Lundgrenphilipsen1955
Ultrasonography in a child with suspected appendicitis is primarily performed to detect inflamed appendix, whereas secondary findings are important in patients with a nonvisualized appendix. The aim of this study is to evaluate the gallbladder wall thickness and volume in patients with suspected appendicitis and search an association between these parameters and appendicitis.
Between January 2018 and August 2018, 113 patients with suspected appendicitis were included in this prospective study. Gallbladder and right lower quadrant were evaluated in separate sessions by different radiologists. The wall thickness along with the width, length, and height of the gallbladder was measured and recorded for each patient. Assessment of the appendix was classified as acute appendicitis, normal, and equivocal. Statistically significant association was sought between the thickness of the gallbladder wall and diagnosis of appendicitis.
Gallbladder wall thickness was significantly higher in patients without appendicitis (P = 0.017), whereas significantly increased gallbladder volume was observed in patients with appendicitis (P = 0.004). Receiver operating characteristic analysis showed gallbladder wall thickness threshold of 0.5 mm with a sensitivity of 83.3, specificity of 93.9, and volume threshold of 41.6 mL with a sensitivity of 100 and a specificity of 0.69.
Gallbladder wall thickness and volume measurements were associated with the diagnosis of appendicitis in pediatric patients.
Gallbladder wall thickness and volume measurements were associated with the diagnosis of appendicitis in pediatric patients.
Open globe injuries (OGIs) in children can be visually devastating traumas and are a common cause of unilateral blindness in children. Three commonly used ocular trauma scores (Ocular Trauma Score [OTS], Pediatric Penetrating Ocular Trauma Score [POTS], and Toddler/Infant Ocular Trauma Score [TOTS]) can be used to help predict visual outcomes in ocular injuries. Each has strengths and weaknesses, but these scores have not been studied extensively in the pediatric population.
The medical records of all pediatric patients presenting at a single institution with OGIs from 2011 to 2016 were retrospectively reviewed. Initial clinical presentation and subsequent examinations were reviewed. The 3 trauma scoring systems were applied to patient data to determine the effectiveness at predicting final visual acuity (VA).
A total of 15 patients met inclusion criteria. The mean age at presentation was 6.97 years. Seven of 15 (47%) of the patients had a final VA of 20/40 or better. The OTS was applied to 8 of 15 patients, as the OTS requires initial VA, which could not be obtained in 7 patients. The POTS and TOTS were applied to all 15 patients. The POTS, TOTS, and OTS were all significantly correlated to final VA. Incidence of relative afferent pupillary defect and more posterior zone of injury were correlated with poorer visual outcomes.
All 3 available ocular trauma scores were effective at predicting final VA in our cohort of pediatric patients with OGIs even outside of the age ranges for which they have been created. Of all the factors included in the scores, relative afferent pupillary defect and zone of injury were most closely correlated with poor final VA.
All 3 available ocular trauma scores were effective at predicting final VA in our cohort of pediatric patients with OGIs even outside of the age ranges for which they have been created. Of all the factors included in the scores, relative afferent pupillary defect and zone of injury were most closely correlated with poor final VA.
Multisystem inflammatory syndrome in children (MIS-C) is a syndrome of abnormal immune response after severe acute respiratory syndrome coronavirus 2 infection that can result in organ dysfunction including severe cardiovascular compromise in children. Increased evidence supports a clinical and laboratory profile in MIS-C distinct from Kawasaki disease, with MIS-C typically occurring in older children and with more prominent gastrointestinal and neurologic symptoms, as well as increased inflammation, lymphopenia, and cardiac injury on laboratory testing. However, high-level evidence regarding best practices for treatment and long-term outcomes in MIS-C is limited.
Multisystem inflammatory syndrome in children (MIS-C) is a syndrome of abnormal immune response after severe acute respiratory syndrome coronavirus 2 infection that can result in organ dysfunction including severe cardiovascular compromise in children. Increased evidence supports a clinical and laboratory profile in MIS-C distinct from Kawasaki disease, with MIS-C typically occurring in older children and with more prominent gastrointestinal and neurologic symptoms, as well as increased inflammation, lymphopenia, and cardiac injury on laboratory testing. However, high-level evidence regarding best practices for treatment and long-term outcomes in MIS-C is limited.
The aim of this study was to describe our expansion of a Massachusetts grassroots initiative-to increase the appointment of pediatric emergency care coordinators (PECCs) in emergency departments (EDs)-to all 6 New England states.
We conducted annual surveys of all EDs in New England from 2015 to 2020 regarding 2014 to 2019, respectively. Data collection included ED characteristics. The intervention from 2018 to 2019 relied on principles of self-organization and collaboration with local stakeholders including state Emergency Medical Services for Children agencies, American College of Emergency Physician state chapters, and Emergency Nursing Association state chapters to help encourage appointment of at least 1 PECC to every ED. Most ED leadership were contacted in person at regional meetings, by e-mail and/or telephone. CFT8634 We reached out to each individual ED to both educate and encourage action.
