There is well-established data linking the adequacy of nurse staffing to patient outcomes. Evidence-based standards for staffing are therefore critical to drive improvements in clinical care. One such evidence-based approach is the use of patient acuity-based tools. The objective of this study is to determine the performance of a neonatal acuity tool in an Australian tertiary neonatal health-care setting, focusing on the classification of patient acuity and nursing:patient staffing ratios compared to current practice.
Methods
Acuity data were collected in a neonatal intensive care unit (NICU) and special care baby unit (SCBU) over a 10-week period in 2023. Patient data were scored in the 16 domains at two time points (prior to morning and evening nursing shift changeover) for all admitted newborns.
Results
For ventilated newborns nursed with a nurse:patient staffing ratio of 1:1, 78% of scores were within the L4-high acuity (score ≥ 26) band, with the remaining scores within the L3-high acuity (18–25) band. For newborns on non-invasive respiratory support in NICU staffed 1:1, the proportion scoring within the L4 acuity band was higher in the nasal high-flow group compared to the nasal continuous positive airway pressure group (P = 0.032), an effect not seen for those nursed 1:2 in NICU or for those on nasal high-flow nursed in SCBU either 1:2 or 1:3.
Conclusion
This study of how a neonatal acuity classification system compares with current nurse:patient staffing allocations in an Australian tertiary NICU, suggests refinements in staffing ratios for specific patient groups on respiratory support are possible.
{"title":"Neonatal acuity tool-defined staffing ratios in a tertiary Australian neonatal intensive care unit","authors":"Adam Barnett, Tara M Crawford, Michael J Stark","doi":"10.1111/jpc.16635","DOIUrl":"10.1111/jpc.16635","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>There is well-established data linking the adequacy of nurse staffing to patient outcomes. Evidence-based standards for staffing are therefore critical to drive improvements in clinical care. One such evidence-based approach is the use of patient acuity-based tools. The objective of this study is to determine the performance of a neonatal acuity tool in an Australian tertiary neonatal health-care setting, focusing on the classification of patient acuity and nursing:patient staffing ratios compared to current practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Acuity data were collected in a neonatal intensive care unit (NICU) and special care baby unit (SCBU) over a 10-week period in 2023. Patient data were scored in the 16 domains at two time points (prior to morning and evening nursing shift changeover) for all admitted newborns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For ventilated newborns nursed with a nurse:patient staffing ratio of 1:1, 78% of scores were within the L4-high acuity (score ≥ 26) band, with the remaining scores within the L3-high acuity (18–25) band. For newborns on non-invasive respiratory support in NICU staffed 1:1, the proportion scoring within the L4 acuity band was higher in the nasal high-flow group compared to the nasal continuous positive airway pressure group (<i>P</i> = 0.032), an effect not seen for those nursed 1:2 in NICU or for those on nasal high-flow nursed in SCBU either 1:2 or 1:3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study of how a neonatal acuity classification system compares with current nurse:patient staffing allocations in an Australian tertiary NICU, suggests refinements in staffing ratios for specific patient groups on respiratory support are possible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16635","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unusual rapid development of portopulmonary hypertension after shunt closure for congenital portosystemic shunt","authors":"Shohei Honda, Issei Kawakita, Kazuyoshi Okumura, Momoko Ara, Ryoichi Goto, Atsuhito Takeda, Tsuyoshi Shimamura, Insu Kawahara, Akinobu Taketomi","doi":"10.1111/jpc.16636","DOIUrl":"10.1111/jpc.16636","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urticaria multiforme is an uncommon presentation of acute urticaria. It most commonly affects children and most often occurs secondary to an underlying viral infection. We performed a retrospective review of a cohort of Asian children with urticaria multiforme and reviewed the literature on the condition.
Methods
We retrospectively reviewed the clinical notes of children and adolescents less than 16 years of age, diagnosed with urticaria multiforme at our tertiary paediatric hospital between January 2017 and December 2022. Data collected and analysed included age, gender, initial diagnosis, antecedent symptoms, recent immunisations and medications, results of diagnostic tests, treatment and outcome.
