Archives of Disease in Childhood: Education & Practice Edition最新文献

{"title":"Common congenital cardiac disease with uncommon postoperative complication","authors":"C. Oakley, Sarita Makam, Y. Aung, S. Shebani","doi":"10.1136/archdischild-2016-311497","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311497","url":null,"abstract":"A boy was born at term, in good condition, with an antenatal cardiac diagnosis. The diagnosis was confirmed on echocardiography. Initial genetic bloods were taken including karyotype and fluorescence in situ hybridisation and he was discharged with outpatient follow-up.\u0000\u0000He was reviewed in clinic at 5 months of age. On examination, his saturations were 85% with a normal first heart sound, soft second heart sound and a loud ejection systolic murmur. The bloods showed a normal karyotype and 22q11 status.\u0000\u0000Following a local joint cardiac meeting he was accepted for surgical repair. Figures 1 and 2 are his preoperative and postoperative chest radiographs (CXRs).\u0000\u0000\u0000\u0000Figure 1 \u0000Preoperative chest radiograph.\u0000\u0000\u0000\u0000\u0000\u0000Figure 2 \u0000Chest radiograph taken first day postoperatively.\u0000\u0000\u0000\u0000\u0000\u00001. What is the most likely underlying cardiac diagnosis?\u0000\u00002. What potentially life-threatening presentation of this condition needs to be monitored for before surgical correction?\u0000\u00003. What is the most prominent complication that is seen on the postoperative CXR?\u0000\u00004. What are the management options for this?\u0000\u0000\u0000\u0000Answers to the questions are on page …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74110624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fifteen minute consultation: A structured approach to the management of children and adolescents with medically unstable anorexia nervosa","authors":"E. Allison, N. Dawson, J. Phillips, C. Lynch, Jacinta Coleman","doi":"10.1136/archdischild-2016-311394","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311394","url":null,"abstract":"Assessing and managing children who are underweight is an integral part of paediatric practice. Young people with anorexia nervosa (AN) are mainly cared for in the community by specialist eating disorder services. However, increasing numbers require admission to paediatric wards with medical instability due to the complications of starvation. Despite recommendations published in the junior MARSIPAN report in 2012, many paediatricians still feel poorly equipped to care for these high-risk patients. This article aims to provide a safe and structured approach to the assessment and management of children and adolescents with medically unstable AN.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89379247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Something for the weak-end? Electromyography appearances of myasthenia gravis","authors":"F. Britton, A. Osei-Lah, M. Tighe","doi":"10.1136/archdischild-2017-312641","DOIUrl":"https://doi.org/10.1136/archdischild-2017-312641","url":null,"abstract":"A 13-year-old girl, with a background of stage 4 thoracic neuroblastoma (diagnosed 2003) and residual spastic paraplegia with neuropathic bladder and irregular bowel habit, presented with increasing muscle fatigue and decreased exercise ability over the past 6 months. She reported symptoms including periodic slurring of speech, difficulty swallowing and the inability to smile or blink. These episodes were reported to last between 10 and 90 min. She also presented with ongoing nausea and a reduced appetite.\u0000\u0000On inspection, she had an indistinct smile and loss of the left nasolabial fold. Examination of the cranial nerves elucidated a bilateral facial weakness, decrease palate movement and bilateral reduced corneal reflexes. She had normal eye movements, no ptosis and her pupils were equal and reactive to light. Neurological examination of the upper limbs demonstrated weakness in C4–5 but otherwise she had normal power in her arms and hands. Tone, reflexes, coordination and sensation were normal.\u0000\u0000In light of her …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90551454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jaundice in newborn babies under 28 days: NICE guideline 2016 (CG98)","authors":"Rachel C Amos, H. Jacob, W. Leith","doi":"10.1136/archdischild-2016-311556","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311556","url":null,"abstract":"In May 2016, the National Institute for Health and Care Excellence (NICE) published updated guidelines entitled ‘Jaundice in newborn babies under 28 days’ (box 1).1 The guideline covers diagnosis and treatment of neonates with jaundice, aiming ‘to help detect and prevent very high levels of bilirubin’. New recommendations focus on measuring and monitoring bilirubin levels and the type of phototherapy. Here, we summarise the guideline, highlighting updates and relevance to clinical practice. Box 1 \u0000### Resources\u0000\u0000www.nice.org.uk/guidance/CG98 \u0000\u0000Link to NICE guideline and threshold table\u0000\u0000www.nice.org.uk/guidance/cg98/resources \u0000\u0000Link to treatment threshold graphs\u0000\u0000www.nice.org.uk/Guidance/cg98/evidence \u0000\u0000Link to guideline committee's discussion and evidence reviews\u0000\u0000The original NICE guideline CG98, published in May 2010, was jointly developed with the National Collaborating Centre for Women and Children's Health (now part of the National Guideline Alliance) to encourage more uniform, evidence-based practice.