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关键词： Cardiology   Timor-Leste   Rheumatic heart disease   Congenital heart disease   Surgery  

摘要： Background The East Timor Hearts Fund (ETHF) is a charitable organisation of Australian cardiologists providing outreach screening in Timor-Leste. For patients requiring intervention, ETHF arranges logistics, procedures, and postoperative care. The aim of this project is to evaluate outcomes of patients requiring intervention. Methods The ETHF database of all patients was utilised to identify patients with disease warranting surgical or percutaneous intervention. Both patients who underwent intervention and those who did not proceed to intervention were included in this study. Patients who had intervention arranged by other organisations but have then had follow-up with ETHF were also included. Overall demographics and pre and postoperative factors were assessed, with sub-group analysis of adult and paediatric patients to identify any differences in care. Results Of 221 patients requiring intervention, 101 patients underwent intervention, receiving 22 different operations or procedures. Patients were predominantly young (median age 17.5 years) and female (64.7%), with rheumatic heart disease (63.8%). Twenty-four (24) (33.3%) women aged 15-45 years old with cardiac disease warranting intervention were documented as pregnant or breastfeeding at time of clinic assessment. Of patients who did not proceed to intervention, adults were more likely to be lost to follow-up (42.4% vs 18.5%) while paediatric patients were more likely to experience progression of disease (18.5% vs 7.5%, p=0.005). Median waitlist time was 5 months, with no significant difference between adults and children, correlating with a preoperative mortality rate of 5.4%. For patients who underwent intervention, post-procedure mortality was extremely low (0.9%) and attendance of at least one post-procedure review was excellent (99.0%). Eleven (11) (10.9%) patients have required repeat intervention, with no difference in rates between adult and paediatric patients. Length of follow-up extends up to 20 year

关键词： AIDS   Children   HIV   Infection   Mother-to-child transmission   Oman  

摘要： Objective: To describe the clinical and epidemiological profiles of HIV-infected Omani children before and after the implementation of the prevention of mother-to-child transmission of HIV (PMTCT) programme. Methods: A retrospective review of HIV-infected children seen at a national paediatric HIV unit between 1992 and 2015 was performed. Results: Ninety-one HIV-infected children were identified;59 (65%) were <= 5 years of age at diagnosis, with 28 (47.5%) of these being <1 year old. The average annual incidence of infection per million children (<= 14 years old) was 5.7, and the highest (11.6) was in 2010. At diagnosis, 48 (60%) patients had a CD4 count of (<)200 cells/mm(3). The median HIV viral load was 81600 copies/ml at diagnosis and 5911 copies/ml at 12 months after HIV treatment (p = 0.015). The median CD4 count was 586 cells/mm(3) at diagnosis and 800 cells/mm(3) at 12 months after therapy (p = 0.004). Compared to those diagnosed before 2009 (n = 68), HIV-infected children diagnosed after 2009 (n = 22) were more likely to be asymptomatic at the time of HIV diagnosis (23.5% (16/68) vs. 59.1% (13/22);p = 0.002) and to have a favourable clinical outcome (42.6% (29/68) vs. 86.4% (19/22);p < 0001). Conclusions: The number of HIV-infected children in Oman has decreased substantially since the introduction of the PMTCT programme. Furthermore, the HIV-infected children diagnosed after 2009 had higher proportions of asymptomatic HIV infections at diagnosis and favourable clinical outcomes, in comparison to those diagnosed before 2009. (c) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://***/licenses/by-nc-nd/4.0/).

关键词： dental emergency   dental trauma   hospital   paediatric   paediatric emergency department   traumatic dental injuries  

