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

{"title":"Setting up a clinic to assess children and young people for female genital mutilation","authors":"D. Hodes, S. Creighton","doi":"10.1136/archdischild-2016-311296","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311296","url":null,"abstract":"It is now mandatory for health, social care professionals and teachers to report to the police all under-18s where female genital mutilation (FGM) has been disclosed by the child or where physical signs of FGM are seen. Such referrals are likely to result in a request for medical examination. New multiagency statutory guidance sets out instructions for physical examination but provides no details how services should be set-up. This review gives practical guidance learnt from the first year of the UK's only dedicated children's FGM service.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80131769","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":"An adolescent with acute abdominal pain and bowel wall thickening","authors":"G. Cozzi, L. Calligaris, C. Germani, D. Sanabor, E. Barbi","doi":"10.1136/archdischild-2016-311823","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311823","url":null,"abstract":"A 15-year-old girl was admitted with acute crampy abdominal pain and repeated vomiting over the preceding 2 hours; no fever, diarrhoea or abdominal trauma was reported. She had started oestrogen–progestin contraception 3 months ago. She had sought medical advice twice in the previous weeks for self-limiting episodes of right hand swelling, without urticaria. On examination, she was unwell and in pain, with severe tenderness in the right lower quadrant, without guarding or rebound tenderness. Bowel sounds were diminished. Blood tests were unremarkable. Two hours after admission, an abdominal ultrasound scanning showed an impressive wall thickening (>1 cm) of the terminal ileum, caecum and ascending colon (figure 1). Abundant free intraperitoneal fluids in the pelvis and in the hepatorenal recess were present. Figure 1 Marked caecal wall thickening evidenced at the ultrasound scanning. Questions Which of the following is the most likely diagnosis in this patient? Ileocolic intussusception Gastrointestinal manifestation of Henoch-Schönlein purpura Abdominal attack of hereditary angioedema (HAE) Acute pancreatitis Which of the following blood tests may help to confirm the diagnosis? Erythrocyte sedimentation rate C4 Serum amylase: 36 IU/L C1-inhibitor How should this patient be evaluated and treated? Answers are on page ▪▪▪.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91257082","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":"Thumb-sucking or nail-biting in childhood led to a reduction in atopic sensitisation but not asthma or hay fever","authors":"F. Roked, J. North","doi":"10.1136/archdischild-2016-311819","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311819","url":null,"abstract":"ed from: Lynch SJ, Sears MR, Hancox RJ. Thumb-sucking, nail-biting, and atopic sensitization, asthma, and hay fever. Pediatrics 2016;138:e20160443. The hygiene hypothesis (biome diversity, biome depletion) accounts for many but not all of the environmental and other epigenetic factors that determine the risk of developing allergy. This study shows that the seemingly innocuous acts of nail-biting and thumbsucking are likely to contribute to protection against later allergic disease and is supportive of a Swedish study of hand versus machine dish washing that showed decreased allergic disease when dishes were hand-washed. In addition to the suggestion that there is oral exposure to an increased range of pro-inflammatory agents, the tolerogenic nature of dendritic cells in the oral cavity could also be promoting specific tolerance to ingested allergens (used in sublingualspecific immunotherapy). The authors avoided investigating food allergy and this is probably wise as self-reporting of food allergy is unreliable and there is a higher rate of false positive skin tests to food allergens than aeroallergens. It would be intriguing to see if thumb-sucking could offset the increase in food allergy associated with probable cutaneous introduction of foods via damaged skin in eczema. Fozia Roked, Jonathan North Birmingham Children’s Hospital, Birmingham, UK City Hospital, SWBH NHS Trust, Birmingham, UK Correspondence to Dr Fozia Roked, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; fozia.roked@doctors.org.uk Contributors FR drafted the abstract/summary of original paper being picketed. JN drafted the commentary. Provenance and peer review Not commissioned; internally peer reviewed. REFERENCES 1 Hesselmar B, Hicke-Roberts A, Wennergren G. Allergy in children in hand versus machine dishwashing. Pediatrics 2015;135:e590–7. 