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82436677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consumption of artificial sweeteners in pregnancy increased overweight risk in infants","authors":"Fahimeda Ali","doi":"10.1136/archdischild-2017-312618","DOIUrl":"https://doi.org/10.1136/archdischild-2017-312618","url":null,"abstract":"Cohort study of mother–infant dyads.\u0000\u0000Setting: Canadian Healthy Infant Longitudinal Development Study. A population-based study with four contributing sites.\u0000\u0000Patients: Mothers of singleton pregnancies and their 1-year-old infants.\u0000\u0000Exposure: Maternal artificial and sugar-sweetened beverage intake from questionnaire, classified according to the number of servings per day/week/month.\u0000\u0000Outcomes: Primary outcome was infant body mass index (BMI) z-score at 1 year of age. Secondary outcome was the risk of being overweight (BMI z-score >97th centile) at 1 year of age.\u0000\u0000Follow-up period : Women recruited over 5 years (2009–2013). Infant BMI was calculated at 1 year of age.\u0000\u0000Patient follow-up : 3033 mother–infant dyads were recruited. 2682 completed follow-up of BMI and 2413 …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90312269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Handy paediatric dermatology","authors":"E. Valerio, Francesca Parata, M. Cutrone","doi":"10.1136/archdischild-2016-312358","DOIUrl":"https://doi.org/10.1136/archdischild-2016-312358","url":null,"abstract":"Dermatological hand signs are common and can be benign (with or without treatment implications), linked to a change in patient's behaviour or herald more severe systemic conditions (dermatomyositis). Despite the peculiarity of underlying diseases, their visual appearances may overlap and sometimes be deceptive. It is therefore important for clinicians to be aware of the possible similarities in such diverse conditions, in order to make a correct diagnosis and target treatment.\u0000\u0000### Which would be the most likely diagnosis for each image based on the cases below:\u0000\u00001. Gottron's papules\u0000\u00002. Psoriasis\u0000\u00003. Cutaneous T-cell lymphoma\u0000\u00004. Chewing pads\u0000\u00005. Knuckle calluses\u0000\u00006. Herpetic lesions\u0000\u00007. Idiopathic/familial knuckle pads\u0000\u00008. Cold burns (frost bites)\u0000\u00009. Common warts\u0000\u000010. Occupational lesions\u0000\u0000We evaluated a 17-year-old girl with dark phototype with an upper respiratory tract infection. Physical examination incidentally revealed plaque lesions located only at the extensor surface of her right hand, at the proximal interphalangeal joints (IJ) (figure 1A). Left hand was unharmed. The rest of the examination, apart from the concomitant respiratory infection, was negative. The girl also reported a recent school change as a current stressor.\u0000\u0000\u0000\u0000Figure 1 \u0000(A) Self-induced ‘chewing pads’, (B) Gottron’s papules, …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77148140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcutaneous calcifications and hypothyroidism: Is there a missing link?","authors":"D. Giri, Ravi Jayaram, S. Senniappan","doi":"10.1136/archdischild-2016-311834","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311834","url":null,"abstract":"A 5-year-old boy was referred with a history of multiple subcutaneous nodules since infancy. He was born at 42 weeks gestation with a birth weight of 3.2 kg. At 8 months of age, he was noted to have an excessive weight gain by the health visitor and was subsequently diagnosed with primary hypothyroidism and commenced on levothyroxine 50 μg once daily. He had a normal newborn congenital hypothyroidism screen. The thyroid autoimmune antibodies were normal.\u0000\u0000By the age of 5 years, he had delayed walking, speech and learning difficulties. Mother gave a history of surgically removed calcified lesions on her back. His weight and height at presentation were 35.5 kg (+3.8 SDS) and 121.4 cm (1.6 SDS), respectively. On examination, he had multiple subcutaneous nodules over and behind the left knee, left forearm, right ankle, chest and abdomen (figures 1 and 2). Investigations revealed a …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87164140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to use … the Monospot and other heterophile antibody tests","authors":"Tess Marshall-Andon, P. Heinz","doi":"10.1136/archdischild-2016-311526","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311526","url":null,"abstract":"Epstein-Barr virus (EBV) is a highly prevalent virus, transmitted via saliva, which often causes asymptomatic infection in children but frequently results in infectious mononucleosis in adolescents. Heterophile antibody tests, including the Monospot test, are red cell or latex agglutination assays, which detect antired cell antibodies produced as part of a polyclonal antibody response occurring during EBV infection. Heterophile antibody tests are rapid, cheap and specific tests that can be performed from the onset of symptoms of infectious mononucleosis. In adolescents, heterophile antibody tests have high specificity and sensitivity in the diagnosis of primary acute EBV infection. However, the