摘要： Background/Aim There is a scarcity of data regarding paediatric traumatic dental injuries (TDI) in tertiary teaching hospitals. Therefore, the aim of this study was to review the TDI presenting to the Women's and Children's Hospital in Adelaide (Australia) on an emergency basis and to identify the characteristics of the presenting patient cohort, their accident, injuries and management. Methods Medical health records of 337 paediatric patients attending the Paediatric Emergency Department (PED) for the management of TDI over 18 months were prospectively reviewed. Results TDI were more frequent in children under 5 years of age (56.1%) with a predominance of injuries sustained by males (63.8%). The accident characteristics included weekend occurrence (35.6%), the most common aetiology was falls (64.4%) and many incidents occurred at home (48.5%). Overall, 654 teeth were injured with the majority affecting deciduous teeth (58.4%) and the maxillary central incisors (69.9%). The most frequent injury was lateral luxation (27.5%). The majority of patients were referred to the Paediatric Dentistry Department (60.8%). However, almost half of presenting patients did not require further management locally and were subsequently discharged to their dental practitioners (39.2%). Most patients receiving treatment were managed under general anaesthetic (36.9%), and there was often a delay of 3-12 hours before treatment commenced (49.1%). Similarly, more severe injuries in the permanent dentition (avulsion, extrusion, root fracture, intrusion, alveolar fracture) were more frequently managed between 3 and 12 hours following the accident. Conclusion The patient, accident, injury and management characteristics are comparable to what has previously been reported in other studies in paediatric populations. Injuries affecting the permanent dentition are more likely to be managed within 3 and 12 hours in an outpatient setting, whereas injuries affecting the deciduous dentition had a delay

关键词： Telemedicine   chronic respiratory failure   ventilator-dependent children   life-threatening event   invasive mechanical ventilation   paediatric home care  

摘要： Introduction Advances in paediatric medicine have increased survival rates for patients with severe chronic illnesses, of which the most complex are ventilator-dependent children (VDCs). Although home care improves their quality of life, morbidity and mortality rates are high. Our aim was to study the medical complications (events) that occur at home and assess the usefulness of telemedicine in their detection and treatment. Methods A prospective clinical study (2007-2017) was performed for tracheotomised VDCs. We used a high-density data telemedicine monitoring system from our Paediatric Intensive Care Unit and analysed events during the first two years of home care to study how different variables inter-correlated with the four most common ones: hospital admissions, admissions avoided, event durations and life-threatening events (LTEs);the significance level was set at an alpha of 0.05 in all cases. Results All our VDCs were included (n = 12);there were 141 events, and these were homogeneously distributed over the study period. The incidence was higher in children who were ventilator dependent for more than 12 h a day (70.9%,p < 0.001) and the main cause was respiratory (69.5%,p < 0.001). Telemedicine was the main initial care and monitoring approach (86.5% and 90.1%, respectively,p < 0.001);13 events were LTEs, nine were resolved telemedically, four required medicalised transfer to hospital and three resulted in a hospital admission. Discussion Clinical complications are frequent in VDCs receiving home care, and respiratory decompensation is the most frequent cause. Telemedicine facilitated diagnosis and early treatment, and was useful in managing LTEs.

关键词： Paediatric   Ureteric stent  

摘要： In children, removal of a post-procedural JJ stent requires a further cystoscopy under general anaesthetic. We describe securing the distal end of the ureteric stent to the tip of a balloon catheter at the end of the primary procedure. Once post-operative oedema has subsided, the stent is removed seamlessly in tandem with the balloon catheter. This can be done on the ward by nursing staff without the need for general anaesthesia or sedation. Our experience in the first 10 successive patients (aged 1.6-16.3 years) demonstrates this technique to be safe, easy to learn and well tolerated.

关键词： Bartonella henselae   cat scratch disease   neurological manifestations  

摘要： What is known and objectives Bartonella henselae is the etiologic agent of "cat scratch disease (CSD)". We describe a case of atypical CSD in a paediatric patient and include a review of the antibiotic treatment for this disease. Case description A 2-year-old child, with convulsive status and loss of consciousness, was admitted to hospital. Several antiepileptics and antibiotics were prescribed due to suspected central nervous system infection. When serology revealed Bartonella henselae antibodies, targeted antibiotic therapy was initiated and symptoms improved. However, seizures reappeared days after finishing the treatment so antiepileptics and antibiotics were reintroduced. What is new and conclusion A wide variety of antibiotic regimens have been used for the treatment of atypical CSD in paediatric patients. This report includes the case of a paediatric patient diagnosed with atypical CSD who presented neurological manifestations, and for which a regimen consisting of azithromycin and rifampin was employed to achieve recovery.

