinical cases of acute poisoning leading to visits to emergency room, the exposure is usually detected by a questionnaire to the parents or children. In the last few years, new validated analytical methodologies have been developed in order to detect parent drugs and their metabolites in different biological matrices. These biological matrices have different time windows for detection of the exposure: acute (i.e., urine, blood, oral fluid), and chronic (i.e., hair, meconium or teeth). The aim of this paper was to review the scenarios where the use of biological matrices is indicated for the detection of acute or chronic exposure to substances of abuse.

  18. Job satisfaction and burnout among paediatric nurses.

    PubMed

    Akman, Ozlem; Ozturk, Candan; Bektas, Murat; Ayar, Dijle; Armstrong, Merry A

    2016-10-01

    This study aims to determine factors of job satisfaction and burnout levels of paediatric nurses. A total of 165 nurses working in paediatric clinics completed the Minnesota job satisfaction scale and the Maslach burnout scale. Average scores of the emotional exhaustion and depersonalisation score were low, while personal accomplishment scores were high. A high level of job satisfaction, being married, increased age and a decreased number of assigned patients were significantly associated with a low level of burnout. Paediatric nurses experience burnout at significant levels. The most important variable that affected job satisfaction was income. The results of the study could guide development of strategies that might prevent or alleviate burnout of paediatric nurses. © 2016 John Wiley & Sons Ltd.

  19. Second malignant neoplasms after cancer in childhood or adolescence. Nordic Society of Paediatric Haematology and Oncology Association of the Nordic Cancer Registries.

    PubMed Central

    Olsen, J H; Garwicz, S; Hertz, H; Jonmundsson, G; Langmark, F; Lanning, M; Lie, S O; Moe, P J; Møller, T; Sankila, R

    1993-01-01

    OBJECTIVE--To assess the relative risk of developing a second malignant neoplasm in people with a diagnosis of cancer in childhood and adolescence. DESIGN--Register based follow up study. SETTING--Populations of Nordic countries. SUBJECTS--30,880 people under the age of 20 with a first malignant neoplasm diagnosed during the period 1943-87. MAIN OUTCOME MEASURES--Relative and attributable risks of second malignant neoplasms by type of first cancer, age at first diagnosis, calendar period, sex, and country. Expected figures were based on the appropriate national incidence rates for cancer. RESULTS--247 cases of second malignant neoplasms were observed in 238 patients, yielding a relative risk for cancer of 3.6 (95% confidence interval 3.1 to 4.1). The risk changed significantly from 2.6 in people first diagnosed during the 1940s and 1950s to 6.9 among cohort members included in the late 1970s and 1980s. Increases were observed for most types of cancer. Highest levels of the relative risk were seen during the 10 years immediately after first malignant diagnosis. The incidence of second malignant neoplasms attributable to the first cancer and associated treatments, however, showed a consistent rise throughout the 45 years of follow up. CONCLUSION--The estimated risks for a second malignant neoplasm were significantly lower than those found in most large hospital based studies but compatible with the results from a similar population based study in the United Kingdom. Extent of risk and cancer pattern were similar among the Nordic countries and are believed to be representative for a large part of the European population. PMID:8251777

  20. Paediatric Blunt Torso Trauma

    PubMed Central

    Bhatti, Khalid M.; Taqi, Kadhim M.; Al-Harthy, Ahmed Z. S.; Hamid, Rana S.; Al-Balushi, Zainab N.; Sankhla, Dilip K.; Al-Qadhi, Hani A.

    2016-01-01

    Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7%) male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0%) received their injuries after having been hit by cars as pedestrians, while 19 (27.1%) were injured by falls, 12 (17.1%) during car accidents as passengers and four (5.7%) by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%), followed by abdominal injuries (42.9%). The most commonly involved solid organs were the liver (15.7%) and spleen (11.4%). The majority of the patients were managed conservatively (92.9%) with a good outcome (74.3%). The mortality rate was 7.1%. Most deaths were due to multisystem involvement. Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach. PMID:27226913

  1. Hypnosis in paediatric respiratory medicine.

    PubMed

    McBride, Joshua J; Vlieger, Arine M; Anbar, Ran D

    2014-03-01

    Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of paediatric respiratory medicine as both a primary and an adjunctive therapy. This article gives a brief overview of how hypnotherapy is performed followed by a review of its applications in paediatric patients with asthma, cystic fibrosis, dyspnea, habit cough, vocal cord dysfunction, and those requiring non-invasive positive pressure ventilation. As the available literature is comprised mostly of case series, retrospective studies, and only a single small randomized study, the field would be strengthened by additional randomized, controlled trials in order to better establish the effectiveness of hypnosis as a treatment, and to identify the processes leading to hypnosis-induced physiologic changes. As examples of the utility of hypnosis and how it can be taught to children with respiratory disease, the article includes videos that demonstrate its use for patients with cystic fibrosis.

