Pub Date : 2016-12-05DOI: 10.1136/archdischild-2016-312340
Giordano Pérez-Gaxiola
ed by: Amanda J Friend, Department of Paediatrics, Leeds General Infirmary, Leeds, UK. Just like in everyday life, new or sophisticated devices in the medical world can wow us. The trial by Brinkman et al is a reminder that we have to keep our heads level and always ask for evidence before spending precious resources in these supposedly marvellous gadgets. A few years ago, a newspaper story caught my attention. The local health and social care programme had bought more than a hundred baby simulators and were going to use them in a public middle school aiming to reduce teen pregnancies. I remember searching for evidence about it and feeling disappointed after not finding any good trials. I did run into Dr Brinkman et al’s protocol. Now that their study has been published, my concern was confirmed. The trial showed that these robots do not reduce pregnancies; on the contrary, the number was larger in the intervention group. The authors adjusted for socioeconomic status, family type, sexual activity before enrolling, previous pregnancy, psychological stress, alcohol or drug use and still an increase in teen pregnancy risk was noted. Granted, this study was done in a high income country, not in my setting in Mexico, so we can’t assume that the results would be the same here. But the least, our health authorities should do is report the outcomes of the 900 local students who entered the programme. If the robots did reduce pregnancies, great. If they did not, just like this study suggests, it will be a learnt lesson so that we don’t spend our limited budget in futile preventive interventions, no matter how shiny or modern they look. Giordano Pérez-Gaxiola Correspondence to Dr Giordano Pérez-Gaxiola, Evidence-Based Medicine, Hospital Pediátrico de Sinaloa, Blvd. Constitución y Donato Guerra SN, Col. Almada, Culiacan 80200, Mexico; giordano@ sinestetoscopio.com Contributors GP-G wrote the commentary. Amanda J Friend wrote the structured abstract. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. REFERENCES 1 Zermeño Y. 900 teenagers will take care of their virtual babies. Noroeste [Culiacán] 8 October, 2013. http:// www.noroeste.com.mx/publicaciones. php?id=901171 2 Brinkman SA, Johnson SE, Lawrence D, et al. Study protocol for the evaluation of an Infant Simulator based program delivered in schools: a pragmatic cluster randomised controlled trial. Trials 2010;11:100–10. Table 1 Pregnancy outcomes Outcomes Intervention group events Control group events Adjusted HR (95% CI) Total pregnancies 210 (17%) 168 (11%) 1.36 (1.10 to 1.67) % of pregnancies ending in abortion 54 60 1.23 (0.89 to –1.69)
编辑:阿曼达J朋友，儿科，利兹总医院，利兹，英国。就像在日常生活中一样，医学界新的或复杂的设备可以让我们惊叹。布林克曼等人的试验提醒我们，在把宝贵的资源花在这些看似不可思议的小玩意上之前，我们必须保持头脑清醒，总是询问证据。几年前，一篇报纸报道引起了我的注意。当地的卫生和社会保健项目已经购买了100多个婴儿模拟器，打算在一所公立中学使用，目的是减少青少年怀孕。我记得我在寻找关于它的证据，在没有找到任何好的试验后感到失望。我碰到了布林克曼博士等人的协议。现在他们的研究发表了，我的担心得到了证实。试验表明，这些机器人并没有减少怀孕;相反，干预组的数字更大。作者调整了社会经济地位、家庭类型、入学前的性活动、以前的怀孕、心理压力、酒精或药物使用等因素，但仍然注意到青少年怀孕风险的增加。当然，这项研究是在一个高收入国家进行的，而不是在我所在的墨西哥，所以我们不能假设这里的结果是一样的。但我们的卫生当局至少应该报告900名参加该计划的当地学生的结果。如果机器人确实能减少怀孕，那就太好了。如果他们没有，就像这项研究表明的那样，这将是一个教训，这样我们就不会把有限的预算花在徒劳的预防性干预上，无论它们看起来多么闪亮或现代。给锡那罗亚大道Pediátrico医院循证医学科乔丹诺·帕萨雷兹-加西奥拉医生的通信Constitución y Donato Guerra SN, Almada上校，墨西哥库利亚坎80200;撰稿人GP-G撰写了这篇评论。阿曼达·J·弗兰德(Amanda J Friend)撰写了结构化摘要。竞争利益无。委托出处和同行评审;内部同行评审。参考文献1 Zermeño Y. 900名青少年将照顾他们的虚拟婴儿。Noroeste [Culiacán] 2013年10月8日。http:// www.noroeste.com.mx publicaciones。php吗?[2]李建军，李建军，李建军，等。评估在学校提供的基于婴儿模拟器的程序的研究方案:一项实用的集群随机对照试验。试验2010;11:100-10。表1妊娠结局干预组事件对照组事件调整后的HR (95% CI)总妊娠210(17%)168(11%)1.36(1.10 ~ 1.67)%流产率54 60 1.23 (0.89 ~ -1.69)