Results
A total of 20 children were identified, with median age of diagnosis of 1.9 years, with most patients (79%) 7 years of age or younger. Viral infections were the commonest triggers. The most common referring diagnoses were erythema multiforme and Stevens–Johnson syndrome. Common antecedent or concomitant symptoms were fever and upper respiratory symptoms. Blood investigations were generally unremarkable except for mildly increased white cell counts and other markers of infection. Outcomes were good in all patients, with resolution of symptoms within 6 weeks without sequelae.
Conclusion
Urticaria multiforme is an uncommon presentation of acute urticaria. Despite its striking appearance, it is generally a benign, self-limiting condition. Extensive investigations are usually not required and management is largely supportive.
{"title":"Urticaria multiforme in Asian children","authors":"Sheau Y Kan, Mark JA Koh, Lynette WY Wee","doi":"10.1111/jpc.16634","DOIUrl":"10.1111/jpc.16634","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Urticaria multiforme is an uncommon presentation of acute urticaria. It most commonly affects children and most often occurs secondary to an underlying viral infection. We performed a retrospective review of a cohort of Asian children with urticaria multiforme and reviewed the literature on the condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed the clinical notes of children and adolescents less than 16 years of age, diagnosed with urticaria multiforme at our tertiary paediatric hospital between January 2017 and December 2022. Data collected and analysed included age, gender, initial diagnosis, antecedent symptoms, recent immunisations and medications, results of diagnostic tests, treatment and outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 20 children were identified, with median age of diagnosis of 1.9 years, with most patients (79%) 7 years of age or younger. Viral infections were the commonest triggers. The most common referring diagnoses were erythema multiforme and Stevens–Johnson syndrome. Common antecedent or concomitant symptoms were fever and upper respiratory symptoms. Blood investigations were generally unremarkable except for mildly increased white cell counts and other markers of infection. Outcomes were good in all patients, with resolution of symptoms within 6 weeks without sequelae.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Urticaria multiforme is an uncommon presentation of acute urticaria. Despite its striking appearance, it is generally a benign, self-limiting condition. Extensive investigations are usually not required and management is largely supportive.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Congenital imperforate submandibular duct in a neonate","authors":"Sofia Seabra Vieira, Jorge Santos Silva","doi":"10.1111/jpc.16633","DOIUrl":"10.1111/jpc.16633","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angela Berkhout, Daniel K Yeoh, Suzy Teutsch, Anne Morris, Clare Nourse, Julia E Clark, Christopher C Blyth, Cheryl A Jones, the APSU Neonatal HSV Study Advisory Group
Aim
As herpes simplex virus (HSV) in infancy is not a mandatory notifiable condition in Australia, completeness of ascertainment by the Australian Paediatric Surveillance Unit (APSU) has been difficult to evaluate to date. We evaluated case capture in Queensland (QLD) and Western Australia (WA) using statewide laboratory and clinical data and complementary surveillance data collected via the APSU.
Methods
HSV polymerase chain reaction positive results in infants (0–3 months) from 2007 to 2017 were obtained from statewide public pathology providers in QLD and WA. Clinical data were extracted from patient records and compared to APSU reported cases.
Results
A total of 94 cases of HSV disease in infancy (70 QLD; 24 WA) were identified from laboratory data sets, compared to 36 cases (26 QLD; 10 WA) reported to the APSU. In total there was 102 unique cases identified; 28 cases were common to both data sets (seven skin eye mouth (SEM) disease, 13 central nervous system (CNS) disease and eight disseminated disease). Active surveillance captured 35% (36/102) of cases overall including 74% (14/19) of CNS, 71% (10/14) of disseminated and 17% (12/69) of SEM disease cases, respectively. Surveillance reported cases had a higher case-fatality rate compared to those not reported (14% vs. 3%, P = 0.038). Neurological sequelae at discharge were comparable between the groups.