  2. Many Terminal Cancer Patients Remain in Denial

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_167297.html Many Terminal Cancer Patients Remain in Denial Not facing reality ... HealthDay News) -- Nearly 10 percent of patients with terminal cancer don't want to know they're ...

  3. Gastric Cancer in Young Patients

    PubMed Central

    Dhobi, Manzoor A.; Wani, Khursheed Alam; Parray, Fazl Qadir; Wani, Rouf A.; Peer, G. Q.; Abdullah, Safiya; Wani, Imtiyaz A.; Wani, Muneer A.; Shah, Mubashir A.; Thakur, Natasha

    2013-01-01

    Aim. The aim of this study was to see the clinical, pathological, and demographic profile of young patients with stomach carcinoma besides association with p53. Patients and Methods. Prospective study of young patients with stomach carcinoma from January 2005 to December 2009. A total of 50 patients with age less than 40 years were studied. Results. Male female ratio was 1 : 1.08 in young patients and 2.5 : 1 in older patients. A positive family history of stomach cancer in the first degree relatives was present in 10% of young patients. Resection was possible only in 50% young patients. 26% young patients underwent only palliative gastrojejunostomy. The most common operation was lower partial gastrectomy in 68%. Amongst the intraoperative findings peritoneal metastasis was seen in 17.4% in young patients. 50% young patients presented in stage IV as per AJCC classification (P value .004; sig.). None of the patients presented as stage 1 disease in young group. Conclusion. Early detection of stomach carcinoma is very important in all patients but in young patients it is of paramount importance. PMID:24381753

  4. Paediatric autoimmune encephalopathies: clinical features, laboratory investigations and outcomes in patients with or without antibodies to known central nervous system autoantigens.

    PubMed

    Hacohen, Yael; Wright, Sukhvir; Waters, Patrick; Agrawal, Shakti; Carr, Lucinda; Cross, Helen; De Sousa, Carlos; Devile, Catherine; Fallon, Penny; Gupta, Rajat; Hedderly, Tammy; Hughes, Elaine; Kerr, Tim; Lascelles, Karine; Lin, Jean-Pierre; Philip, Sunny; Pohl, Keith; Prabahkar, Prab; Smith, Martin; Williams, Ruth; Clarke, Antonia; Hemingway, Cheryl; Wassmer, Evangeline; Vincent, Angela; Lim, Ming J

    2013-07-01

    To report the clinical and investigative features of children with a clinical diagnosis of probable autoimmune encephalopathy, both with and without antibodies to central nervous system antigens. Patients with encephalopathy plus one or more of neuropsychiatric symptoms, seizures, movement disorder or cognitive dysfunction, were identified from 111 paediatric serum samples referred from five tertiary paediatric neurology centres to Oxford for antibody testing in 2007-2010. A blinded clinical review panel identified 48 patients with a diagnosis of probable autoimmune encephalitis whose features are described. All samples were tested/retested for antibodies to N-methyl-D-aspartate receptor (NMDAR), VGKC-complex, LGI1, CASPR2 and contactin-2, GlyR, D1R, D2R, AMPAR, GABA(B)R and glutamic acid decarboxylase. Seizures (83%), behavioural change (63%), confusion (50%), movement disorder (38%) and hallucinations (25%) were common. 52% required intensive care support for seizure control or profound encephalopathy. An acute infective organism (15%) or abnormal cerebrospinal fluid (32%), EEG (70%) or MRI (37%) abnormalities were found. One 14-year-old girl had an ovarian teratoma. Serum antibodies were detected in 21/48 (44%) patients: NMDAR 13/48 (27%), VGKC-complex 7/48(15%) and GlyR 1/48(2%). Antibody negative patients shared similar clinical features to those who had specific antibodies detected. 18/34 patients (52%) who received immunotherapy made a complete recovery compared to 4/14 (28%) who were not treated; reductions in modified Rankin Scale for children scores were more common following immunotherapies. Antibody status did not appear to influence the treatment effect. Our study outlines the common clinical and paraclinical features of children and adolescents with probable autoimmune encephalopathies. These patients, irrespective of positivity for the known antibody targets, appeared to benefit from immunotherapies and further antibody targets may be defined in the

  5. Paediatric surgery in Uganda.

    PubMed

    Sekabira, John

    2015-02-01

    The Hugh Greenwood Lecture acknowledges the extremely generous support from Mr Greenwood that has enabled the BAPS to establish funds to advance paediatric surgical training in developing countries. In this Inaugural Lecture, Dr. Sekabira, the first Hugh Greenwood Fellow, describes the influence that this has had on his career and reviews the state of paediatric surgery in Uganda.

