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关键词： Paediatric   Stroke   Resilience   Cognition   Predictors  

摘要： Little is known about resilience after paediatric stroke (PS), or the factors that contribute to better outcomes. Rather, research emphasis has been on impairment, measured through cross-sectional or retrospective designs, often heavily weighted to children presenting for clinical or rehabilitation followup. Implementing a resilience framework, this study aimed to investigate cognitive recovery post-stroke and factors that contribute to cognitive resilience at 12 months following PS. In a single site, prospective, longitudinal study (baseline, 1, 6, 12 months post-stroke), 61 children (55.7% male) aged 0-18 years, with a diagnosis of acute arterial ischemic stroke were recruited. Neurological status, lesion and child characteristics were collected at diagnosis. Cognitive, language and motor skills were assessed directly using age-appropriate, standardised tools. Parents rated their mental health, and child social and adaptive abilities. Participants were classified as 'resilient' (74%) or Vulnerable' based on 12-month cognitive scores. The resilient group demonstrated more intact acute neurological status and higher language and adaptive abilities 1-month post-stroke;88% of the vulnerable group had strokes involving both cortical and subcortical regions. Neonatal stroke, large lesions, cortical-only lesions, and middle cerebral artery involvement were associated with poorer cognition over the 12 months post-stroke. Absence of seizures and older age at stroke predicted better cognitive outcomes. In summary, most children surviving PS are cognitively resilient at 12 months post-insult. Risk and protective factors identified may guide targeted clinical intervention for more vulnerable children. Future research is needed to explore cognitive resilience trajectories beyond 12 months post-stroke. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of European Paediatric Neurology Society.

关键词： Palliative care   paediatrics   child   Delphi technique   communication   prompt list  

摘要： Background: Effective communication is a cornerstone of quality paediatric palliative care. Families report struggling, however, to know what to discuss, with whom, and when. Although question prompt lists exist for adult palliative care, they do not suit the unique circumstances of paediatric palliative care. Aim: To develop a prompt list suitable for paediatric palliative care. Design: Underpinned by Delphi methodology, a six-phase procedure was adopted: (1) drafting items based on the findings of a literature review, (2) condensing the list of items based on group discussion, (3) refining items based on a survey of expert healthcare professionals, (4) additional refining of items based on another survey of professionals, (5) further refining of items based on cognitive interviews with family members, and (6) final review by healthcare professional and family member groups. Participants: Three participant groups were involved during various phases: (1) members of an Australasian paediatric palliative care national reference group, (2) healthcare professionals associated with a local paediatric palliative care service, and (3) family members who were users of the same local service. Results: Through multi-phase consultation across participant groups, the draft question prompt list was refined progressively to 28 items, split across two booklets to allow end-of-life items to be provided separately, and reconceptualised as a discussion prompt list rather than a question prompt list. Conclusion: By involving representatives of major stakeholder groups, this study has facilitated the design of a prompt list suited to the circumstances of paediatric palliative care. Future research should trial the effectiveness of this resource.

关键词： bacterial infection   bloodstream infection   chemotherapy febrile neutropenia   fungal infection   paediatric oncology  

摘要： Febrile neutropenia (FN) is a common and dangerous consequence of myelosuppressive chemotherapy but can occur as part of the disease processes. Bacterial bloodstream infection is the most commonly diagnosed cause of febrile neutropenia, with Gram-positive organisms most frequently isolated. However, Gram-negative organisms are becoming more prevalent, with a worrying trend towards resistant organisms. When FN is prolonged, lasting for more than 5 days, there is an increased risk of invasive fungal infections. Prompt recognition, diagnosis and initiation of treatment with broad-spectrum antibiotics are essential to avoid complications and prevent rapid progression to sepsis and possible death. This short article summarises the definition, causes, pathogenesis, applied physiology and management of FN in children. © 2019 Elsevier Ltd

摘要： Fourteen per cent of the patients did not present with gallstone-related symptoms, but underwent cholecystectomy concomitant with an elective splenectomy for spherocytosis because they had ultrasound findings of gallstones. Half of the patients undergoing elective cholecystectomy due to cholecystitis had experienced more than one episode of cholecystitis. Postoperative stay for patients undergoing only cholecystectomy or cholecystectomy with a concomitant procedure was median 1 (1-19) day and 2 (1-19) days, respectively. [Extracted from the article]

关键词： 中医儿科学   中国   宋代   《小儿药证直诀》   注释  

ISBN: (纸本)9787534987779

摘要： 《小儿药证直诀笺正》是近代名医张寿颐（字山雷）依宋代医家钱仲阳的《小儿药证直诀》一书，结合临证经验进行逐一笺正而成，撰于1922年。全书凡三卷，卷上为脉证治法，计八十一症；卷中为临证治疗案例，凡二十三条；卷下为附方。张氏对原书之精义详加阐发，持论公允，见解独到；对谬误不当之处，则提出自己见解，同时还指出由于时代不同，临床应用不能拘守古方，执一不化，而应灵活化裁，有所变通。是书曾作为兰溪中医专门学校的儿科教材，故又名《幼科学讲义》。

