Neonatal sepsis is a frequent disease affecting newborns worldwide. It can be life threatening causing multi-organ dysfunction. We present a case of a 28-day old neonate who was admitted for an acute kidney injury in the context of neonatal sepsis. Management was conservative and successful, and consisted of adequately treating the infection with antibiotics, correcting electrolyte imbalances, and judiciously administrating fluids.
Primary health care for children in Europe is often not optimal. Primary care providers might not have been trained adequately in dealing with common conditions affecting children and adolescents, and outdated practices often persist. To address these problems, WHO developed the Pocket Book of Primary Health Care for Children and Adolescents. It is for use by doctors, nurses and other health workers who are responsible for the care of children and adolescents at the primary health care level. It summarizes guidance on how to manage – and when to refer – children and adolescents presenting with common complaints and conditions. It includes information to enable primary health care providers to coordinate the continued care of children and adolescents with long-term conditions and diseases managed by specialists. Preventive and promotive measures from the newborn period to adolescence include advice on the timing and content of well-child visits, the promotion of early childhood development and health messages for adolescents.
The recommendations of the Pocket Book apply across the WHO European Region and may be adapted by countries to suit their specific circumstances. A mobile APP for Android and IOS phones is available to facilitate uptake and dissemination. The Pocket Book and APP aim to improve quality of care for children and adolescents at the primary health care level. Quality of care is at the core of the comprehensive European Child and Adolescent Health Strategy that is being developed by Member States supported by WHO and partners to refocus attention on child and adolescent health after the COVID-19 pandemic had scooped attention and resources away from this age group. Countries are encouraged to adapt Pocket Book and Strategy to improve the situation of child and adolescent health and well-being in their settings and monitor progress.
Infants with congenital CMV (cCMV) infection may show manifestations at birth and develop symptomatic disease, although the majority have no apparent clinical signs and should be considered asymptomatic (acCMV). Studies about neurodevelopmental and neurological sequelae in acCMV patients during childhood are few and contradictory, thus, the purpose of this study is to evaluate the neurological and neurodevelopmental outcomes in 1-year-old children with acCMV infections.
Thirty-five infants with acCMV infections were followed-up for 12 months and were compared to healthy children matched for age and gender. The Bayley Scales of Infant Development III (BSID-III) were administered, and neurological examinations were performed.
Children with acCMV infection showed minimal to mild neurological signs and the score obtained from the Motor Scale was significantly lower than that of the control group. No significant differences between the two groups were found regarding the Cognitive and Language Scales.
Asymptomatic congenital infection of CMV may be associated with a decrease in motor skills that may become evident during the first year of life. Close monitoring is essential to determine if rehabilitative treatment is required for children with asymptomatic congenital cytomegalovirus (acCMV). Longer follow-up is necessary to provide further details about their neurodevelopmental outcomes.
This study aimed to assess the socio-economic impact of sickle cell disease (SCD) on families of patients receiving care at the SCD clinic of Aminu Kano Teaching Hospital (AKTH) in Kano, Northwest Nigeria. The research adopted a descriptive cross-sectional approach, involving the participation of 273 individuals selected through a multi-stage sampling method. Data was gathered using semi-structured interviews and subjected to analysis using SPSS software. The study achieved a 100 % response rate, with 84 % of the participants being females. The average age of the participants was 35.1 ± 8.6 years, and a significant proportion (79.9 %) reported a monthly income of thirty thousand naira or less. The findings of the study revealed that SCD had a notable social impact, affecting 93.5 % of participants occasionally and 5.8 % most of the time. Furthermore, a substantial financial burden was experienced by 54.2 % of respondents most of the time and 45.1 % occasionally. The research also highlighted the significant influence of SCD on guardians' employment status, income levels, time spent in hospitals, medical expenditures, and overall quality of life. These findings underscore the considerable social and financial challenges faced by guardians of SCD patients. Study results supports prioritizing affordable healthcare access for families affected by SCD to alleviate the burdens they face.