  6. Paediatrics in Berlin.

    PubMed

    Barbato, A; Bertuola, F; Kuehni, C; Korppi, M; Kotecha, S; Pijnenburg, M W; Ratjen, F; Seddon, P; Bush, A

    2009-08-01

    The aim of this report is to describe the highlights of the European Respiratory Society annual congress in Berlin, Germany. The best abstracts in asthma and allergy, cystic fibrosis, respiratory infection, paediatric and neonatal intensive care, paediatric investigative techniques (in particular respiratory physiology and bronchoscopy) and respiratory epidemiology are presented and set in the context of the current literature.

  7. [Nutrition therapy of cancer patients].

    PubMed

    Lövey, József

    2017-09-20

    The majority of cancer patients becomes malnourished during the course of their disease. Malnutrition deteriorates the efficiency of all kinds of oncologic interventions. As a consequence of it, treatment-related toxicity increases, hospital stay is lengthened, chances of cure and survival as well as the quality of life of the patients worsen. Nutritional status therefore influences all aspects of outcome of oncology care. In spite of this the use of nutritional therapy varies across health care providers but its application is far from being sufficient during active oncology interventions as well as rehabilitation and supportive care. It threatens not only the outcome and quality of life of cancer patients but also the success of oncologic treatments which often demand high input of human and financial resources. Meanwhile application of nutritional therapy is legally regulated in Hungary and a very recent update of the European guideline on cancer patient nutrition published in 2017 is available. Moreover, cost effectiveness of nutritional therapy has been proven in a number of studies. In this review we present the basics of nutritional therapy including nutritional screening and evaluation, nutritional plan, the role of nutrition support teams, oral, enteral and parenteral nutrition, the use of different drugs and special nutrients and the follow-up of the patients.

  8. Infliximab paediatric Crohn's disease educational plan: a European, cross-sectional, multicentre evaluation.

    PubMed

    Arana, Alejandro; Allen, Sam; Burkowitz, Jörg; Fantoni, Valerio; Ghatnekar, Ola; Rico, María Teresa; Vanhaverbeke, Nathalie; Wentworth, Charles E; Brosa, Max; Arellano, Felix M

    2010-06-01

    they were made aware of the benefits and risks through the educational programme. However, the majority of physicians reported that they had been approached by the sponsor's personnel in France (98%), Italy (100%), Spain (83%) and Sweden (70%). In Germany and the UK this proportion was 42%. Almost all physicians were aware of the need to perform tuberculosis (TB) and cancer screening prior to initiating therapy with infliximab, and to screen for hypersensitivity reactions before, during and after treatment. Ninety percent of the physicians were aware of the need to update immunization therapy before initiating therapy and, except in Italy (92% aware), around 50% of the physicians were aware of the need to provide patients with the infliximab Patient Alert Card. In the other European countries where the survey took place among physicians identified by the sponsor, 99% of paediatric gastroenterologists and 90% of gastroenterologists or paediatricians declared themselves aware of the benefits and risks of using infliximab for the treatment of paediatric Crohn's disease, and all of them were aware of the risk of TB and opportunistic infections and the need to perform TB and cancer screening prior to initiating therapy with infliximab. Overall, the results of the evaluation of the Infliximab Paediatric Crohn's Disease Educational Plan were satisfactory. The objective of education of internal personnel of the pharmaceutical companies distributing infliximab was completely achieved; over 90% of physicians reported being aware of the benefits and risks of infliximab for the treatment of paediatric Crohn's disease. Further work should be carried out across all countries to educate physicians on providing patients with the infliximab Patient Alert Card. In Germany and the UK in particular, where <50% of physicians reported having been approached by the sponsor's personnel, further work is needed to raise awareness of the educational programme.

