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关键词： elective   inter-hospital   paediatric   surgery   transfer  

摘要： Background A significant number of surgeries in children are being performed in the private setting. Our aim was to determine the rate of unplanned inter-hospital transfers (IHTs) for paediatric patients undergoing elective surgical procedures in a private hospital without a paediatric intensive care unit to a tertiary hospital, and to investigate the reasons for these transfers. Methods A retrospective clinical audit was performed searching hospital coded data of all patients aged 18 years or less at the date of admission, who underwent elective surgery between 1 January 2013 and 31 October 2018 at St Vincent's East Melbourne Private Hospital. Results A total of 17 366 patients were identified, of whom 23 required IHT, with an overall transfer rate of 0.13%. Adenotonsillectomy had the highest IHT rate of 0.26%;however, operative specialty had no statistical correlation with IHT (P = 0.24) with a comparable transfer rate across all specialties. Hypoxia was the most frequent reason for IHT and was the cause in 16 out of 23 transfers (69%). Nine cases (39%) were transferred due to hypoxia while awake and seven (30%) due to hypoxia only while asleep. Three patients requiring IHT were identified as having preoperative acute respiratory illness. Conclusion Elective paediatric surgery undertaken at St Vincent's East Melbourne Private Hospital is safe and has a low IHT rate, with surgery involving the upper airway having a higher risk. In the paediatric population, hypoxia while awake is the most frequent cause for IHT.

关键词： Hydroxymethylglutaryl-CoA reductase inhibitors   dyslipidaemia   paediatrics   risk factors   atherosclerosis  

摘要： Background: The use of statins in children, although not frequent, is recommended in specific clinical contexts, namely, familial hypercholesterolaemia, conditions carrying a moderate-high cardiovascular risk and sub-optimal cholesterol levels after implementation of lifestyle modifications. The aim of this study is to characterise children with dyslipidaemia managed with statins, followed at a tertiary referral centre in central Portugal. Methods and results: The authors carried out a retrospective and descriptive study made up of 66 patients (50% males, mean age of therapy onset 11.9 years) followed up at the Cardiovascular Clinic of a tertiary referral centre between January, 2012, and May, 2018. Clinical, analytical, and echocardiographic parameters were analysed. About 60.6% had clinical and/or molecular diagnosis of familial hypercholesterolaemia. On average, each patient had three cardiovascular risk factors, obesity (31%) being most prevalent, followed by arterial hypertension (14%). Statin therapy showed a statistically significant reduction in the lipid profile, particularly in the total cholesterol (23%) and low-density lipoprotein cholesterol (30%) levels, as well as in the carotid intima-media thickness (p = 0.015). Hepatic and muscle integrity markers were within normal range. Conclusions: Statins are safe and efficient in the management of children with hypercholesterolaemia. Our study showed that apart from its lipid-lowering properties, it also reduced significantly the carotid intima-media thickness and, implicitly, the cardiovascular risk of these patients.

摘要： Children have not been severely affected by SARS-CoV-2-related illness but are vulnerable to the economic and social deprivation arising from the pandemic.[1] This document describes unique risks and burdens for children and their care givers during the COVID-19 pandemic. The allocation of intensive care resources applies to all patients needing ICU, not only those with COVID-19, and it applies to the whole population, from newborns to the elderly. Determining eligibility for ICU admission Eligibility for ICU is based both on the clinical need of the patient and their likelihood of benefit from intensive care. How should non-ICU paediatric clinicians prepare for ICU resource scarcity?. [Extracted from the article]

摘要： The incidence of paediatric glioblastoma is uncommon in comparison to their adult counterpart. Even more infrequent are extraneural metastases in glioblastoma. A previously well 14-year-old female presented with progressive right hemiparesis secondary to a left fronto-temporal lobe glioblastoma (WHO IV). She underwent successful gross total resection for her brain tumour. Prior to commencement of her adjuvant treatment, she developed tumour recurrence associated with intra-lesional haemorrhage. Although she underwent a second surgery, the patient developed bilateral malignant pleural effusion secondary to extraneural pulmonary metastases. Early awareness of its existence enables prompt diagnosis for this devastating disease. The authors emphasize the urgent need for international collaborations to work together for children affected by this challenging brain tumour. (C) 2020 Elsevier Ltd. All rights reserved.

关键词： Ultrasmall bacteria   Filterable bacteria   Nanobacteria   Myalgic encephalomyelitis (ME)   Infectious disease  

摘要： A total of 108 blood samples obtained from 28 male and 80 female patients diagnosed with ME were diluted in sterile, Ringer's Solution and forced (by suction) through 0.2 mu m filters. Of the 28 male samples, 4 yielded filterable bacteria and of the 80 female samples, 18 gave filterable bacteria;as a result, of the total of 124 samples, 22 yielded FB. Filterable (0.4 and 0.2, but not 0.1micron filterable) bacteria were also isolated from the nose throat and skin of paediatric patients and from the throat and skin of staff at an emergency paediatric hospital. The highest percentage of bacterial passage occurred through the largest (0.4 mu(m)) pores. The results show that ultrasmall bacteria occur in ME patients and in paediatric patients and nurses. The potential pathogenic role of such filterable bacteria is briefly discussed. (C) 2020 The Author. Published by Elsevier B.V. on behalf of King Saud University.

关键词： Child health   Health systems evaluation   Paediatrics   Prevention strategies   Other study design  

摘要： Background Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children in South Africa. The PACK Child intervention, comprising clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO's Integrated Management of Childhood Illness programme, extending care of children under 5 years to those aged 0-13 years, those with chronic conditions needing regular follow-up, integration of curative and preventive measures and routine care of the well child. In 2017-2018, PACK Child was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations. Methods Process evaluation using linguistic ethnographic methodology which provides analytical tools for investigating human behaviour, and the shifting meaning of talk and text within context. Methods included semi-structured interviews, focus groups, ethnographic observation, audio-recorded consultations and documentary analysis. Analysis focused on how mapped contextual features structured clinician-caregiver interactions. Results Primary healthcare facilities demonstrated an institutionalised orientation to minimising risk upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely receive routine care. These contextual features constrained the ability of clinicians to use the PACK Child guide to facilitate diagnosis of long-term conditions, elicit and manage psychosocial issues, and navigate use of the guide alongside provincial documentation. Conclusion Ou

关键词： medical image processing   learning (artificial intelligence)   cancer   patient diagnosis   paediatrics   support vector machines   biomedical MRI   image processing technology   PC   computer-assisted method   MRI detection model   algorithm model   combines image processing   detection effect   MRI diagnosis   support vector machine   magnetic resonance imaging   performing paediatric pancreatic cancer diagnosis   poor diagnosis   diagnostic effect   machine learning   SVM  

摘要： When performing paediatric pancreatic cancer (PC) diagnosis, magnetic resonance imaging (MRI) will be interfered by many factors, resulting in poor diagnosis. In order to improve the diagnostic effect of MRI on PC, this study is based on machine learning and combines SVM (support vector machine) and MRI detection with the support of image processing technology and improves the diagnostic accuracy of MRI for PC by the computer-assisted method. At the same time, in the research, this study combines the characteristics of MRI detection to construct an MRI detection model based on SVM. In addition, this study obtains test samples through data collection, analyses the performance of the algorithm model through actual cases, and combines image processing to improve the detection effect. Studies have shown that the algorithm model proposed in this study can effectively improve the accuracy of MRI diagnosis of PC and provide a theoretical reference for subsequent related research.