Добірка наукової літератури з теми "3213 Paediatrics"

BACKGROUND Abdominal pain is a common disorder in children and adolescents worldwide with prevalence rate ranging from 20 - 25 % in school-going children in India. It is a frustrating concern to the child, parents and the physician. Even though abdominal pain is one of the most common complaints in children, it poses a diagnostic challenge owing to the variety of underlying causes. The purpose of this study was to evaluate the aetiology of abdominal pain associated with significant mesenteric lymphadenopathy in a paediatric population. METHODS This is a hospital based prospective, observational study done in Department of Paediatrics, Malla Reddy Institute of Medical Sciences (MRIMS), Hyderabad. RESULTS Out of the 65 children studied, 30.8 % were of 5 - 8 years age group, 36.9 % were 9 - 12 years age group and 32.3 % were 13 - 15 years age group. In our study, we found 50.8 % were boys and 49.2 % were girls. 20 % of them were having fever, 16.9 % were having cough, 16.9 % were having diarrhoea, 13.8 % were having sore throat, 16.9 % dysuria, and 15.4 % were having constipation. All patients in our study group underwent ultrasound of abdomen. All cases were having significant mesenteric lymphadenopathy (more than 5 mm in short axis with three or more number of lymph nodes). In 53.8 % cases, etiological agent for the mesenteric lymphadenopathy was not proved with our investigations. In the remaining 46.2 % of children, cause of mesenteric lymphadenopathy was proved and 38.5 % were bacterial infections, 6.2 % were viral infections and 1.5 % were parasitic infections. CONCLUSIONS It is important to recognise mesenteric lymphadenitis as a clinical entity in paediatric cases presenting with abdominal pain. They should be evaluated for an etiological agent and if no proven source of infection and etiological agent is found, it can be considered as functional abdominal pain. If we are able to get a proper etiological diagnosis in these cases, we could treat them and we could make huge difference in terms of quality of life. KEYWORDS Abdominal Pain, Mesenteric Lymphadenitis, Ultrasound, Significant Mesenteric Lymphadenopathy

ObjectiveTo ascertain the extent to which community paediatricians are involved in the care of children with mental health conditions in order to determine which difficulties are appropriate for single or joint surveillance by the British Paediatric Surveillance Unit (BPSU) and Child and Adolescent Psychiatry Surveillance System (CAPSS).DesignAn online survey of the 1120 members of the British Association of Community Child Health (BACCH) working in 169 Community Child Health (CCH) services in the UK.ResultsA total of 245 community paediatricians responded to the survey. This represents 22% of members of BACCH but likely to have covered many of the 169 CCH units because participants could respond on behalf of other members in their unit. The survey showed that children and young people (CYP) with neurodevelopmental conditions presented more frequently to paediatrics than to Child and Adolescent Mental Health Services (CAMHS). In addition, a sizeable proportion of CYP with emotional difficulties presented to paediatricians (eg, 29.5% for anxiety/obsessive compulsive disorder (OCD), and 12.8% for depression)—mainly due to difficulty with accessing CAMHS. More than half of the community paediatricians are involved in the care of CYP with anxiety and OCD, while 32.3% are involved in the care of those with depression.ConclusionThere is significant involvement of community paediatricians in the care of CYP with mental health conditions. Involvement is highest for neurodevelopmental conditions, but also significant for CYP with emotional difficulties. The implication of the findings for surveillance case ascertainment is that joint BPSU and CAPSS is recommended for surveillance studies of neurodevelopmental conditions. However, for emotional disorders, single or joint surveillance should be made based on the specific research question and the relative trade-offs between case ascertainment, and the additional cost and reporting burden of joint surveillance. Single CAPSS studies remain appropriate for psychosis and bipolar disorder.