Conclusion
Active surveillance captures one third of hospitalised HSV cases in QLD and WA, including the majority with severe disease. However, morbidity and mortality remain high. Future studies on HSV will rely on observational studies. Enhanced case ascertainment through combined laboratory and surveillance data is essential for better understanding and improving outcomes.
{"title":"Herpes simplex virus in infancy: Evaluation of national surveillance case capture","authors":"Angela Berkhout, Daniel K Yeoh, Suzy Teutsch, Anne Morris, Clare Nourse, Julia E Clark, Christopher C Blyth, Cheryl A Jones, the APSU Neonatal HSV Study Advisory Group","doi":"10.1111/jpc.16596","DOIUrl":"10.1111/jpc.16596","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>As herpes simplex virus (HSV) in infancy is not a mandatory notifiable condition in Australia, completeness of ascertainment by the Australian Paediatric Surveillance Unit (APSU) has been difficult to evaluate to date. We evaluated case capture in Queensland (QLD) and Western Australia (WA) using statewide laboratory and clinical data and complementary surveillance data collected via the APSU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>HSV polymerase chain reaction positive results in infants (0–3 months) from 2007 to 2017 were obtained from statewide public pathology providers in QLD and WA. Clinical data were extracted from patient records and compared to APSU reported cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 94 cases of HSV disease in infancy (70 QLD; 24 WA) were identified from laboratory data sets, compared to 36 cases (26 QLD; 10 WA) reported to the APSU. In total there was 102 unique cases identified; 28 cases were common to both data sets (seven skin eye mouth (SEM) disease, 13 central nervous system (CNS) disease and eight disseminated disease). Active surveillance captured 35% (36/102) of cases overall including 74% (14/19) of CNS, 71% (10/14) of disseminated and 17% (12/69) of SEM disease cases, respectively. Surveillance reported cases had a higher case-fatality rate compared to those not reported (14% vs. 3%, <i>P</i> = 0.038). Neurological sequelae at discharge were comparable between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Active surveillance captures one third of hospitalised HSV cases in QLD and WA, including the majority with severe disease. However, morbidity and mortality remain high. Future studies on HSV will rely on observational studies. Enhanced case ascertainment through combined laboratory and surveillance data is essential for better understanding and improving outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peong Gang Park, Yo Han Ahn, Hee Gyung Kang, Il-Soo Ha
Aim
Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD-associated peritonitis in the past decades.
Methods
This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups.
Results
A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (P = 0.001). During the 2000–2008 period, the 2-year peritonitis-free survival rate was significantly lower for patients under 2 years of age than for the other age groups (P = 0.004), whereas this was not observed during the 2009–2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000–2008 period. However, this was not evident in the 2009–2017 period.
Conclusions
The incidence of PD-associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD-associated peritonitis.
{"title":"Decreased incidence of peritoneal dialysis-associated peritonitis in young children","authors":"Peong Gang Park, Yo Han Ahn, Hee Gyung Kang, Il-Soo Ha","doi":"10.1111/jpc.16630","DOIUrl":"10.1111/jpc.16630","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD-associated peritonitis in the past decades.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (<i>P</i> = 0.001). During the 2000–2008 period, the 2-year peritonitis-free survival rate was significantly lower for patients under 2 years of age than for the other age groups (<i>P</i> = 0.004), whereas this was not observed during the 2009–2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000–2008 period. However, this was not evident in the 2009–2017 period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence of PD-associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD-associated peritonitis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16630","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the methodological quality of studies that analysed the relationship between accessibility to emergency services and infant mortality.
Methods
A systematic review with meta-analysis, registered on the international prospective register of systematic reviews (PROSPERO) platform under code CRD42021279854. Medline/Pubmed, Embase, SciElo, Lilacs, Scopus and web of science electronic databases were searched between November 2021 and May 2024, without language or publication time restriction. We included observational studies that compared the infant mortality outcome with the different distances travelled or travel time to health services in a paediatric emergency. Thus, we excluded studies with primary outcomes present in the pre- and perinatal periods, as well as distances or travel time to obstetric emergency units. We used the grade to assess the methodological quality of the studies and the Newcastle-Ottawa scale for the risk of bias, in addition to performing a meta-analysis.
