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关键词： Burn   Scald   Paediatric   Mixed method   First aid  

摘要： Background: In sub-Saharan Africa, burn and scald injuries occur more commonly in children aged less than five years, than in any other age group, and carry a high lifetime morbidity. The optimal first aid at the time of injury includes the use of cool running water, which can reduce pain, scarring, and skin grafting. Data on the types of first aid used in Malawi is lacking, as is an in-depth understanding of the underlying factors which may influence this health behaviour. This study sought to: (a) document the types of first aid after paediatric burn and scald injuries in Southern Malawi;and (b) explore factors affecting the choice of first aid used. Methods and findings: We conducted a sequential explanatory mixed methods study. Quantitative analysis of a prospectively collected database of all patients aged less than 17 years admitted to the only burn unit in Southern Malawi was followed by thematic analysis of semi-structured interviews with 15 adults who had witnessed a paediatric burn or scald injury. 1326 patients aged less than 17 years were admitted to the Queen Elizabeth Central Hospital between July 2009 and December 2016. Median age was 3.0 years (IQR 1.9-5.0) and male to female ratio 1:0.9. The commonest cause of injury was hot liquid (45%), followed by open fire (31%) and porridge (12%). First aid was applied in 829 patients (69%), the commonest applications used were water (31%) and egg (21%). There was a statistically significant association between the type of first aid and secondary education of the father (p = 0.009) or mother (p = 0.036);however, the type of first aid used was more likely to be egg rather than water. Analysis of qualitative interviews identified four main themes: perceived roles and responsibilities within the community, drivers of individual behaviours, availability, and trust. Participants reported using eggs as a first aid treatment, as these were readily available and were seen to reduce the occurrence of blisters and preven

关键词： Body temperature   Forehead thermometer   Tympanic thermometer   Axillary thermometer   Children   Bland-Altman  

摘要： Purpose: This study was conducted to investigate the interchangeability of infrared forehead, digital axillary, and infrared tympanic thermometers while identifying the most reliable non-invasive body temperature measurement method in paediatric settings. Design and methods: A multicentre observational study was conducted enrolling all children less than or equal to 14 years of age requiring a temperature measurement and after obtaining their parent's informed consent. Sociodemographic characteristics and temperature values in Celsius (degrees C) were simultaneously collected using forehead, axillary, and tympanic thermometers. Results: A total of 433 children were enrolled, 57.5% were male and the mean age was 5.3 = 3.9 years. The average value of tympanic temperature (37.05 degrees C) was higher than forehead (36.87 degrees C) and axillary (36.8 degrees C). The mean difference between axillary and forehead temperatures (-0.06 degrees C) was not statistically significant (p = 0.158). Comparing the measurements of each type of thermometer with the overall average of the three measurements recorded as the virtual gold standard, Bland Altman analysis highlighted tympanic with narrower 95% limits of agreement (+0.96 degrees C to -0.68 degrees C). The tympanic thermometer also had the highest percentage (81.6%) of differences falling within the maximum clinically acceptable difference (+/- 0.5 degrees C). Conclusions: Differences between paired measurements of the three investigated devices demonstrated the devices are not interchangeable. Measurements using the tympanic thermometer more closely resembled the reference temperature indicating its preferential use in paediatric clinical practice. Practice implications: To safely and consistently measure body temperature, nurses should not assume peripheral thermometers are interchangeable. It is essential to clinically validate all temperature values with clinical observations. (C) 2019 Published by Elsevier Inc.

关键词： Molecular medicine   Paediatric cancer  

摘要： The recognition that new cancer drugs can be truly tumour-agnostic based on mechanism-of-action is important for paediatric cancers, where access to novel targeted therapies developed for adult indications has sometimes been problematic. The recently approved drug larotrectinib is an excellent case study of the development of a tumour-agnostic drug relevant to children.

关键词： COVID-19   Coronavirus   epidemic   Epidemiology   nCoV   Outbreak   Paediatric  

摘要： Objective: This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia Background: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease. Cases: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy. Discussion: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

关键词： children   nutrition   obesity prevention   physical activity   public health policy  