  9. Lung cancer in elderly patients

    PubMed Central

    Diso, Daniele; Onorati, Ilaria; Anile, Marco; Mantovani, Sara; Rendina, Erino A.

    2016-01-01

    There is a worldwide-accepted evidence of a population shift toward older ages. This shift favors an increased risk of developing lung cancer that is primarily a disease of older populations. Decision making is extremely difficult in elderly patients, since this group is under-represented in clinical trials with only 25% of them historically opening to patients older than 65 years. For all these reasons, a “customized” preoperative assessment to identify physiological or pathological frailty should be encouraged since standard tools may be less reliable. The work already done to improve patient selection for lung surgery in the elderly population clearly shows that surgical resection seems the treatment of choice for early stage lung cancer. Further studies are required to improve outcome by reducing postoperative morbidity and mortality. PMID:27942414

  10. Developing an index for the orthodontic treatment need in paediatric patients with obstructive sleep apnoea: a protocol for a novel communication tool between physicians and orthodontists

    PubMed Central

    Altalibi, Mostafa; Saltaji, Humam; Roduta Roberts, Mary; Major, Michael P; MacLean, Joanna; Major, Paul W

    2014-01-01

    Introduction Sleep disordered breathing in the paediatric population can manifest as an array of different systemic symptoms; among them is a distinct malocclusion and craniofacial phenotype. Emerging research suggests that the treatment of this malocclusion and/or craniofacial phenotype through orthodontic intervention may help with the symptoms of these patients. Selecting the patients who would benefit from orthodontic treatment can be a difficult task for the physician with minimal dental training. Therefore the aim of this study is to develop a simple index to be used by medical professionals to identify those paediatric patients with orthodontic treatment needs who may benefit their obstructive sleep apnoea (OSA) symptoms. Methods and analysis The methodology in this project has been devised through the WHO's recommendations on developing an index, with modifications based on the specific needs of this study. Based on the available literature, a draft index will be produced and subjected to multiple iterative revisions based on the feedback from: the Index Development Group, a group of multidisciplinary and internationally acclaimed experts in the field; the External Review Group, a group of potential end users and interested parties and the Steering Committee. Once the index has been formalised, it will be subjected to a pair of reliability tests using physicians and orthodontists scored 2 weeks apart. Subsequently, the index will be validated using dichotomous responses from orthodontists on whether they would treat a patient for OSA symptoms, and comparing the responses to the score of the index on the same patient. Ethics and dissemination The index will be translated into French and will be presented in orthodontic and medical conferences, workshops, seminars, round table discussions, and free copies for download will be made available on the website of the University of Alberta Interdisciplinary Airway Research Clinic (iarc.ualberta.ca). Furthermore

  11. Efficacy and safety of Wilate in paediatric VWD patients under 6 years of age - results of a prospective multicentre clinical study including recovery information.

    PubMed

    Nowak-Göttl, U; Krümpel, A; Russo, A; Jansen, M

    2013-11-01

    Treatment with exogenous von Willebrand factor (VWF) is indicated in patients with von Willebrand disease (VWD) in whom treatment with 1-deamino-8-d-arginine vasopressin/desmopressin is contraindicated. Wilate is a new generation plasma-derived concentrate of native VWF and coagulation factor VIII (FVIII) (in a physiological 1:1 ratio) developed for the treatment of VWD. This is the first study to report safety, efficacy and in vivo recovery (IVR) data from 15 paediatric patients less than 6 years of age who received Wilate for either prophylaxis, on-demand treatment or for treatment in surgical procedures during a prospective open-label trial (VWD type 1: 5, type 2A: 1, type 2B: 2, type 3: 6, unknown type: 1 patients). Analysis of IVR for VWF and FVIII suggested an appropriate and consistent rise in coagulation activity after Wilate administration. Overall efficacy was rated as excellent or good for 99.7% [prophylactic infusions] and 100% [bleeding episodes/surgical procedures]. More than 82% of bleeding episodes resolved after 1 day of treatment, and a Wilate dosage of 20-50 IU kg(-1) was sufficient to achieve haemostasis in 97% of bleeding episodes. All surgical procedures were successfully managed with Wilate. No thromboembolic events were observed during the study, and no patient developed anti-VWF antibodies or FVIII inhibitors. In conclusion, this study confirms both the expected IVR profile in paediatric patients and the excellent efficacy, tolerability and safety profile of Wilate observed previously in adults. Wilate showed excellent efficacy in the treatment of bleeding when used prophylactically or on-demand, and in the treatment of surgical procedures. © 2013 John Wiley & Sons Ltd.