ObjectivesThe foot posture index (FPI) is an observational tool designed to measure the position of the foot. The objective of this study was to establish international reference data for foot posture across childhood, and influence of body mass index (BMI) on paediatric foot posture.DesignCross-sectional study.Setting and participantsThe dataset comprised 3217 healthy children, aged from 3 to 15 years. Contributing data were acquired from Spain, UK and Australia.InterventionsFoot posture was described by means and z-score of the FPI and the height and weight of each subject was measured and the BMI was calculated.ResultsThe foot posture of 3217 children were reviewed. A pronated (FPI ≥+6) foot posture was found in 960 (29.8%) children, a normal (FPI 0 to +6) foot posture in 1776 (55.2%) and a highly pronated (FPI +10) foot posture was found in 127 children (3.9%) (range −4 to +12 FPI). Less than 11% were found to have a supinated foot type (n=354). Approximately 20% of children were overweight/obese, but correlation between BMI and FPI was weak and inverse (r=−0.066, p<0.01), refuting the relationship between increased body mass and flatfeet.ConclusionsThis study confirms that the ‘flat’ or pronated foot is the common foot posture of childhood, with FPI score of +4 (3) the average finding. Trend indicated a less flatfoot with age, although non-linear. A wide normal range of foot posture across childhood is confirmed.

Objectives: We aimed to determine the need for revision adenoidectomy following the standard technique of blind curettage with digital palpation.Methods: Within a district general hospital, we undertook a retrospective study of 3231 children who underwent adenoidectomy between 1996 and 2003, 53 of whom required revision adenoidectomy. The main outcome measure was the number of children needing revision adenoidectomy.Results: A total of 53 children required a repeated operation for recurrence of symptoms (1.6 per cent); of these, 42 were for treatment of glue ear, five were for nasal symptoms and six were for adenoidal infection.Conclusion: Adenoidectomy performed without vision may be one of the reasons for recurrence of symptoms. Residual adenoids are acknowledged in the literature as one of the complications of the traditional technique. We highlight the fact that the need for revision adenoidectomy is not uncommon and suggest that we should improve our surgical technique in the UK by visualization of the postnasal space either by a mirror or an endoscope.

ObjectivesTo examine the severity and progression of acute illness or injury in children using vital signs obtained during ambulance transport and categorised according to a paediatric triage model.DesignA population-based historical cohort study using data from prehospital patient medical records linked to a national civil registration database.SettingEmergency medical services providing ground-level transport in a mixed urban–rural region with three hospitals in Denmark.Participants25 039 events with patients aged <18 years attended by emergency medical services dispatched after a 1-1-2 emergency call during the years 2006–2018.Primary and secondary outcome measuresDistribution of the first observed vital signs according to a paediatric triage model: heart rate, Glasgow Coma Score, respiratory rate, oxygen saturation and oxygen treatment, and proportion of patients progressing to a triage score with a lower level of urgency during ambulance transport.ResultsThe proportion of patients with the first observed vital signs outside the normal age-specific range was as follows: 33.6% for heart rate, 15.3% for Glasgow Coma Score, 17.4% for respiratory rate and 37.4% for oxygen saturation regardless of oxygen treatment. The proportion of patients progressing to a triage score with a lower level of urgency during transport varied with age: 146/354 (41.2%) for age 0–2 months, 440/986 (44.6%) for age 3–11 months, 1278/3212 (39.8%) for age 1–2 years, 967/2814 (34.4%) for age 3–7 years and 4029/13 864 (29.1%) for age 8–17 years (p<0.001). One-day mortality was 3.05 deaths per 1000 patient-days (95% CI 2.43 to 3.83).ConclusionsOne third of the patients’ condition progressed to a triage score with a lower level of urgency during ambulance transport. Vital sign documentation in paediatric patients was incomplete, and educational initiatives should be taken to increase documentation of vital signs, especially in patients aged ≤2 years.