2 Allam JP, Duan Y, Winter J, et al. Tolerogenic T cells, Th1/Th17 cytokines and TLR2/TLR4 expressing dendritic cells predominate the microenvironment within distinct oral mucosal sites. Allergy 2011;66:532–9. 3 Verrill L, Bruns R, Luccioli S, U.S. Food and Drug Administration. Prevalence of self-reported food allergy in U.S. adults: 2001, 2006, and 2010. Allergy Asthma Proc 2015;36:458–67. Table 1 Prevalence of atopy at age 13 years according to oral habit History of oral habits (%) No history of oral habits (%) p Value Atopic sensitisation/positive skin prick test (n=328) 38 49 0.009 Asthma (n=95) 13.3 12.8 0.8 Hay fever (n=219) 29.6 29.9 0.9 Table 2 Atopic sensitisation and type of oral habit Outcomes Thumb-sucking or nail–biting, OR (95% CI) Thumb–sucking, OR (95% CI) Nail-biting, OR (95% CI) Atopic sensitisation/positive skin prick test at 13 years (n=724) 0.64 (0.45 to 0.90) 0.64 ( 0.42 to 0.97) 0.70 (0.47 to 1.10) Atopic sensitisation/positive skin prick test at 32 years (n=935) 0.62 (0.45 to 0.86) 0.69 (0.47 to 1.00) 0.71 (0.49 to 1.02)","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72859124","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":"Bilateral hydroureters and hydronephrosis in a neonate","authors":"F. Rabah, D. Al-Nabhani","doi":"10.1136/archdischild-2016-311091","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311091","url":null,"abstract":"A newborn boy was diagnosed antenatally with bilateral hydronephrosis. Postnatal renal ultrasound scan (USS) measured a renal pelvic anteroposterior diameter (APD) of 12 mm on the left side and 7 mm on the right side. The baby had good urine stream. Parents missed the repeat USS at the age of 1 week. An ultrasound done at 4 weeks revealed progressive hydronephrosis, bilateral hydroureters, with increased renal echogenicity. Normal bladder wall thickness was noted but two intravesical lesions were seen (figures 1 and 2). The APD was 13.5 and 11 mm on the left and right side, respectively. Figure 1 Renal ultrasound scan of (A) left kidney (LT) and (B) right kidney (RT) showing bilateral hydronephrosis (white arrows) and hydroureters (red arrow). Increased renal echogenicity is not shown in the figure. Figure 2 Showing normal bladder wall thickness but two intravesical lesions were seen (white arrows). Question How would you describe the intravesical lesions in figure 2? Bilateral ureteroceles Bilateral vesicoureteral reflux (VUR) Bilateral pelvi-ureteric junction obstruction Posterior urethral valves (PUVs) Which complication(s) may you expect in such cases? Urinary tract infection (UTI) Obstructive voiding symptoms Failure to thrive Ureteral calculus All of the above How would you treat this problem? Endoscopic puncture Deflux surgery Pyeloplasty Vesicostomy Answers are on page ▪▪▪","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81931394","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":"Challenging behaviour and learning disabilities: prevention and interventions for children with learning disabilities whose behaviour challenges: NICE guideline 2015","authors":"M. Tanwar, B. Lloyd, P. Julies","doi":"10.1136/archdischild-2015-309575","DOIUrl":"https://doi.org/10.1136/archdischild-2015-309575","url":null,"abstract":"In May 2015, the National Institute for Health and Care Excellence (NICE) published guidance entitled ‘Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges’.1 The guideline concerns children (aged 12 years or younger) and young adults (13–17 years) covering principles of management.\u0000\u0000The British Psychological Society published a report entitled ‘Challenging behaviour: a unified approach’ in 2007.2 This guideline was developed for clinical psychologists working mainly within the child and adolescent mental health services. To our knowledge, the NICE guideline1 is the first to provide guidance to paediatricians and general practitioners working in this field.\u0000\u0000Learning disability : This guideline highlights that ‘Learning disability’ is the most widely and accepted term in the UK — defined by three core criteria:\u0000\u00001. Lower intellectual ability (IQ <70)\u0000\u00002. Significant impairment of social adaptive functioning\u0000\u00003. Onset in childhood\u0000\u0000‘Behaviour that challenges’ is not a diagnosis and is used in this guideline to indicate that although difficult behaviour may be a challenge to services, family members or carers, it may serve a purpose for the person with a learning disability and often indicates an unmet need.\u0000\u0000The terminology in intellectual disability is a contentious issue. In this guideline, the term ‘Behaviour that challenges’ is used rather than ‘challenging behaviour’ to highlight that an individual with challenging behaviour is not the only one requiring treatment and to therefore ensure that other elements such as the environment, skills, attitudes of carers/staff and service capabilities are simultaneously assessed and are also the focus of intervention.