{"title":"An infant simulator programme did not reduce teenage pregnancy","authors":"Giordano Pérez-Gaxiola","doi":"10.1136/archdischild-2016-312340","DOIUrl":"https://doi.org/10.1136/archdischild-2016-312340","url":null,"abstract":"ed by: Amanda J Friend, Department of Paediatrics, Leeds General Infirmary, Leeds, UK. Just like in everyday life, new or sophisticated devices in the medical world can wow us. The trial by Brinkman et al is a reminder that we have to keep our heads level and always ask for evidence before spending precious resources in these supposedly marvellous gadgets. A few years ago, a newspaper story caught my attention. The local health and social care programme had bought more than a hundred baby simulators and were going to use them in a public middle school aiming to reduce teen pregnancies. I remember searching for evidence about it and feeling disappointed after not finding any good trials. I did run into Dr Brinkman et al’s protocol. Now that their study has been published, my concern was confirmed. The trial showed that these robots do not reduce pregnancies; on the contrary, the number was larger in the intervention group. The authors adjusted for socioeconomic status, family type, sexual activity before enrolling, previous pregnancy, psychological stress, alcohol or drug use and still an increase in teen pregnancy risk was noted. Granted, this study was done in a high income country, not in my setting in Mexico, so we can’t assume that the results would be the same here. But the least, our health authorities should do is report the outcomes of the 900 local students who entered the programme. If the robots did reduce pregnancies, great. If they did not, just like this study suggests, it will be a learnt lesson so that we don’t spend our limited budget in futile preventive interventions, no matter how shiny or modern they look. Giordano Pérez-Gaxiola Correspondence to Dr Giordano Pérez-Gaxiola, Evidence-Based Medicine, Hospital Pediátrico de Sinaloa, Blvd. Constitución y Donato Guerra SN, Col. Almada, Culiacan 80200, Mexico; giordano@ sinestetoscopio.com Contributors GP-G wrote the commentary. Amanda J Friend wrote the structured abstract. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. REFERENCES 1 Zermeño Y. 900 teenagers will take care of their virtual babies. Noroeste [Culiacán] 8 October, 2013. http:// www.noroeste.com.mx/publicaciones. php?id=901171 2 Brinkman SA, Johnson SE, Lawrence D, et al. Study protocol for the evaluation of an Infant Simulator based program delivered in schools: a pragmatic cluster randomised controlled trial. Trials 2010;11:100–10. Table 1 Pregnancy outcomes Outcomes Intervention group events Control group events Adjusted HR (95% CI) Total pregnancies 210 (17%) 168 (11%) 1.36 (1.10 to 1.67) % of pregnancies ending in abortion 54 60 1.23 (0.89 to –1.69)","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82723286","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}
Pub Date : 2016-11-22DOI: 10.1136/archdischild-2016-310527
J. Bielicki, D. Cromwell, M. Sharland
Potentially life-threatening infections require immediate antibiotic therapy. Most early stage antibiotic treatment for these infections is empirical, that is, covering a range of possible target bacteria while awaiting culture results. Empirical antibiotic regimens need to reflect the epidemiology of most likely causative bacteria, type of infection and patient risk factors. Summary data from relevant isolates in similar patients help to identify appropriate empirical regimens. At present, such data are mostly presented as hospital or other aggregate antibiograms, showing antimicrobial susceptibility testing results by bacterial species. However, a more suitable method is to calculate weighted incidence syndromic combination antibiograms for different types of infections and regimens, allowing head-to-head comparisons of empirical regimens. Once there is confirmatory or negative microbiological evidence of infection, empirical regimens should be adapted to the identified bacterial species and susceptibilities or discontinued.