  12. Fever of unknown origin in cancer patients.

    PubMed

    Loizidou, A; Aoun, M; Klastersky, J

    2016-05-01

    Fever of unknown origin (FUO) remains a challenging clinical problem, namely in patients with cancer. In cancer patients, FUO may be due to the cancer itself, as it is the case of hematological malignancies; digestive tumors (colon cancer, liver metastases) are significantly associated with FUO and infection can be demonstrated in some cases. Prevention with G-CSF and empirical antimicrobial therapy are essential approaches for the management of FUO in cancer patients. New diagnostic approaches, such as PET imaging, should be further evaluated in cancer patients with FUO. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Malnutrition in Patients With Cancer.

    PubMed

    Gyan, Emmanuel; Raynard, Bruno; Durand, Jean-Philippe; Lacau Saint Guily, Jean; Gouy, Sébastien; Movschin, Marie Lespiau; Khemissa, Faiza; Flori, Nicolas; Oziel-Taieb, Sandrine; Bannier Braticevic, Cécile; Zeanandin, Gilbert; Hebert, Christophe; Savinelli, Francesco; Goldwasser, François; Hébuterne, Xavier

    2017-01-01

    Malnutrition is a critical predictor of toxicity and outcome in patients with cancer and may be perceived differently by patients, relatives, and physicians. To assess the prevalence of malnutrition in oncology departments and to compare it with the perceptions of nutrition status by patients themselves, their closest relatives, and attending physicians. A 1-day multicentric cross-sectional survey on the prevalence of malnutrition was conducted in different oncology departments using patient-, relative-, and physician-specific questionnaires. Malnutrition was defined by a weight loss ≥5% within 1 month or ≥10% within 6 months, a body mass index ≤18.5 kg/m(2) in patients aged <70 years or ≤21 kg/m(2) in patients aged ≥70 years, and/or albuminemia <35 g/L. Questionnaires for assessing medical condition, knowledge of nutrition status, and perceptions of the impact of malnutrition on daily life were distributed to consenting patients, attending physicians, and closest relatives. A total of 2197 patients were included, and 2071 and 976 questionnaires were collected from patients and relatives, respectively. Prevalence of malnutrition was 39%. Physicians overestimated malnutrition (44%), whereas patients and relatives underestimated it (22% and 23%, respectively, P < .001). Conversely, malnutrition-associated symptoms were underestimated by physicians compared with patients and relatives. We found a prevalence of malnutrition of 39%: it was underestimated by patients and relatives and overestimated by physicians.

  14. What's new in paediatric dentistry?

    NASA Astrophysics Data System (ADS)

    Vitale, M. C.

    2016-03-01

    Since the early 80's, the use of laser has been introduced in the daily dental practice and the technological development has also provided over time to optimize its use. Various types of lasers with different wavelengths have been developed for use in a handy, easy and ergonomic manner. In daily paediatric dentistry, laser could be a very useful medical device which can completely replace the traditional high hand-piece and bur to realize a "micro-invasive" dentistry and a "clean" surgery, without bleeding and sutures. According to the international literature and in the light of recent researches, this work could give an overview on assisted laser therapy in paediatric dentistry, highlighting advantages and disadvantages of this new technology and pointing out the high compliance of the young patient.

  15. Emergence of quinolone-resistant strains in Streptococcus pneumoniae isolated from paediatric patients since the approval of oral fluoroquinolones in Japan.

    PubMed

    Takeuchi, Noriko; Ohkusu, Misako; Hoshino, Tadashi; Naito, Sachiko; Takaya, Akiko; Yamamoto, Tomoko; Ishiwada, Naruhiko