\u0000\u0000It is relatively common for people with a learning disability to develop behaviour that challenges (5%–15%), acknowledging that objective assessment is often difficult.\u0000\u0000### Assessment\u0000\u0000\u0000\u00001. Pre-assessment : Early identification of behaviour that challenges is the key. Everyone involved in caring for and supporting children and young adults …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86315535","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":"Developing immunotherapies for childhood cancer","authors":"A. Capsomidis, John Anderson","doi":"10.1136/archdischild-2016-311284","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311284","url":null,"abstract":"The development of immune-based treatment (immunotherapy) for childhood cancer is a rapidly advancing field with impressive results already achieved in children with leukaemia.1 ,2 For cancers resistant to conventional treatments, harnessing the power and specificity of the immune system to fight cancer is one of several current avenues of research. The immune system is essential for controlling cancer progression by continual surveillance and elimination of transformed cells. This protective process is hindered by the ability of cancer cells to develop mechanisms enabling them to ‘hide’ from immune destruction (including downregulation of tumour-associated antigens and major histocompatibility complex (MHC) class I, and the creation of an immunosuppressive tumour microenvironment). The aims of cancer immunotherapy are to enhance existing antitumour immune responses (active immunotherapy), including cancer vaccines and immune checkpoint inhibitors, or to enable the immune system to specifically recognise and kill cancer cells (passive immunotherapy) (table 1).\u0000\u0000View this table:\u0000\u0000Table 1 \u0000Classification of immune-based therapies for childhood cancer\u0000\u0000\u0000\u0000The identification of targetable tumour antigens is fundamental to the development of successful ‘passive’ immunotherapies. Ideally, targets should be highly expressed on cancer cells with little or no expression on normal tissue …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84414993","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":"NICE clinical guideline NG39: Major trauma: assessment and initial management","authors":"A. Kanani, S. Hartshorn","doi":"10.1136/archdischild-2016-310869","DOIUrl":"https://doi.org/10.1136/archdischild-2016-310869","url":null,"abstract":"Major trauma is the most frequent cause of death in the UK for children aged between 1 and 18 years. It is responsible for 31% of deaths in children aged 1–4 years, increasing to 48% of deaths in young people aged 15–18 years.1 The most common mechanism of injury is high-energy blunt trauma from road traffic collisions. This mechanism is responsible for 41% of injury deaths in children (1–9 years old) and 77% among young people (10–18 years old).2\u0000\u0000One of the great advances in outcomes for children has been the development of paediatric major trauma centres (MTCs) within trauma networks. Prehospital teams will follow defined algorithms to divert severely injured children to MTCs. However, 25% of severely injured children will be brought by their parents in their own vehicles to non-MTC hospitals.3\u0000\u0000Hospital trauma care for children and young people comprises a multispecialty team, including paediatricians, to rapidly identify and appropriately treat high-risk injury patterns. A major trauma outcome study demonstrated that between 1989 and 1995, good quality hospital care reduced the odds of death after severe injury by 16% per year in patients younger than 25 years.4\u0000\u0000The National Institute for Health and Care Excellence (NICE) NG39 ‘Major trauma: assessment and initial management’ guideline was published in February 2016.5 The guideline aims to reduce deaths and disabilities in people with serious injuries by improving the quality of their immediate care. This guideline was published alongside four other major trauma-related guidelines (see box 1). In this guideline review, we focus only on those recommendations of NG39 specific to children and young people. Box 1 \u0000### Resources","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83366045","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-2016-311920","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311920","url":null,"abstract":"When I was a very new paediatric doctor I worked in a unit that routinely used steam to treat children who had croup. It was a fantastic treatment—you could tell that you were doing something seriously efficacious; you would open the cubicle door to review the child and walk into this thick