Pelvic fixation during procedures performed to treat spinal deformities in paediatric patients remains challenging. No computed tomography studies in paediatric have assessed the optimal trajectory of ilio- sacral screws to prevent screw malposition. We used pelvic computed tomography from 80 children divided into four groups : females <10 and ≥10 years and males <10 and ≥10 years. A secure triangular corridor parallel to the upper S1 endplate was delineated based on three fixed landmarks. The optimal screw insertion angle was subtended by the horizontal and the line bisecting the secure corridor. Student’s t test was applied to determine whether the optimal screw insertion angle and/or anatomical parameters were associated with age and/or sex. Mean optimal angle was 32.3°±3.6°, 33.8°±4.7°, 30.2°±5.0°, and 30.4°±4.7° in the younger females, younger males, older females, and older males, respectively. The mean optimal angle differed between the two age groups (p=0.004) but not between females and males (p=0.55). Optimal mean screw length was 73.4±9.9 mm. Anatomical spinal canal parameters in the transverse plane varied with age (p=0.02) and with sex in the older children (p=0.008), and those in the sagittal plane varied with sex (p=0.04). Age affected ilio-sacral screw positioning, whereas sex did not. Several anatomical spinal canal parameters varied with age and sex. These results should help to ensure safe and easy ilio-sacral screw placement within a secure corridor.

INTRODUCTION Kirschner wires (K-wires) are immensely versatile in fracture fixation in the paediatric population. Complications associated with the K-wiring procedure vary from minor to a life-threatening. The aim of this study was to analyse the outcome of fracture fixation using K-wires in all types of upper-extremity fractures in children in order to assess the incidence and type of complication critically. PATIENTS AND METHODS Between September 1999 and September 2001, we retrospectively reviewed a consecutive series of 105 fractures in 103 paediatric trauma cases (below 12 years) treated with K-wires in a university teaching hospital. The case notes and radiographs were reviewed by an independent single assessor. All paediatric, acute, upper-extremity, displaced and unstable fractures were included. All elective procedures using K-wires were excluded. RESULTS We observed an overall 32.3% complication rate associated with the K-wiring procedure affecting 34 pins (24 patients). Wound-related complications included over-granulation in 13 cases, pin tract infection in 6 cases and hypersensitive scar in 1 case. Neurapraxia was found in 3 patients and axonotmesis in 1 patient. Wire loosening at the time of removal in 14 cases and retrograde wire migration in 4 cases were observed. There were 2 cases of penetrating tendonitis and 1 case of osteomyelitis. There was a higher complication rate in terms of wire loosening and pin tract infection when the K-wires: (i) were left outside the skin compared with those placed under the skin; (ii) stayed longer in the patients; and (iii) did not traverse both cortices. There were more complications in complex operations performed by senior surgeons (P = 0.056). The duration of K-wire stay, associated co-morbidity and anatomical location were statistically insignificant. CONCLUSIONS Complications are part of operative procedures; an important point to consider is what causes them in order to take preventative measures. We recommend that the risks and complications should be explained to parents during the consenting process to allay their anxiety, irrespective of the fact that most complications are minor and of short duration.

ObjectiveTo investigate the frequency in which the physician provides a global assessment of disease activity (PhGA) >0 and an active joint count (AJC)=0 in children with juvenile idiopathic arthritis (JIA) and search for determinants of divergence between the two measures.MethodsData were extracted from a multinational cross-sectional dataset of 9966 patients who had JIA by International League of Associations for Rheumatology criteria, were recruited between 2011 and 2016, and had both PhGA and AJC recorded by the caring paediatric rheumatologist at the study visit. Determinants of discordance between PhGA>0 and AJC=0 were searched for by multivariable logistic regression and dominance analyses.ResultsThe PhGA was scored >0 in 1647 (32.3%) of 5103 patients who had an AJC of 0. Independent associations with discordant assessment were identified for tender or restricted joint count >0, history of enthesitis, presence of active uveitis or systemic features, enthesitis-related or systemic arthritis, increased acute phase reactants, pain visual analogue scale (VAS)>0, and impaired physical or psychosocial well-being. In dominance analysis, tender joint count accounted for 35.43% of PhGA variance, followed by pain VAS>0 (17.72%), restricted joint count >0 (16.14%) and physical health score >0 (11.42%).ConclusionWe found that many paediatric rheumatologists did not mark a score of 0 for patients who they found not to have active joints. The presence of pain in joints not meeting the definition of active joint used in JIA was the main determinant of this phenomenon.