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Pub Date : 2016-11-18DOI: 10.1136/archdischild-2016-312256
I. Wacogne
Endoscopy plays a pivotal role in the diagnosis and treatment of Gastrointestinal disease. Gastrointestinal endoscopy (GIE) is widely performed with around 1.5 million procedures undertaken annually in the United Kingdom and approximately 18.5 million procedures in the USA. The lifetime chance of requiring a GIE is now greater than 35%. As the technology of endoscopes and the technical expertise of endoscopists have advanced so have the number of clinical settings in which endoscopy may be applied. Modern endoscopists are now no longer simple diagnosticians who find pathology, take biopsies and refer on patients for others to manage. Endoscopists can now characterise and manage a wide range of conditions diagnosed at the time of an endoscopic procedure. In this issue of Frontline Gastroenterology, timed to coincide with ENDOLIVE UK, a number of articles describe the role of endoscopy in managing conditions throughout the GI tract. The widespread adoption of cancer screening at population level and for individuals at increased risk has led to earlier diagnosis and the opportunity to treat cancer and pre cancer entirely endoscopically. Old et al describe the role of endoscopy in the management of Barrett’s oesophagus. The authors describe how Barrett’s can be diagnosed and characterised accurately with pre malignant and early malignant changes in the oesophagus treated to prevent progression to advanced cancer. With the increased ability to detect pathology comes the increased burden of surveillance. Oesophageal and colonic surveillance are reviewed with the clear message that measures to stratify risk are needed in order to deliver surveillance appropriately. Cancer management was once the preserve of the surgeon but high quality assessment, decision making and skilled practice allow many lesions to be managed endoscopically avoiding the need for invasive surgery. Colorectal cancer screening has increased the diagnosis of ‘polyp cancers’ and the review by Neilson et al describes a practical approach to assessment and management of the potentially malignant polyp. Patel et al review recent developments in endoscope technology explaining how this technology may assist diagnosis and management of luminal pathology. The small bowel was once only imaged radiologically and managed by surgery but capsule endoscopy and small bowel enteroscopy mean that pathology maybe diagnosed and managed entirely medically. Fundamental to all endoscopy is the need to ensure that endoscopists delivering diagnostic and therapeutic endoscopy are well trained and deliver high quality procedures. Veitch describes how high quality endoscopy can be delivered and supported and Geraghty et al report on management of large polyps demonstrating that training and accreditation are crucial in order to maintain quality. Demands on endoscopy services continue to grow as do the number of conditions that can be managed endoscopically. The opportunity to diagnose and treat more and more
{"title":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2016-312256","DOIUrl":"https://doi.org/10.1136/archdischild-2016-312256","url":null,"abstract":"Endoscopy plays a pivotal role in the diagnosis and treatment of Gastrointestinal disease. Gastrointestinal endoscopy (GIE) is widely performed with around 1.5 million procedures undertaken annually in the United Kingdom and approximately 18.5 million procedures in the USA. The lifetime chance of requiring a GIE is now greater than 35%. As the technology of endoscopes and the technical expertise of endoscopists have advanced so have the number of clinical settings in which endoscopy may be applied. Modern endoscopists are now no longer simple diagnosticians who find pathology, take biopsies and refer on patients for others to manage. Endoscopists can now characterise and manage a wide range of conditions diagnosed at the time of an endoscopic procedure. In this issue of Frontline Gastroenterology, timed to coincide with ENDOLIVE UK, a number of articles describe the role of endoscopy in managing conditions throughout the GI tract. The widespread adoption of cancer screening at population level and for individuals at increased risk has led to earlier diagnosis and the opportunity to treat cancer and pre cancer entirely endoscopically. Old et al describe the role of endoscopy in the management of Barrett’s oesophagus. The authors describe how Barrett’s can be diagnosed and characterised accurately with pre malignant and early malignant changes in the oesophagus treated to prevent progression to