humid atmosphere— you could almost hear the witches chanting ‘Double, double toil and trouble; Fire burn, and caldron bubble’ in the distance. There was just one problem. It was rubbish. This was roundly demonstrated when new smoke detector systems were installed which were triggered by the steam, so we had to stop using it; it made absolutely no difference to the children we were treating. The evidence that steam was a waste of time was well established even by this time—plus the risks of directly or indirectly teaching parents insanities like ‘boil a kettle in the corner of the child’s room’ were apparent. But it took a practical issue like fire alarms to make us change our practice. I recalled this experience when reading the paper from Carroll and Sinivas (see page 113). They describe the very familiar scenario of a 13-month-old child with recurrent wheeze; indeed they comment that they’ve seen dozens of such patients in the last 12 months. It made me think that if they’d only so few, then no wonder they’ve the time to write such an excellent review; sometimes it seems that my practice is wall to wall with such patients. We’ve got used to using our slightly more modern ‘toil and trouble’ treatments —because, boy, nebulisers are jolly efficacious looking treatments, aren’t they? Indeed, if you compared a nebuliser with, say, a bone marrow transplant—perhaps the single most anticlimactic looking therapy I’ve ever observed—then I know which one looks the more efficacious. But in this careful review they note that there really is no evidence that bronchodilators are of any use in the vast majority of patients, and that our—and our families’—perception that they’re helpful is just that. This paper is this month’s Editor’s choice. So, speaking of perceptions of usefulness, who has bought into the sales pitch for the newer tests for TB—the interferon γ release assays (IGRA) tests? I’ll admit that I did, buoyed up by enthusiasm from a number of sources. A shame then that they’re a tricky and expensive way of saying pretty much exactly the same as a Mantoux—with roughly the same specificity and sensitivity. Of course, I’m stressing the positive points of a Mantoux over an IGRA here, and Pollock, Roy and Kampmann provide a useful comparison table between the two, in their Interpretations article on IGRA (see page 99). Elsewhere in the journal we have an Interpretations paper from Jong and colleagues (see page 93) on how to use neonatal TORCH testing—a much misused generalisation used instead of actually doing the right test for the right indication. We also have a great addition to Lio’s everfascinating Dermatophile collection —I hope you note that I’ve avoided the ","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90632794","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… serum creatinine, cystatin C and GFR","authors":"Swetha Pasala, J. Carmody","doi":"10.1136/archdischild-2016-311062","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311062","url":null,"abstract":"Glomerular filtration rate (GFR) is the best overall measure of kidney function. The GFR is relatively low at birth but increases through infancy and early childhood to reach adult levels of approximately 120 mL/min/1.73 m2 by age 2. While GFR can be measured most accurately by the urinary clearance of an exogenous ideal filtration marker such as inulin, it is more clinically useful to estimate GFR using a single serum measurement of an endogenous biomarker such as creatinine or cystatin C. When in steady state, there is an inverse relationship between creatinine/cystatin C and GFR, allowing GFR to be estimated from either using simple equations. Because of the non-linear relationship between creatinine/cystatin C and GFR, relatively small initial increases in these markers represent significant decreases in GFR. While cystatin C is produced by all nucleated cells, creatinine is a waste product of muscle metabolism and is therefore influenced by diet and muscle mass/body habitus. Decreased GFR is used to diagnose and stage chronic kidney disease (CKD) using the Kidney Disease: Improving Global Outcomes system. A diagnosis of CKD requires GFR <60 mL/min/1.73 m2 for more than 3 months; higher GFR also represents CKD if evidence of kidney damage (such as albuminuria or abnormal imaging) is present. Changes in serum creatinine and urine output are used to diagnose acute kidney injury. It is possible to calculate a kinetic GFR when the creatinine is changing rapidly, though more complex calculations are required.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82160673","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-2016-311515","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311515","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79991724","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}