Survey response rates were greater than 85% in all years. From 2014 to 2016, less than 30% of New England EDs re 90%. This framework also led to the creation of a New England-wide PECC network and has fostered ongoing collaboration and communication throughout the region.
To assess the impact of the COVID-19 pandemic on physical abuse in young children, we compared the following before and during the pandemic (1) skeletal survey volume, (2) percent of skeletal surveys revealing clinically unsuspected (occult) fractures, and (3) clinical severity of presentation. We hypothesized that during the pandemic, children with minor abusive injuries would be less likely to present for care, but severely injured children would present at a comparable rate to prepandemic times. We expected that during the pandemic, the volume of skeletal surveys would decrease but the percentage revealing occult fractures would increase and that injury severity would increase.
We conducted a retrospective study of children younger than 2 years undergoing skeletal surveys because of concern for physical abuse at a tertiary children's hospital. Subjects were identified by querying a radiology database during the March 15, 2019-October 15, 2019 (pre-COVID-19) period and the March 15, 2020-October 15, 202reased presentation of less severely injured children.
Diffuse axonal injury (DAI) is typically associated with significant mechanisms of injury and the effects of acceleration-deceleration forces on brain tissues. The prognosis of DAI remains a matter of active investigation, but little is known about outcome differences between adult and pediatric populations with DAI.
We performed a retrospective cohort study involving blunt trauma patients with DAI between the years 1997 and 2018 from the Israeli National Trauma Registry. The patients were divided to pediatric (age <15 years) and adult (age >15 years) groups, with subsequent comparison of demographics and outcomes.
Diffuse axonal injury was identified in 1983 patients, including 469 pediatric victims (23.6%) and 1514 adults (76.4%). Adults had higher Injury Severity Score (20.5% vs 13.2%, P = 0.0004), increased mortality (17.7% vs 13.4%, P < 0.0001), longer hospitalizations (58.4% vs 44.4%, P < 0.001), and higher rehabilitation need rates (56.4% vs 41.8%, P < 0.0001). Associated extracranial injuries were also more common in adults, particularly to the chest.
Pediatric patients with DAI have improved outcomes and fewer associated injuries than adult counterparts.
Pediatric patients with DAI have improved outcomes and fewer associated injuries than adult counterparts.Background Typhoid and paratyphoid fever (enteric fever) is a common cause of non-specific febrile infection in adults and children presenting to health care facilities in low resource settings such as the South Asia. A 7-day course of a single oral antimicrobial such as ciprofloxacin, cefixime, or azithromycin is commonly used for its treatment. Increasing antimicrobial resistance threatens the effectiveness of these treatment choices. We hypothesize that combined treatment with azithromycin (active mainly intracellularly) and cefixime (active mainly extracellularly) will be a better option for the treatment of clinically suspected and culture-confirmed typhoid fever in South Asia. Methods This is a phase IV, international multi-center, multi-country, comparative participant-and observer-blind, 11 randomised clinical trial. Patients with suspected uncomplicated typhoid fever will be randomized to one of the two interventions Arm A azithromycin 20mg/kg/day oral dose once daily (maximum 1gm/day) and cefixime 20mg/kg/day oral dose in two divided doses (maximum 400mg bd) for 7 days, Arm B azithromycin 20mg/kg/day oral dose once daily (max 1gm/day) for 7 days AND cefixime-matched placebo for 7 days. We will recruit 1500 patients across sites in Bangladesh, India, Nepal, and Pakistan. We will assess whether treatment outcomes are better with the combination after one week of treatment and at one- and three-months follow-up. Discussion Combined treatment may limit the emergence of resistance if one of the components is active against resistant sub-populations not covered by the other antimicrobial activity. If the combined treatment is better than the single antimicrobial treatment, this will be an important result for patients across South Asia and other typhoid endemic areas. Clinicaltrials.gov registration NCT04349826 (16/04/2020).Background The purpose of the present study was to examine the effects of a newly developed computer-assisted instructional package for life skills (CAIFLS) specifically designed to raise awareness of risky sexual behaviors among Thai early adolescents in Bangkok. Methods The research process included two phases (1) the development and (2) the use and evaluation of the newly developed CAIFLS package. First, 5 teachers and 5 Grade 7 students of a Bangkok school were interviewed to collect information needed for the development of CAIFLS. The second phase was to implement learning activities through CAIFLS with a total of 87 Bangkok school students, consisting of 44 students for the experimental group who received CAIFLS for 4 sessions, and 43 students for the control group who received routine class lecture. CAIFLS instructions, lesson plans and worksheets were designed as the experiment methods. Then questionnaires of life skills assessments and student satisfaction were used to investigate the effects and the student satisfaction of CAIFLS.