Non-pharmaceutical interventions (NPIs) implemented during the SARS-CoV-2 pandemic have been proven effective. While reducing SARS-CoV-2 transmission, NPIs also reduced children's exposure to other pathogens, leading to a decline in the incidence of many viral and bacterial infections. The reduction in contact with viruses and bacteria could result in insufficient immune stimulation of pathogens in the population, leading to an increase in susceptible populations and a decline in herd immunity, which form the immunity debt during the SARS-CoV-2 pandemic. Immunity debt can impact the pattern of seasonal pathogens, increase the incidence and severity of invasive infections, and potentially raise the risk of allergic diseases in children. Immunization, continuing to implement NPIs, pathogen monitoring, and health education are important measures to repay immunity debt. Besides, trained immunity, referring to the memory immunity produced by the innate immune system upon re-stimulation, can be employed as a non-specific measure to prevent the spread of pathogens. The protective effect of trained immunity can be used as a temporary preventive measure for emerging infectious diseases and create conditions for vaccine development.
Vapes or e-cigarettes are battery operated devices that heat a liquid until it becomes a vapour, which is inhaled. Typically, e-liquids contain nicotine, different flavourings, and propylene glycol. Vaping devices are either disposable vapes or rechargeable. Vapes were initially developed as stop smoking aid but they have now become a recreational product popular among teenagers.
Vaping has increased at an alarming rate among teenagers and young adults in Ireland. The European Schools Project for Alcohol and Other Drugs (ESPAD) survey 2019 showed that almost 4 in 10 Irish 16-year-olds had tried vaping and 15 % currently use them. More worrying is the dramatic rise in the use of disposable vapes in recent years. An Action on Smoking and Health (ASH) UK survey data revealed a 9-fold increase from 2021 to 2023 in their use (7.7 % to 69 %) among 11–17-year-old vapers.
A combination of clever marketing by vaping companies, a strong social media presence, attractive flavours and easy accessibility has contributed to the increasing use of vapes by young people.
Exposure of children and adolescents to nicotine in vaping solutions can lead to long-term negative impacts on brain development, as well as addiction. Many teenagers who vape experience poor concentration, anxiety, mood disorders and sleep disturbance. A paper from NEJM in 2022 reported a case series where chronic vaping resulted in small airway fibrosis of the airways. A systematic review conducted in 2021 concluded that teenager vapers were three to five times more likely to take up tobacco smoking when compared with non-vapers.
Strong legislation is required to ban the sale of disposable vapes to teenagers along with controls on marketing online. Healthcare Professionals should ask and counsel their patients about vaping. Increased public awareness and education for Health care professionals on teenage vaping needs to be addressed.
Vaping has become a global public health issue that must be addressed urgently.
In childhood, all forms of adult urinary incontinence occur, only the underlying causes and their distribution may be different.
Patients and Methods
5725 children (aged 0–18 years) underwent urodynamic examination in the Velkey László Child Health Center, Miskolc, and in the Heim Pál National Pediatric Institute, Budapest between 1986 and 2023.
Results: 675 children had urinary incontinence. 471/1335 children with nocturnal enuresis had non-monosymptomatic enuresis with urge incontinence. 115 children have dysfunctional voiding.
Videourodynamic study showed overactive bladder dysfunction in 31 %, neurogenic bladder dysfunction in 7 %, urine outflow obstruction in 3 %, and vaginal reflux in 2 % children.
Conclusion: The disorder of urinary retention and emptying occurs as a result of the disorder of the coordinated functioning of the bladder emptying muscle, the detrusor and the closing muscle group, the sphincter. Urge incontinence, overactive bladder function is the most common form of UI in childhood. Anamnesis and uroflow examination are sufficient to establish an accurate diagnosis. Unfortunately, anticholinergic medication is still the accepted treatment for children, with many side effects.
Incontinence after urination is most often caused by vaginal reflux, which can be easily detected with a video urodynamic examination.
Nocturnal enuresis is one of the most common problems in early childhood. Simple explanation, the bladder fills up at night, either because there is a lot of urine output at night, or because the bladder capacity is small. The next step is that the child does not wake up with a full bladder. He sleeps so deeply that he does not respond to the urge to urinate during sleep, and he wets the bed or wakes up and becomes a nocturnal urinates.