advanced cancer. With the increased ability to detect pathology comes the increased burden of surveillance. Oesophageal and colonic surveillance are reviewed with the clear message that measures to stratify risk are needed in order to deliver surveillance appropriately. Cancer management was once the preserve of the surgeon but high quality assessment, decision making and skilled practice allow many lesions to be managed endoscopically avoiding the need for invasive surgery. Colorectal cancer screening has increased the diagnosis of ‘polyp cancers’ and the review by Neilson et al describes a practical approach to assessment and management of the potentially malignant polyp. Patel et al review recent developments in endoscope technology explaining how this technology may assist diagnosis and management of luminal pathology. The small bowel was once only imaged radiologically and managed by surgery but capsule endoscopy and small bowel enteroscopy mean that pathology maybe diagnosed and managed entirely medically. Fundamental to all endoscopy is the need to ensure that endoscopists delivering diagnostic and therapeutic endoscopy are well trained and deliver high quality procedures. Veitch describes how high quality endoscopy can be delivered and supported and Geraghty et al report on management of large polyps demonstrating that training and accreditation are crucial in order to maintain quality. Demands on endoscopy services continue to grow as do the number of conditions that can be managed endoscopically. The opportunity to diagnose and treat more and more ","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80651129","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}
Pub Date : 2016-11-15DOI: 10.1136/archdischild-2015-309964
J. Davison
White blood cell (leucocyte) enzyme assays are an important part of the investigation of potential metabolic disorders, in particular, lysosomal storage disorders. It is imperative that appropriate tests are selected, and that knowledge of the limitations of these assays is applied to avoid erroneous conclusions about confirmation or exclusion of diagnoses.
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Pub Date : 2016-11-11DOI: 10.1136/archdischild-2015-309083
J. Cyriac, K. Holden, K. Tullus
‘Urine dipstick’, the commonly used point-of-care test, is an extremely sensitive investigation. Results of this test affected by numerous factors, if not meticulously linked with detailed history and examination, can lead a well-meaning clinician down the wrong clinical pathway. The aim of this article is to provide an overview of this every day test, touching on the physiological and technological basis initially, but mainly focusing on common questions like when to request the dipstick test, the correlation of dipstick results with urine specimen collected by different method and complexities of interpretation of dipstick results in everyday clinical scenarios.
{"title":"How to use… urine dipsticks","authors":"J. Cyriac, K. Holden, K. Tullus","doi":"10.1136/archdischild-2015-309083","DOIUrl":"https://doi.org/10.1136/archdischild-2015-309083","url":null,"abstract":"‘Urine dipstick’, the commonly used point-of-care test, is an extremely sensitive investigation. Results of this test affected by numerous factors, if not meticulously linked with detailed history and examination, can lead a well-meaning clinician down the wrong clinical pathway. The aim of this article is to provide an overview of this every day test, touching on the physiological and technological basis initially, but mainly focusing on common questions like when to request the dipstick test, the correlation of dipstick results with urine specimen collected by different method and complexities of interpretation of dipstick results in everyday clinical scenarios.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90972200","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}
Pub Date : 2016-11-07DOI: 10.1136/archdischild-2015-309729
A. Kumaran, S. Sakka, R. Dias