摘要： Global childhood obesity increased more than 8-fold over 40 years, inducing a very large personal, societal, and economic burden. Effects of available treatments are less than satisfactory;therefore, effective prevention is of high priority. In this narrative review, we explore preventive opportunities. The available evidence indicates large benefits of improving nutrition and lifestyle during early life, such as promoting breast-feeding and improving the quality of infant and early childhood feeding. Promoting healthy eating patterns and limiting sugar-containing beverage consumption from early childhood onwards are of great benefit. Regular physical activity and limited sedentary lifestyle and screen time alone have limited effects but are valuable elements in effective multicomponent strategies. The home environment is important, particularly for young children, and can be improved by educating and empowering families. School- and community-based interventions can be effective, such as installing water fountains, improving cafeteria menus, and facilitating regular physical activity. Reducing obesogenic risk factors through societal standards is essential for effective prevention and limiting socioeconomic disparity;these may comprise food, drink, and physical activity standards for day cares and schools, general food quality standards, front-of-pack food labeling, taxation of unhealthy foods, restriction of food advertisements to children, and others. Effective prevention of childhood obesity is not achieved by single interventions but by integrated multicomponent approaches involving multiple stakeholders that address children, families, and societal standards. Pediatricians and their organizations should be proactive in supporting and empowering families to support their children's health, and in promoting societal measures that protect children.

关键词： Insula   Paediatric   SEEG   Operculum   Epilepsy  

摘要： Purpose: Failure to recognise involvement of the insula / opercula (I/O) region is associated with poor outcome in epilepsy surgery. Recognition is challenging due to high connectivity with adjacent structures resulting in variable and misleading semiology, often subjective and therefore likely to be underreported by children. In this study we explored prevalence and characteristics of I/O involvement in paediatric patients undergoing sEEG exploration. Method: We retrospectively included all consecutive patients undergoing sEEG at our centre between 11/2014 and 01/2018 with at least three contacts within I/O and excluded those with undetermined seizure onset zone (SOZ) by sEEG. We divided patients into three groups: 1) SOZ in I/O, 2) spread to I/O and 3) no I/O involvement. We compared pre-invasive characteristics, sEEG results, surgery and outcome for each group. Results: 29 of all 53 consecutive patients had an identified SOZ by sEEG and at least three contacts within the I/O and were included. 41% had I/O SOZ, 38% had I/O spread and 21% had no I/O involvement. Insula associated symptoms described in adult literature were not statistically different between the three groups. Complications due to sEEG were low (2 of 53 patients). Following I/O surgery, 63% were seizure free while an additional 26% of patients achieved seizure reduction. Postoperative deficits were seen in 75% of the patients but completely resolved in all but one patient. Conclusions: Our data suggest an important role of the I/O region with frequent onset or propagation to the I/O region (at least 64% of all 53 sEEG cases). Semiology appears less specific than in adults. Insula depth electrode insertion is safe with subsequent good surgical outcomes albeit common transient deficits.

关键词： intermediate care   paediatric care   paediatric hospitals  

摘要： Keywords: intermediate care; paediatric care; paediatric hospitals EN intermediate care paediatric care paediatric hospitals 1062 1063 2 04/22/20 20200501 NES 200501 Paediatric intermediate care units (PIMCUs) are designed for children with complex or at-risk entities, providing advanced monitoring and therapeutic options when compared to general wards. When PIMCUs are not available, the patients may be admitted to general wards or to intensive care units with an increasing of risk or a waste of resources, respectively. Large prospective studies are warranted to evaluate their impact in improving patients' safety and quality of care, while ameliorating PICU resources utilisation. [Extracted from the article]

关键词： ankylosis   apical root resorption   dental trauma   orthodontic tooth movement   pulp obliteration  

摘要： Background Trauma-induced adverse reactions may trigger complications when moving teeth orthodontically. Aim The purpose of this study was to evaluate the knowledge of dental practitioners about this topic. Design A questionnaire survey was organized among general dentists, paediatric dentists, and orthodontists in Flanders (Belgium). Three clinical cases describing trauma-induced tooth damage (tooth ankylosis, apical root resorption, and pulp/root canal obliteration) were presented, followed by a set of questions. Results The questionnaire was completed by 121 general dentists (GD), 47 paediatric dentists (PD), and 99 orthodontic specialists (OS). In the case with ankylosis, impossibility to move the tooth orthodontically was reported as most frequent adverse reaction (82.8% of GD, 95.7% of PD, and 100.0% of OS) (P < .001). In the situation of apical root resorption, the most frequently reported adverse event was progressive apical root resorption (78.9%, 85.7%, and 88.8% respectively;P = .265). Most frequently mentioned adverse reaction in the case with pulp and root canal obliteration was tooth discoloration (64.1%, 57.1%, and 78.3%;P = .055), followed by apical root resorption (57.4%, 56.8%, and 68.7%;P = .283). Orthodontic treatment recommendation differed among specific clinical situations but also among groups of dental practitioners. Conclusions Important knowledge gaps exist regarding the orthodontic managment of traumatized teeth. This topic requires more attention in undergraduate training, specialist training, and continuing education.