Background:Childrens skin illnesses are a significant cause of morbidity and may be impacted by regional, racial, social, cultural, and economic variables. Despite their global prevalence, skin disorders have not played a significant role in the development of public health initiatives. Methods: The current study aimed to determine the prevalence of dermatological disorders among pediatric population at a single point of measurement as reported by parents. The most suitable design is cross-sectional study. It was descriptive and correlational study. This enables the researcher to measure the effect and the outcome at a single point of time. This study design gives reliable results with short time and less effort. The study was conducted at (place). The participants were selected during the period during October 2022. This study included children aged less than 12 years old via non-probability convenient sampling technique at a confidence level of 95% using Epi Info software equation. Results: The study included 1106 parents reporting dermatological disorders among their children. The most frequent dermatological disorders among children as reported by parents were cuts, scratches and grazes (n= 127, 11.5%). Cuts, scratches and grazes and insects bite was the most frequent combination of dermatological disorders among children (n= 108, 9.8%). There were 7% of children suffered from eczema (n= 77). Other dermatological disorders that children included in the current study suffered from are: Boils (n= 30, 2.7%), Cellulitis (= 24, 2.2%), Fifth disease (n= 12, 1.1%), Impetigo (n= 13, 1.2%), Herpes zoster (n= 12, 1.1%), Ring worm (n= 24, 2.2%), Warts (n= 10, 0.9%). The most frequent age group among children was 3-6 years (n= 357, 32.3%). Male to female ratio among children was very close and almost 1:1. There were 575 males (52%) and 531 females (48%). Conclusion:The group studied had a high frequency of skin irritation, infection, and insect bite reactions. Dermatological diseases are readily recognized, treated, and prevented. Many of the examined children had not sought medical help for the identified pathology, which may indicate a lack of access to health care. The studys strengths include its large sample size and age-focused epidemiology. Due to its methodology, this study, like many prevalence studies, cannot show causal relationships.This study reveals that its necessary to give fast access to health care services, enhance cleanliness in homes and public areas, and adopt preventive measures including complete vaccination and targeted fumigation.