Despite a levelling off in obesity rates, 3 out of 10 children in England aged 2–15 years were either overweight or obese in 2011.1 Seventy-nine per cent of children who are obese in their early teens are likely to remain obese as adults. Consequently, they will be at greater risk of conditions such as type 2 diabetes, non-alcoholic fatty liver disease, hypertension and psychological morbidity starting in adolescence,2 as well as coronary heart disease and some cancers in adulthood.3–5 This high proportion of overweight or obese children poses financial challenges for the National Health Service (NHS).3 The focus of this review is on aspects pertaining to children from two recently published guidelines from the National Institute for Health and Care Excellence (NICE) (box 1). NICE also has a suite of previous guidelines for managing obesity (box 1). Box 1 ### Resources: National Institute for Health and Care Excellence (NICE) guidelines on obesity Recent guidelines reviewed in this article 1. Identification, assessment and management of overweight and obesity in children, young people and adults. NICE clinical guidance 189 (2014): https://nice.org.uk/guidance/cg189 (link to full guidance) https://www.nice.org.uk/guidance/cg189/resources (link to tools and resources) https://www.nice.org.uk/guidance/cg189/ifp/chapter/about-this-information (link to information for the public) 2. Prevention and lifestyle weight management in children and young people NICE quality standard 94 (2015): http://nice.org.uk/guidance/qs94 3. Public Health England's healthier, more sustainable catering: provides information for those involved in purchasing food and drink and provides definitions for low, medium and high levels of fat, saturates, sugars and salt per portion/serving size for food and drink. The Change4Life website gives suggestions for healthy food and drink alternatives :http://www.nhs.uk/change4life/Pages/change-for-life.aspx Previous NICE guidance on obesity CG43 Obesity prevention (December 2006, updated March 2015) PH17 Promoting physical activity for children and young people (2009). PH27 Weight management before, during and after pregnancy (July 2010). PH42 …
{"title":"Obesity in children: recent NICE guidance","authors":"A. Kumaran, S. Sakka, R. Dias","doi":"10.1136/archdischild-2015-309729","DOIUrl":"https://doi.org/10.1136/archdischild-2015-309729","url":null,"abstract":"Despite a levelling off in obesity rates, 3 out of 10 children in England aged 2–15 years were either overweight or obese in 2011.1 Seventy-nine per cent of children who are obese in their early teens are likely to remain obese as adults. Consequently, they will be at greater risk of conditions such as type 2 diabetes, non-alcoholic fatty liver disease, hypertension and psychological morbidity starting in adolescence,2 as well as coronary heart disease and some cancers in adulthood.3–5 This high proportion of overweight or obese children poses financial challenges for the National Health Service (NHS).3\u0000\u0000The focus of this review is on aspects pertaining to children from two recently published guidelines from the National Institute for Health and Care Excellence (NICE) (box 1). NICE also has a suite of previous guidelines for managing obesity (box 1). Box 1 \u0000### Resources: National Institute for Health and Care Excellence (NICE) guidelines on obesity\u0000\u0000Recent guidelines reviewed in this article\u0000\u00001. Identification, assessment and management of overweight and obesity in children, young people and adults. NICE clinical guidance 189 (2014):\u0000\u0000https://nice.org.uk/guidance/cg189 (link to full guidance)\u0000\u0000https://www.nice.org.uk/guidance/cg189/resources (link to tools and resources)\u0000\u0000https://www.nice.org.uk/guidance/cg189/ifp/chapter/about-this-information (link to information for the public)\u0000\u00002. Prevention and lifestyle weight management in children and young people NICE quality standard 94 (2015):\u0000\u0000http://nice.org.uk/guidance/qs94\u0000\u00003. Public Health England's healthier, more sustainable catering: provides information for those involved in purchasing food and drink and provides definitions for low, medium and high levels of fat, saturates, sugars and salt per portion/serving size for food and drink. The Change4Life website gives suggestions for healthy food and drink alternatives :http://www.nhs.uk/change4life/Pages/change-for-life.aspx\u0000\u0000Previous NICE guidance on obesity\u0000\u0000CG43 Obesity prevention (December 2006, updated March 2015)\u0000\u0000PH17 Promoting physical activity for children and young people (2009).\u0000\u0000PH27 Weight management before, during and after pregnancy (July 2010).\u0000\u0000PH42 …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81850254","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}
Pub Date : 2016-10-31DOI: 10.1136/archdischild-2016-311782
L. Speirs, S. McVea, R. Little, T. Bourke