Results
The evidence quality on infant mortality was moderate for four studies and low for three studies. The meta-analysis showed that children who travelled more than 5 km to the emergency service had a 28% increase in the chance of dying (P = 0.002), as well as those travelling for more than 40 min increased by 45% (P < 0.001).
Conclusions
There was a relationship between the increase in geographic accessibility distance and travel time with the increase in infant mortality. However, the studies still showed moderate to low methodological quality.
{"title":"Relationship between geographic accessibility to emergency services and infant mortality: A systematic review and meta-analysis","authors":"Patrícia Meireles Brito, Katia Suely Queiroz Silva Ribeiro, Renato S Melo, Afonso Rodrigues Tavares Netto, Silvia Wanick Sarinho","doi":"10.1111/jpc.16627","DOIUrl":"10.1111/jpc.16627","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the methodological quality of studies that analysed the relationship between accessibility to emergency services and infant mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review with meta-analysis, registered on the international prospective register of systematic reviews (PROSPERO) platform under code CRD42021279854. Medline/Pubmed, Embase, SciElo, Lilacs, Scopus and web of science electronic databases were searched between November 2021 and May 2024, without language or publication time restriction. We included observational studies that compared the infant mortality outcome with the different distances travelled or travel time to health services in a paediatric emergency. Thus, we excluded studies with primary outcomes present in the pre- and perinatal periods, as well as distances or travel time to obstetric emergency units. We used the grade to assess the methodological quality of the studies and the Newcastle-Ottawa scale for the risk of bias, in addition to performing a meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The evidence quality on infant mortality was moderate for four studies and low for three studies. The meta-analysis showed that children who travelled more than 5 km to the emergency service had a 28% increase in the chance of dying (<i>P</i> = 0.002), as well as those travelling for more than 40 min increased by 45% (<i>P</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was a relationship between the increase in geographic accessibility distance and travel time with the increase in infant mortality. However, the studies still showed moderate to low methodological quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Isolated fallopian tube torsion is a rare surgical emergency in adolescent girls, with an estimated incidence of one in 1 500 000 cases.<span><sup>1</sup></span> The clinical representation is not specific, leading to challenging and delayed diagnosis, often made intraoperatively. Conservative surgical management is uncommon in these young patients due to late diagnosis.<span><sup>1</sup></span> This work aims to recall the main characteristics of isolated fallopian tube torsion through a clinical case that successfully underwent conservative treatment.</p><p>We report the case of isolated fallopian tube torsion in a 14-year-old girl who consulted the hospital's emergency department due to sudden pain in the right iliac fossa. The pain has been ongoing for 8 h without radiation to other parts of the body and associated with an episode of vomiting without transit disorder or urinary functional signs. A similar episode that resolved spontaneously 3 months ago was reported. This patient has no medical or surgical history. No abdominal or pelvic trauma was reported. She was a virgin. Menarche occurred at the age of 12 years with irregular cycles. She was on the 25th day of her menstrual cycle.</p><p>On physical examination, the patient was apyretic and haemodynamically stable. Urine Multistix analysis was negative. Abdominal examination revealed a right iliac fossa defence, without palpable mass or abdominal contracture. The lumbar fossa was not tender. The digital rectal examination did not trigger pain. The gynaecological examination was not performed.</p><p>Suprapubic pelvic ultrasound, conducted with a full bladder, showed a normal uterus, and left ovary. The assessment of the right adnexa revealed a unilocular rounded anechoic mass with a regular and thin wall, without vegetation, non-vascularised by colour Doppler, measuring 50 mm in diameter.</p><p>No inflammatory syndrome in biology was found. Serum β-human chorionic gonadotropin (HCG) level was negative.