Critical elements of early infant motor development can be observed when very young babies spontaneously kick and wave their arms. This initial movement phase progresses through various motor milestones from engaging the inhibition of the primitive reflexes through to rudimentary movements, fundamental motor skills, and finally to engaging in specialised sports activities in the early primary school age years (Gabbard, 2012; Goodway, Ozmun, & Gallahue, 2019). Even though infants have the propensity to naturally move through these rudimentary motor milestones, time spent in awake prone positions is central to achieving to achieving these skills (Ohman, Nilsson, Lagerkvist, & Beckung, 2009). Prone positioning is commonly referred to as tummy time, which has been described as a practice whereby an infant is placed on their stomach during awake play times (Hewitt, Stanley, & Okely, 2017). This tummy time positioning encourages head, neck and arm strength supporting timely rudimentary rolling and crawling skills (Dudek-Shriber & Zelazny, 2007; Jennings, Sarbaugh, & Payne, 2009; Lobo & Galloway, 2012; Majnemer & Snider, 2005), and also reducing the risk of deformational plagiocephaly or flat head syndrome (Kennedy, Majnemer, Farmer, Barr, & Platt, 2009). Researchers have proposed that motor development and motor milestones in infants may be affected or in some cases delayed, following the introduction of sleeping babies on their backs as a result of the SIDS (Sudden Infant Death Syndrome) campaign of the 1990s (Davis, Moon, Sachs, & Ottolini, 1998; Speltz et al., 2010). As a consequence of this campaign the incidence of SIDs declined worldwide in the following years although it was reported that parents tended to avoid placing their infants on their stomach during awake times, subsequently affecting motor milestones, head shape and core strength (Davis et al., 1998; Robertson, 2011). This doctoral research centres on the Baby Activity Chart-Program (BAC-Program) that was devised and created to support families and to provide a variety of fun, tummy time and vestibular focused actions for infants from 6 weeks post birth. Families are encouraged to interact with BAC-Program’s four milestone focused divisions of 34 activities, and culminating when the infant is mobile, feasibly crawling on hands and knees. The doctoral research incorporated the concept and activities within the BAC- Program, and subsequently undertook two separate but inter-linked research studies. Study one involves the evaluation of the BAC-Program through an ‘experts’ response questionnaire’ (ERQ) presented to sixteen experts in the early childhood and the allied health professions. The questionnaire consisted of five sections covering all aspects of the BAC Program’s design, layout, diagrams, text and contents. The Experts were instructed to rate all milestone divisions within the BAC-Program within the questionnaire’s five sections and to also include comments and suggestions according to each expert’s professional expertise. Overall, this first study produced a very positive result with the BAC-Program being effectively recommended by 93% of the experts. Consequently, a BAC-Program/2 (BAC- P/2) was created as the Expert’s recommendations were carefully analysed and those considered significant and theory based to enhance the activities were incorporated into the newly produced infant activity program-edition two. The positive endorsement and results achieved in Study one enabled the newly created BAC-P/2 to be investigated in a further study within this doctoral research. Study two investigated whether an experimental group of twenty nine infants that commenced participation in the BAC-Program/2 at 10 weeks of age, were more advanced in their motor skills (prone, supine, sitting, standing) when compared to a control group of thirty four infants also observed at 7-9 months post birth. The control group had not participated in the BAC-P/2 but were presented with the program at the completion of the testing procedure. The overall results defined that the total percentage mean score on the Alberta Infant Motor Scale (AIMS) of the experimental group was significantly higher (the difference was significant at .023 alpha level) than the control group’s mean score based on all sixty three infant’s AIMS’ motor development scores. The interpretation at a practical level suggests that the participation by parents and carers in the activities within the BAC-P/2 have contributed to the overall differences in the recorded scores when comparing the means between the sample groups using the SPSS independent sample t-test. Study two also examined the differences in overall motor development between groups in relation to time spent daily in tummy time and in vestibular stimulating activities. The experimental group spent greater time daily in both activity categories (tummy time and vestibular) and recorded a higher total percentage mean AIMS score when compared to the control group, however, the differences were not statistically significant. The data revealed that the association between the two study group’s AIMS scores may be influenced by the varying amount of both daily tummy time and daily vestibular time. Interestingly, both study groups reported higher total mean percentage scores in relation to greater amounts of time spent in both tummy time and vestibular activities. The overall conclusion to this study was reinforced by the result that when participating in the BAC-Program/2 from 10 weeks to 7-9 months, involving specifically modified infant movement activities, the twenty nine experimental group infants were significantly advanced in their motor development. There are also recognisable benefits (e.g. improved head control, core strength, response to gravity, spatial and body awareness) for infants to spend significant time in tummy and vestibular focused movements in regard to achieving their motor milestones.

In newborn infants, birth asphyxia represents the predominant cause of brain injury. These infants will later exhibit neurodevelopmental disabilities or a more major cerebral palsy. Prevention of adverse outcomes requires an understanding of the way in which these deficits develop. Endogenous protective mechanisms arising from the insult have opened new insights in neuroprotective strategies. Neurotrophic factors such as IGF-1 and its N-terminal tripeptide GPE have been shown to confer some neuroprotection after HI injury in the adult rodent. In the P21 rat brain after moderate HI injury, exogenous intracerebral and intraperitoneal injections of GPE (30μg and 300μg respectively) were neuroprotective in the hippocampus and lateral cortex possibly through binding to glia as detected by autoradiography of 3H-GPE. In the preterm infant the mechanisms of white matter injury remain to be clearly elucidated. To mimic the pattern of diffuse cerebral injury of the very preterm infant, a transient moderate focal HI injury has been applied on the immature P3 rat. This new model showed a significant reduction in the lateral cortical volume with reduction and alteration of the myelination pattern in the cortical white matter (WM) at P21. These cortical alterations result from neuro-axonal damage 24h after the insult as shown with Fluoro-Jade B staining and β-APP accumulation. In addition activated astrocytes from 24h after HI up to P21 were present. This model should enable us to elucidate some of the pathogenic mechanisms involved in diffuse WM injury. Brain damage in the developing brain has two components: 1) the pattern and mechanisms of injury are correlated with the stage of development at the time of injury; 2) it will influence subsequent brain development.