    2017-01-31

    Tosufloxacin (TFLX) is a fluoroquinolone antimicrobial agent. TFLX granules for children were initially released in Japan in 2010 to treat otitis media and pneumonia caused by drug-resistant bacteria, e.g. penicillin-resistant Streptococcus pneumoniae and beta-lactamase-negative, ampicillin-resistant Haemophilus influenzae. The evolution of bacterial resistance since TFLX approval is not known. To clarify the influence of quinolones administered to children since their approval, we examined the resistance mechanism of TFLX-resistant S. pneumoniae isolated from paediatric patients as well as patient clinical characteristics. TFLX-resistant strains (MIC ≥ 2 mg/L) were detected among clinical isolates of S. pneumoniae derived from children (≤15 years old) between 2010 and 2014. These strains were characterised based on quinolone resistance-determining regions (QRDRs), i.e. gyrA, gyrB, parC, and parE. In addition, the antimicrobial susceptibility, serotype, and multilocus sequence type of strains were determined, pulsed-field gel electrophoresis was performed, and patient clinical characteristics based on medical records were assessed for cases with underling TFLX-resistant strains. Among 1168 S. pneumoniae isolates, two TFLX-resistant strains were detected from respiratory specimens obtained from paediatric patients with frequent exposure to TFLX. Both strains had mutations in the QRDRs of gyrA and parC. One case exhibited gradual changes in the QRDR during the clinical course. This is the first study of quinolone-resistant S. pneumoniae isolated from children, including clinical data, in Japan. These data may help prevent increases in infections of quinolone-resistant S. pneumoniae in children; specifically, the results emphasise the importance of administering fluoroquinolones only in appropriate cases.

  16. Proteomics-based discovery of biomarkers for paediatric acute lymphoblastic leukaemia: challenges and opportunities

    PubMed Central

    López Villar, Elena; Wu, Duojiao; Cho, William C; Madero, Luis; Wang, Xiangdong

    2014-01-01

    There are important breakthroughs in the treatment of paediatric acute lymphoblastic leukaemia (ALL) since 1950, by which the prognosis of the child majority suffered from ALL has been improved. However, there are urgent needs to have disease-specific biomarkers to monitor the therapeutic efficacy and predict the patient prognosis. The present study overviewed proteomics-based research on paediatric ALL to discuss important advances to combat cancer cells and search novel and real protein biomarkers of resistance or sensitivity to drugs which target the signalling networks. We highlighted the importance and significance of a proper phospho-quantitative design and strategy for paediatric ALL between relapse and remission, when human body fluids from cerebrospinal, peripheral blood, or bone-marrow were applied. The present article also assessed the schedule for the analysis of body fluids from patients at different states, importance of proteomics-based tools to discover ALL-specific and sensitive biomarkers, to stimulate paediatric ALL research via proteomics to ‘build’ the reference map of the signalling networks from leukemic cells at relapse, and to monitor significant clinical therapies for ALL-relapse. PMID:24912534

  17. Proteomics-based discovery of biomarkers for paediatric acute lymphoblastic leukaemia: challenges and opportunities.

    PubMed

    López Villar, Elena; Wu, Duojiao; Cho, William C; Madero, Luis; Wang, Xiangdong

    2014-07-01

    There are important breakthroughs in the treatment of paediatric acute lymphoblastic leukaemia (ALL) since 1950, by which the prognosis of the child majority suffered from ALL has been improved. However, there are urgent needs to have disease-specific biomarkers to monitor the therapeutic efficacy and predict the patient prognosis. The present study overviewed proteomics-based research on paediatric ALL to discuss important advances to combat cancer cells and search novel and real protein biomarkers of resistance or sensitivity to drugs which target the signalling networks. We highlighted the importance and significance of a proper phospho-quantitative design and strategy for paediatric ALL between relapse and remission, when human body fluids from cerebrospinal, peripheral blood, or bone-marrow were applied. The present article also assessed the schedule for the analysis of body fluids from patients at different states, importance of proteomics-based tools to discover ALL-specific and sensitive biomarkers, to stimulate paediatric ALL research via proteomics to 'build' the reference map of the signalling networks from leukemic cells at relapse, and to monitor significant clinical therapies for ALL-relapse.

  18. Acute kidney injury in the cancer patient.

    PubMed

    Campbell, G Adam; Hu, Daniel; Okusa, Mark D

    2014-01-01

    Acute kidney injury (AKI) is a frequent and significant complication of cancer and cancer therapy. Cancer patients frequently encounter risk factors for AKI including older age, CKD, prerenal conditions, sepsis, exposure to nephrotoxins, and obstructive physiology. AKI can also be secondary to paraneoplastic conditions, including glomerulonephritis and microangiopathic processes. This complication can have significant consequences, including effects on patients' ability to continue to receive therapy for their malignancy. This review will serve to summarize potential etiologies of AKI that present in patients with cancer as well as to highlight specific patient populations, such as the critically ill cancer patient.

  19. Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden.

    PubMed

    Elinder, Karolina; Söderman, Anne-Charlotte Hessén; Stalfors, Joacim; Knutsson, Johan

    2016-08-01