Case history A healthy 15-month-old girl presented to the emergency department with a 24-hour history of fever and rash. The initial blanching rash developed into non-blanching areas with associated leg swelling. She had received no recent medications, had no known drug allergies and no unwell contacts. On examination, she was feverish at 38.6°C, capillary refill time was <2 s with warm peripheries, heart rate 169 bpm and blood pressure 94/59 mm Hg. A palpable purpuric rash was evident on all four limbs and face (figure 1) although the trunk was spared. Her legs were tense and oedematous to the knee. Figure 1 Rash at presentation. Initial investigations: Haemoglobin level: 131 g/L, white cell count: 16.6×109/L, neutrophils: 11.1×109/L and platelets: 407×109/L Coagulation screen: normal C reactive protein level: 20 mg/L Lactate level: 1.7 mmol/L Intravenous ceftriaxone was commenced following blood culture and meningococcal PCR. The following day, while remaining systemically well, she developed a vesicular rash on her trunk and back (figure 2). Figure 2 Vesicular rash. Questions What is the diagnosis? Henoch-Schonlein purpura (HSP) Meningococcal septicaemia Acute haemorrhagic oedema of infancy (AHOI) Vasculitic urticaria Gianotti-Crosti syndrome What further investigation is required? Check viral serology including Epstein-Barr virus and hepatitis B virus Complement levels and autoimmune screen Skin biopsy Lumbar puncture and audiology No further investigation How should this child be managed? Complete 7 days of ceftriaxone treatment Oral aciclovir Oral steroids Regular follow-up with urinalysis and blood pressure monitoring Stop antibiotics if cultures were negative at 48 hours and discharge Answers are on page▪▪
健康15个月女童，24小时发热及皮疹就诊于急诊科。最初的焯水皮疹发展为非焯水区域，并伴有腿部肿胀。她最近没有接受任何药物治疗，没有已知的药物过敏，也没有不适的接触者。检查时，患者发热38.6℃，毛细血管再充血时间<2 s，外周温暖，心率169 bpm，血压94/59 mm Hg。四肢和面部可见明显的紫癜疹(图1)，躯干未见。她的腿紧绷，肿到了膝盖。图1出现皮疹。初步调查:血红蛋白水平:131 g/L，白细胞计数:16.6×109/L，中性粒细胞:11.1×109/L，血小板:407×109/L凝血筛查:正常C反应蛋白水平:20 mg/L乳酸水平:1.7 mmol/L在血培养和脑膜炎球菌PCR后开始静脉注射头孢曲松。第二天，在全身正常的情况下，患者躯干和背部出现水疱疹(图2)。什么是诊断?过敏性紫癜(HSP)脑膜炎球菌性败血症婴儿期急性出血性水肿(AHOI)血管性荨麻疹(Gianotti-Crosti综合征)需要进一步调查吗?检查病毒血清学，包括eb病毒和乙型肝炎病毒补体水平和自身免疫筛查皮肤活检腰椎穿刺和听力学没有进一步的调查如何处理这个孩子?完成7天头孢曲松治疗口服阿昔洛韦口服类固醇定期随访尿检和血压监测48小时后如果培养阴性停止使用抗生素并出院答案见页* * *
{"title":"What is that rash?","authors":"L. Speirs, S. McVea, R. Little, T. Bourke","doi":"10.1136/archdischild-2016-311782","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311782","url":null,"abstract":"Case history A healthy 15-month-old girl presented to the emergency department with a 24-hour history of fever and rash. The initial blanching rash developed into non-blanching areas with associated leg swelling. She had received no recent medications, had no known drug allergies and no unwell contacts. On examination, she was feverish at 38.6°C, capillary refill time was <2 s with warm peripheries, heart rate 169 bpm and blood pressure 94/59 mm Hg. A palpable purpuric rash was evident on all four limbs and face (figure 1) although the trunk was spared. Her legs were tense and oedematous to the knee. Figure 1 Rash at presentation. Initial investigations: Haemoglobin level: 131 g/L, white cell count: 16.6×109/L, neutrophils: 11.1×109/L and platelets: 407×109/L Coagulation screen: normal C reactive protein level: 20 mg/L Lactate level: 1.7 mmol/L Intravenous ceftriaxone was commenced following blood culture and meningococcal PCR. The following day, while remaining systemically well, she developed a vesicular rash on her trunk and back (figure 2). Figure 2 Vesicular rash. Questions What is the diagnosis? Henoch-Schonlein purpura (HSP) Meningococcal septicaemia Acute haemorrhagic oedema of infancy (AHOI) Vasculitic urticaria Gianotti-Crosti syndrome What further investigation is required? Check viral serology including Epstein-Barr virus and hepatitis B virus Complement levels and autoimmune screen Skin biopsy Lumbar puncture and audiology No further investigation How should this child be managed? Complete 7 days of ceftriaxone treatment Oral aciclovir Oral steroids Regular follow-up with urinalysis and blood pressure monitoring Stop antibiotics if cultures were negative at 48 hours and discharge Answers are on page▪▪","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76152972","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}
Pub Date : 2016-10-31DOI: 10.1136/archdischild-2016-311068
M. Prasad, A. Seal, S. Mordekar
Acute confusional state (ACS) refers to sudden impairment of cognitive function and represents a major medical emergency. The impairment may be global or confined specifically to a particular faculty of higher mental function, such as memory. This review highlights the importance of relevant medical history and clinical signs and symptoms in reaching the correct diagnosis. In this review, we have presented a diagnostic approach to a child presenting with ACS and described commonly encountered causes, their treatments and outcomes. We have also presented an algorithm for the diagnostic approach to the child with ACS.