摘要： Aims The risk to develop adverse drug reactions (ADRs) is high for paediatric patients. This is, amongst other reasons, due to the inevitable use of off-label and unlicensed medicines. Moreover, there is limited knowledge on ADRs in children. Thus, adequate recognition may be challenging. The lack of dedicated studies and the voluntary nature of pharmacovigilance systems used to gain insight into the characteristics of ADRs contribute to this problem. The goal of this study is to identify whether ADRs in paediatric patients are adequately documented by the medical team and whether they are subsequently reported to the national pharmacovigilance system. Methods All patients admitted to the paediatric medium care of the Radboudumc Amalia Children's hospital during 1 month, and using one or more drugs, were included. Two researchers analysed retrospectively and independently the number of possible ADRs in the medical records. The ADRs were listed per paediatric subspecialty, to evaluate any differences in documentation and reporting of the ADRs. Subsequently, the causality, severity, and seriousness of the ADRs were assessed. The ADRs were categorised by system organ class and drug class. The national pharmacovigilance centre was consulted to check if there were any reports coming from our hospital and to collect the total number of reports. Results The medical records of 301 patients were analysed, 81 patients were suffering from one or more ADRs. In total 132 suspected ADRs were found, divided among 19 different paediatric subspecialties. Numbers were too small to investigate the differences in ADR documentation. Of these found ADRs, 55% were not explicitly noted as such in the medical records by the treating physician. None of the ADRs were reported to the national pharmacovigilance centre. Most ADRs scored 'possible' in the causality assessment, were mild or moderate, and a small number were serious. The ADRs occurred in 25 different organ systems. In total 25 diff

关键词： Emergency medical service   Cardiopulmonary resuscitation   Paediatric out-of-hospital cardiac arrest  

摘要： Background: The absence of nationwide surveillance data on out-of-hospital cardiac arrest (OHCA) in the United States (US) limits understanding of the epidemiology of paediatric OHCA. We investigated the national characteristics of paediatric OHCA using the National Emergency Medical Services Information System (NEMSIS). Methods: We conducted a cross-sectional study using the 2016 NEMSIS dataset, a national registry of emergency medical services (EMS) activations at 46 states in the US. We included paediatric patients (age <18 years) with "9-1-1" EMS responses to OHCA. We defined OHCA as (a) presence of cardiac arrest;(b) EMS reported initiation of cardiac arrest resuscitation;(c) performance of chest compressions;or (d) performance of defibrillation. We reported the incidence and characteristics of paediatric OHCA, stratified by age group: <1 year: infants, 1-5 years: young children, 6-12 years: older children, and 13-17 years: adolescents. Results: Among 1,531,469 paediatric EMS responses, we identified a total of 23,514 EMS responses to paediatric OHCA (95% confidence interval [CI], 23,217-23,814), incidence of 15.4 per 1000 paediatric EMS responses (95% CI, 15.2-15.5), and estimated national incidence of 37.9 per 100,000 child-years (95% CI, 37.4-38.4). Among 23,514 EMS responses to paediatric OHCA, we observed 4515 (19.2%) of EMS responses in infants, 5588 (23.8%) in young children, 4976 (21.2%) in older children, and 8435 (35.9%) in adolescents. Conclusion: Using data from the NEMSIS, we estimate that there are over 23,000 annual paediatric OHCA in the US. These data provide key insights of paediatric OHCA in the US.

摘要： Aim The aim of this survey was to determine compliance towards dental radiography selection criteria for paediatric patients undergoing new patient examinations in specialised tertiary care centres in the United Kingdom. Methods Five university-associated dental hospitals were included in this study. Retrospective data was collected reviewing all paediatric patients on the new patient assessment clinics, where dental imaging was requested or the patient had relevant previous imaging. Data was collected from 28 June 2018, continuing retrospectively for a maximum of six months or until 150 patients were reached. Patients referred solely for orthodontic assessment were excluded. Results Seven hundred and fifty patients were included with an average age of eight years - 95.5% of patients had a radiographic justification provided. All patients were grouped into 56 disease categories and a total range of one cross-sectional and nine planar radiographs were prescribed in this cohort. Each radiograph was assessed for compliance to the Faculty of General Dental Practice, European Association of Paediatric Dentistry and national Italian guidelines for dental diagnostic imaging. Additionally, selection criteria for CBCT scans were taken from SEDENTEXCT guidelines. Full panoramic radiographs were the most commonly prescribed at 34.8% (n = 261). However, this demonstrated the lowest compliance rate as per selection criteria at 75.9%. This was due to referrers requesting radiographs primarily for assessing dental development (18.8%;n = 49) and caries assessment (2.7%;n = 7). Other radiograph formats demonstrated varying levels of guideline compliance ranging from 93.5-100%. Conclusion This study identifies common radiograph request errors and can inform paediatric clinicians to improve compliance to guidelines and reduce radiation exposure to young patients.