</p><p>The diagnosis of right adnexal torsion was evoked. The patient underwent an emergency laparoscopy.</p><p>On examination, the uterus and left adnexa were normal in appearance. There was a bluish, 5-cm rounded, juxta-uterine mass with fringes, suggesting an isolated torsion of the right fallopian tube, coiling around the utero-ovarian ligament four times in clockwise direction, with ipsilateral unaffected right ovary. No cysts, especially in the mesosalpinx, were found. The appendix was normal (Fig. 1).</p><p>The right fallopian tube was then untwisted. A progressive recoloration was noted after about 10 min of observation and uncoiled tubal recovery was satisfactory (Fig. 2). The right fallopian tube appeared to be abnormally elongated. Conservative treatment with saline solution cleansing and post-operative antibiotic coverage was conducted.</p><p>The post-operative follow-up was uneventful. The patient was fully and clearly informed of her condition. A detailed medical report was d
{"title":"Isolated fallopian tube torsion: A rare cause of acute pelvic pain in adolescence","authors":"Khaoula Magdoud, Hiba Mkadmi, Fatma Moussa, Zeineb Ghali, Sana Menjli, Abir Karoui","doi":"10.1111/jpc.16629","DOIUrl":"10.1111/jpc.16629","url":null,"abstract":"<p>Isolated fallopian tube torsion is a rare surgical emergency in adolescent girls, with an estimated incidence of one in 1 500 000 cases.<span><sup>1</sup></span> The clinical representation is not specific, leading to challenging and delayed diagnosis, often made intraoperatively. Conservative surgical management is uncommon in these young patients due to late diagnosis.<span><sup>1</sup></span> This work aims to recall the main characteristics of isolated fallopian tube torsion through a clinical case that successfully underwent conservative treatment.</p><p>We report the case of isolated fallopian tube torsion in a 14-year-old girl who consulted the hospital's emergency department due to sudden pain in the right iliac fossa. The pain has been ongoing for 8 h without radiation to other parts of the body and associated with an episode of vomiting without transit disorder or urinary functional signs. A similar episode that resolved spontaneously 3 months ago was reported. This patient has no medical or surgical history. No abdominal or pelvic trauma was reported. She was a virgin. Menarche occurred at the age of 12 years with irregular cycles. She was on the 25th day of her menstrual cycle.</p><p>On physical examination, the patient was apyretic and haemodynamically stable. Urine Multistix analysis was negative. Abdominal examination revealed a right iliac fossa defence, without palpable mass or abdominal contracture. The lumbar fossa was not tender. The digital rectal examination did not trigger pain. The gynaecological examination was not performed.</p><p>Suprapubic pelvic ultrasound, conducted with a full bladder, showed a normal uterus, and left ovary. The assessment of the right adnexa revealed a unilocular rounded anechoic mass with a regular and thin wall, without vegetation, non-vascularised by colour Doppler, measuring 50 mm in diameter.</p><p>No inflammatory syndrome in biology was found. Serum β-human chorionic gonadotropin (HCG) level was negative.</p><p>The diagnosis of right adnexal torsion was evoked. The patient underwent an emergency laparoscopy.</p><p>On examination, the uterus and left adnexa were normal in appearance. There was a bluish, 5-cm rounded, juxta-uterine mass with fringes, suggesting an isolated torsion of the right fallopian tube, coiling around the utero-ovarian ligament four times in clockwise direction, with ipsilateral unaffected right ovary. No cysts, especially in the mesosalpinx, were found. The appendix was normal (Fig. 1).</p><p>The right fallopian tube was then untwisted. A progressive recoloration was noted after about 10 min of observation and uncoiled tubal recovery was satisfactory (Fig. 2). The right fallopian tube appeared to be abnormally elongated. Conservative treatment with saline solution cleansing and post-operative antibiotic coverage was conducted.</p><p>The post-operative follow-up was uneventful. The patient was fully and clearly informed of her condition. A detailed medical report was d","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16629","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohit Kumar, James Little, Sarah Pearce, Bradley MacDonald, Melanie Greenland, Adrian Tarca, James Ramsay, Judith Katzenellenbogen, Deane Yim
Aim
To describe the clinical profile of acute rheumatic fever (ARF) presentations to paediatric cardiology tertiary services in Western Australia (WA).