Most childhood urinary incontinence can be successfully treated and resolved in childhood.
Clinical bedside teaching the cornerstone of medical education in the 19th century has been shaped and developed by changes in healthcare delivery and work practices. Developing skilled clinicians to work and thrive in these complex environments requires innovative and adaptive strategies. In this rapidly changing environment compounded by a shorter duration of training, there is an increasing focus on the student learner, team-based working and the development of professionalism. The continuum of medical education from undergraduate through postgraduate to continued professional development has been greatly enhanced by the adoption of new strategies and technologies. Simulation is long established in medical education and its benefits well recognised. Technological developments including Artificial Intelligence have supported and enhanced the quality of simulation in medical education. There is a broad range of simulation available with varying degrees of fidelity, as required, culminating in immersive virtual reality. The challenges for medical educators of the Covid-19 pandemic, with closure or restricted access to clinical patients, wards and classrooms, resulted in rapid restructuring of teaching programs and for many to move “on-line”. This resulted in widespread rapid adoption of technologically driven medical education, with E-learning, blended learning and innovative strategies to increase student engagement. The seismic changes in medical education necessitated by the Covid-19 pandemic coupled with the upskilling of medical educators and technological advances, should result in an exciting period of continued innovation in medical education, a second “Golden Era” and enhance medical education for many years to come.
The burden of obesity, diabetes mellitus and asthma remains a significant public health issue worldwide. These conditions are associated with premature deaths and a reduced quality of life. Primary health care plays a key role in the prevention, detection, and management of noncommunicable diseases in childhood, including diabetes and asthma. Health promotion is crucial for a healthy life from early childhood, preventing from obesity, a sedentary lifestyle, exposure to tobacco smoke, and other risk factors associated to noncommunicable diseases. Asthma and type 1 diabetes mainly begin in childhood; thus, recognition and early detection at the primary health care level are essential. In the long term, management of children with chronic diseases requires regular follow-up and cooperation with a specialized team. Care coordination by the primary health care provider is key for optimal control of the disease and development of the child or adolescent in the physical, emotional, and social spheres. Over-referral for diagnosis and follow-up is associated with unnecessary specialist overload, patient anxiety, and financial burden for the families and the health system. Clear criteria and referral pathways with efficient communication between the professional team members are essential to empower primary health care providers, avoid unnecessary referrals, and optimize the care and quality of life of children and adolescents with chronic diseases.
The WHO Pocket book of primary health care for children and adolescents was recently developed to address knowledge gaps and improve the diagnosis and management of children and adolescents at the outpatient level. It dedicates an entire chapter to health promotion and disease prevention with counselling messages addressed to children, adolescents and their families; provides guidance for the diagnosis and management of asthma, diabetes and other chronic diseases; and includes additional considerations for adolescents living with chronic conditions.
Although the benefits of thoracoscopic esophageal atresia repair (TEAR) are well documented, there has been resistance to the uptake of this approach in low- and middle-income countries. This study reviews a single unit's experience introducing TEAR in a South African state sector tertiary hospital.
We describe how we set up MIS for esophageal atresia (EA) at our centre. All neonates with EA managed at our institution from January 2016 to January 2022 were included. Excluded patients included those who were not operated on or if data was missing. We compared the different approaches for managing type C EA in our setting. We analyzed the data using the Mann-Whitney U test.
Sixty-five patients were managed with EA over the study duration. There were 54 patients who had type C EA. Thirty-nine patients underwent thoracotomy to repair the defect, and eighteen underwent TEAR, of which sixteen were completed thoracoscopically. There was a statistically significant difference in weight (p-value 0.035), gestational age (p-value 0.002), and age at operation (p-value 0.004) between the groups treated by TEAR and OEAR (open esophageal atresia repair). There was a small median difference in the operative time between TEAR and OEAR of 20 min. The mortality in the OEAR group was higher (20.5 %) compared to the TEAR group (5.5 %), with a p-value of 0.094.
A dedicated quality improvement program focused on introducing MIS for EA can produce results comparable to the open procedure in an LMIC setting.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：