tests have low sensitivity and low negative predictive value in young children and are not useful under the age of 4. Heterophile tests may be positive in other viral infections, autoimmune disease and haematological malignancies, but do not appear to be positive in primary bacterial infection. Virus-specific serology is required in children under the age of 4 or if an older child is heterophile negative. Virus-specific serology allows diagnosis and the pattern of positivity and negativity enables the clinician to stage the EBV infection. Virus-specific serology appears to have better sensitivity in young children, but there is cross-reaction with other herpesvirus infections, a longer turnaround time and it is more expensive to perform. Further research is needed to establish which children benefit from and hence require testing for heterophile antibodies, the cost-effectiveness of EBV investigations and whether heterophile titres have predictive value for the severity of infection and the likelihood of complications.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89549083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal forearm fractures can be reliably diagnosed using ultrasound","authors":"A. Friend, D. Roland","doi":"10.1136/archdischild-2016-312428","DOIUrl":"https://doi.org/10.1136/archdischild-2016-312428","url":null,"abstract":"In patients with possible distal forearm fracture, is ultrasound scanning a reliable method of diagnosis when compared with X-ray?\u0000\u0000Design : Systematic review and meta-analysis.\u0000\u0000Data source : Medline, Web of Science, the Cochrane Library.\u0000\u0000Study inclusion criteria : Comparison of ultrasound and X-ray in patients with potential distal forearm fractures; written in English, French, German or Spanish language.\u0000\u0000A total of 16 studies involving 1204 patients with 641 fractures were included. Twelve studies involving 951 patients looked specifically at children. Included studies all used X-ray as their ‘gold standard’ for diagnosing fractures and compared ultrasound to this. Most studies …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82602606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2016-312564","DOIUrl":"https://doi.org/10.1136/archdischild-2016-312564","url":null,"abstract":"In the odd delay built into a journal like E&P, I’m writing this in the immediate aftermath of attending the Royal College of Paediatrics and Child Health Spring Conference. It’s interesting that in this age of more real print and virtual print than we can even begin to think of completing, and more resources for learning than our predecessors could have imagined, we still make the time to travel and to sit in the same room as a speaker, to hear them talk. I wonder why we do this? I suspect there are a few reasons. One of them is to do with trusting that an eminent speaker will have prepared an interesting and stimulating talk, which introduces us to a new set of ideas. Another is to listen to how people have responded to difficulties similar to our own. But I suspect that the main reason is the buzz of meeting a bunch of people, some of whom you’ve never met before, some of whom you’ve not seen for a year or two, and, well, chatting. It would be easy to create a misunderstanding here—after all, our employing bodies are often supporting us financially to attend, and I’m pretty sure they’d be reluctant to fund us to go on a general gossip. So, to clarify, it’s more than a gossip—it’s the pollination of different ideas across multiple people, and the creation of exciting new thoughts. And what about when you’re in the same room as a bad speaker? Well, these days there is always WiFi. But, that aside, I also find value in a conference where I can unfocus a little, and let the thoughts rattle around a bit. What can a journal do to recreate the best parts of a conference? Well, obviously it can’t simulate putting people in the same room. But it can bring the thoughts of some diverse people into the room you’re in— which, by some accounts, might be the littlest room in the house. This issue we’ve got lymph nodes, croup, BCG abscess, mouth ulcers, neonatal antibiotics, haemangiomas, odd X-rays, capillary refill time, pulse oximetry, and a Picket on cooling after brain injury. I reckon that’s pretty eclectic, and should, if you unfocus a little while reading, give you a few fairly diverse thoughts. My Editor’s choice is the paper on recurrent oral ulceration in children (see page 82). Esse Menson, who wrote this paper with Kirsty Le Doare, Esther Hullah and Stephen Challacombe, has been helping curate a infectious diseases subseries within the Fifteen-Minute Consultation section, so expect a lot of these over the next few months. Oral ulceration is a clinical scenario I find tricky; the range of possibilities, from idiopathic to some very serious diagnoses, and the high incidence—from 1 to 10% of children —make it important to pick the right child to investigate robustly. The authors provide a helpful table of first line investigations with the useful caveat that the absence of systemic features, you can usually avoid testing. Awhile ago I used to take copious notes in talks, convinced that I’d pore over them later, absorbing the knowledge and becoming a","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90473593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}