Methods
A retrospective clinical audit of individuals with confirmed ARF referred to the only paediatric tertiary cardiac service in WA (1 January 1987 to 31 December 2020). Comparisons between inpatient, outpatient, remote and non-remote groups were assessed.
Results
Four hundred seventy-one episodes of ARF in 457 individuals (235 male; median age = 8 years) met clinical criteria. The majority were Aboriginal and Torres Strait Islander children (91.2%), with 62.1% living in remote areas. The number of ARF and rheumatic heart disease (RHD) diagnoses per year increased from 1987 to 2017 with notable peaks in 2013 and 2017. The average annual incidence of tertiary-referred ARF in WA of 4–15-year-olds from 1987 to 2020 was 4.96 per 100 000. ARF features included carditis (59.9%), chorea (31%), polyarthritis (30%) and polyarthralgia (24.2%). RHD was evident in 61.8% of cases and predominantly manifested as mitral regurgitation (55.7%). Thirty-four children (7.4%) with severe RHD underwent valvular surgery. 12% had at least one recurrent ARF episode. Remote individuals had more than double the rate of recurrence compared to non-remote individuals (P = 0.0058). Compared to non-remote episodes, remote presentations had less polyarthritis (P = 0.0022) but greater proportions of raised ESR (P = 0.01), ASOT titres (P = 0.0073), erythema marginatum (P = 0.0218) and severe RHD (P = 0.0133).
Conclusion
The high proportion of Aboriginal and Torres Strait Islander Australians affected by ARF/RHD in WA reflects the significant burden of disease within this population. Children from remote communities were more likely to present with concurrent severe RHD. Our study reinforces the persisting need to improve primary and secondary ARF initiatives in rural and remote communities.
{"title":"Clinical profile of paediatric acute rheumatic fever and rheumatic heart disease in Western Australia: 1987 to 2020","authors":"Mohit Kumar, James Little, Sarah Pearce, Bradley MacDonald, Melanie Greenland, Adrian Tarca, James Ramsay, Judith Katzenellenbogen, Deane Yim","doi":"10.1111/jpc.16617","DOIUrl":"10.1111/jpc.16617","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe the clinical profile of acute rheumatic fever (ARF) presentations to paediatric cardiology tertiary services in Western Australia (WA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective clinical audit of individuals with confirmed ARF referred to the only paediatric tertiary cardiac service in WA (1 January 1987 to 31 December 2020). Comparisons between inpatient, outpatient, remote and non-remote groups were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred seventy-one episodes of ARF in 457 individuals (235 male; median age = 8 years) met clinical criteria. The majority were Aboriginal and Torres Strait Islander children (91.2%), with 62.1% living in remote areas. The number of ARF and rheumatic heart disease (RHD) diagnoses per year increased from 1987 to 2017 with notable peaks in 2013 and 2017. The average annual incidence of tertiary-referred ARF in WA of 4–15-year-olds from 1987 to 2020 was 4.96 per 100 000. ARF features included carditis (59.9%), chorea (31%), polyarthritis (30%) and polyarthralgia (24.2%). RHD was evident in 61.8% of cases and predominantly manifested as mitral regurgitation (55.7%). Thirty-four children (7.4%) with severe RHD underwent valvular surgery. 12% had at least one recurrent ARF episode. Remote individuals had more than double the rate of recurrence compared to non-remote individuals (<i>P</i> = 0.0058). Compared to non-remote episodes, remote presentations had less polyarthritis (<i>P</i> = 0.0022) but greater proportions of raised ESR (<i>P</i> = 0.01), ASOT titres (<i>P</i> = 0.0073), erythema marginatum (<i>P</i> = 0.0218) and severe RHD (<i>P</i> = 0.0133).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The high proportion of Aboriginal and Torres Strait Islander Australians affected by ARF/RHD in WA reflects the significant burden of disease within this population. Children from remote communities were more likely to present with concurrent severe RHD. Our study reinforces the persisting need to improve primary and secondary ARF initiatives in rural and remote communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disease characterised by recurrent episodes of fever and polyserositis. Sacroiliac joint involvement is rare in FMF patients. The purpose of this study was to evaluate the demographic, clinical, laboratory and imaging findings of patients with FMF who developed sacroiliitis.