{"title":"Fifteen-minute consultation: Approach to the child with an acute confusional state","authors":"M. Prasad, A. Seal, S. Mordekar","doi":"10.1136/archdischild-2016-311068","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311068","url":null,"abstract":"Acute confusional state (ACS) refers to sudden impairment of cognitive function and represents a major medical emergency. The impairment may be global or confined specifically to a particular faculty of higher mental function, such as memory. This review highlights the importance of relevant medical history and clinical signs and symptoms in reaching the correct diagnosis. In this review, we have presented a diagnostic approach to a child presenting with ACS and described commonly encountered causes, their treatments and outcomes. We have also presented an algorithm for the diagnostic approach to the child with ACS.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87714800","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}
Pub Date : 2016-10-27DOI: 10.1136/archdischild-2016-310632
S. Drysdale, D. Kelly
Enterovirus (EV) is the most common cause of aseptic meningitis and has a benign course, unlike EV encephalitis, which can result in long-term neurological sequelae. There are no active treatments or prophylactic agents, and management is purely supportive. Obtaining an EV-positive cerebrospinal fluid result usually allows antimicrobial treatment to be stopped. This review will answer some of the common questions surrounding EV meningitis/encephalitis.
{"title":"Fifteen-minute consultation: enterovirus meningitis and encephalitis—when can we stop the antibiotics?","authors":"S. Drysdale, D. Kelly","doi":"10.1136/archdischild-2016-310632","DOIUrl":"https://doi.org/10.1136/archdischild-2016-310632","url":null,"abstract":"Enterovirus (EV) is the most common cause of aseptic meningitis and has a benign course, unlike EV encephalitis, which can result in long-term neurological sequelae. There are no active treatments or prophylactic agents, and management is purely supportive. Obtaining an EV-positive cerebrospinal fluid result usually allows antimicrobial treatment to be stopped. This review will answer some of the common questions surrounding EV meningitis/encephalitis.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88572714","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}
Pub Date : 2016-10-25DOI: 10.1136/archdischild-2015-308957
E. Wedge, E. Abrahamson, G. Tudor-Williams, S. Nadel, J. Deal
The case of an 11-year-old child presenting with acute haemoptysis and breathlessness is described. The girl was Malaysian and had recently arrived in the UK. She subsequently deteriorated, developing respiratory failure. The course of the illness is described, with reference to the diagnostic process at each stage. The case demonstrates the importance of having a broad investigatory approach in acute haemoptysis.
{"title":"When water is thicker than blood: recognising a systemic cause of haemoptysis","authors":"E. Wedge, E. Abrahamson, G. Tudor-Williams, S. Nadel, J. Deal","doi":"10.1136/archdischild-2015-308957","DOIUrl":"https://doi.org/10.1136/archdischild-2015-308957","url":null,"abstract":"The case of an 11-year-old child presenting with acute haemoptysis and breathlessness is described. The girl was Malaysian and had recently arrived in the UK. She subsequently deteriorated, developing respiratory failure. The course of the illness is described, with reference to the diagnostic process at each stage. The case demonstrates the importance of having a broad investigatory approach in acute haemoptysis.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79484633","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}
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