Methods
The files of paediatric patients aged 0–18 years who were followed up with a diagnosis of FMF were retrospectively reviewed. FMF patients with evidence of sacroiliitis on magnetic resonance imaging (MRI) were included in the study.
Results
Among 1062 FMF patients, 22 (12 males; median age 8.5) (2.1%) of them were found to have sacroiliitis. FMF was diagnosed before sacroiliitis in nine (40.9%) patients and after in 13 (59.1%) patients. The most common symptom in patients with sacroiliitis was low back pain (n = 21, 95.5%). In MEFV gene analysis, M694V was found in 16 (72.7%) patients and was the most common mutation. MRI showed evidence of sacroiliitis in all patients. All patients were using colchicine. Patients with FMF-associated sacroiliitis, remission was achieved with non-steroidal anti-inflammatory drugs in 12 (54.5%), conventional disease-modifying antirheumatic drugs in six (27.3%) and tumour necrosis factor inhibitor treatment in four (31.8%). Four (31.8%) patients experienced sacroiliitis when colchicine incompatible and four (31.8%) patients experienced sacroiliitis while using biologic agents for colchicine-resistant FMF.
Conclusions
FMF-associated sacroiliitis should be considered especially in patients with M694V mutation if they have symptoms such as low back pain. Colchicine-resistant FMF patients should be evaluated for sacroiliitis symptoms at each visit.
{"title":"Sacroiliitis in familial Mediterranean fever: A rare joint involvement of the disease","authors":"Emine Özçelik, Elif Çelikel, Zahide Ekici Tekin, Vildan Güngörer, Cüneyt Karagöl, Melike Mehveş Kaplan, Nimet Öner, Merve Cansu Polat, Didem Öztürk, Mehveş Işıklar Ekici, Yasemin Uğur Es, Banu Çelikel Acar","doi":"10.1111/jpc.16623","DOIUrl":"10.1111/jpc.16623","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disease characterised by recurrent episodes of fever and polyserositis. Sacroiliac joint involvement is rare in FMF patients. The purpose of this study was to evaluate the demographic, clinical, laboratory and imaging findings of patients with FMF who developed sacroiliitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The files of paediatric patients aged 0–18 years who were followed up with a diagnosis of FMF were retrospectively reviewed. FMF patients with evidence of sacroiliitis on magnetic resonance imaging (MRI) were included in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1062 FMF patients, 22 (12 males; median age 8.5) (2.1%) of them were found to have sacroiliitis. FMF was diagnosed before sacroiliitis in nine (40.9%) patients and after in 13 (59.1%) patients. The most common symptom in patients with sacroiliitis was low back pain (<i>n</i> = 21, 95.5%). In <i>MEFV</i> gene analysis, M694V was found in 16 (72.7%) patients and was the most common mutation. MRI showed evidence of sacroiliitis in all patients. All patients were using colchicine. Patients with FMF-associated sacroiliitis, remission was achieved with non-steroidal anti-inflammatory drugs in 12 (54.5%), conventional disease-modifying antirheumatic drugs in six (27.3%) and tumour necrosis factor inhibitor treatment in four (31.8%). Four (31.8%) patients experienced sacroiliitis when colchicine incompatible and four (31.8%) patients experienced sacroiliitis while using biologic agents for colchicine-resistant FMF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FMF-associated sacroiliitis should be considered especially in patients with M694V mutation if they have symptoms such as low back pain. Colchicine-resistant FMF patients should be evaluated for sacroiliitis symptoms at each visit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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