关键词： Lyme   Tick-borne   Borrelia burgdorferi   Child   Surveillance  

摘要： Background: Lyme disease (LD) is an infectious disease that is emerging in eastern and central Canada associated with the spread of the tick vector Ixodes scapularis. National surveillance shows that children are an at-risk age group. Objectives: To study the epidemiology of LD in Canadian children using the Canadian Paediatric Surveillance Program (CPSP) to better understand exposure history, clinical manifestations, diagnosis and treatment of paediatric LD cases in Canada. Methods: A structured questionnaire was completed by paediatricians for each LD case reported as part of the Canadian Paediatric Surveillance Program from 2014 to 2017. Results: There were 95 cases that met inclusion criteria as confirmed or probable cases. The median age was 7 years;38 % were 5-9 years and 35 % were 10-15 years of age. Most cases were acquired in known Canadian endemic locations;5 were acquired during travel to the US. Most cases were reported from Nova Scotia and Ontario (46 % and 38 % respectively). The most common clinical presentation was arthritis (59 % of all cases), which is a manifestation of the late disseminated stage of LD. Late disseminated disease presented through the year, whereas early LD (Erythema migrans) and early disseminated LD presented during the summer and fall. Antibiotic choice and duration of therapy generally followed accepted guidelines. Conclusion: This study of the clinical spectrum of LD in Canadian children underlines the need for preventive measures to protect children in Canada from emerging LD, and the need for health care provider awareness.

关键词： Seroprevalence   Survey   Vaccine   Immunity   Children   Adolescents   Singapore   Epidemiology   Public health  

摘要： Objectives: The Ministry of Health (MOH), Singapore, conducted the National Paediatric Seroprevalence Survey 2018 (NPSS 2018) to estimate the latest immunity levels against measles, rubella, varicella, diphtheria, tetanus and hepatitis B, and the seroprevalence of chronic hepatitis B virus (HBV) carriage in children and adolescents in Singapore. Methods: The survey involved prospective collection of residual sera from 1,200 children and adolescents aged 1-17 years in two public acute hospitals. Enzyme-linked immunosorbent assays (EIA) or plague reduction neutralisation tests (PRNT) were used to determine the seroprevalence of the vaccine-preventable diseases. Results: Overall prevalence of measles and rubella antibodies among Singaporean children and adolescents aged 1-17 years were 98.2% (95% CI: 91.2-98.8%) and 94.8% (95% CI: 93.4-95.9%) respectively. 97.1% (95% CI: 96.0-97.9%) of subjects had at least basic protection against diphtheria, while 89.3% (95% CI: 87.5-91.0%) were protected against tetanus. The prevalence of chronic HBV carriage was 0.4% (95% CI: 0.2-1.0%), while 45.7% (95% CI: 42.9-48.5%) were immune against HBV. The seroprevalence for varicella antibodies was 52.9% (95% CI: 50.1-55.7%). Concordance between vaccination status and seroprevalence was observed for measles, rubella, diphtheria and tetanus. Conclusion: Singapore's children and adolescents are well-protected against measles, rubella, diphtheria and tetanus. Continual efforts in ensuring high vaccination coverage should be sustained. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

关键词： Coeliac disease   Scalloping   Mucosal pattern   Duodenal folds  

摘要： Background and Study Aims: The recognition of suggestive endoscopic markers in the duodenum during open access endoscopy can help identifying patients who are likely to develop coeliac disease (CD). This study aims to determine the diagnostic accuracy of duodenal endoscopic markers for the diagnosis of CD. Patients and methods: All children (0-15 years) who underwent oesophagogastroduodenoscopy (EGD) for any reason suggestive of CD at the paediatric department of Al-Assad University Hospital in Latakia, Syria during a 4-year period (from January 2010 to December 2013) were retrospectively included, in the study;this yielded a consecutive cohort without selection bias. The relevant data were obtained from the patients' files. Four duodenal endoscopic markers, including scalloping, reduction of duodenal folds, nodular mucosal pattern, and scattered white spots, were evaluated. Results: During the study period, 504 children underwent EGD of whom 123 (24.4%) were ultimately diagnosed with CD. At least one marker was observed in 200/504 children (39.6%) and the diagnostic values were as follows: Sensitivity (91%), specificity (76%), positive predictive value (56%), and negative predictive value (97%). Scalloping had the highest sensitivity and specificity of 89% and 96%, respectively. Conclusion: Careful examination of the second and third parts of the duodenum during endoscopy can be helpful in identifying CD. Scalloping is the most common endoscopic marker, and the high NPV values of endoscopic markers should be interpreted cautiously, as the diagnosis of CD can be missed. (C) 2020 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

关键词： Ankle   Injury   Low risk ankle rule   X-ray   Clinical prediction rule  

摘要： Introduction: Ankle injuries are a common presentation to the paediatric emergency department (PED), accounting for approximately 2% of presentations) X-rays are ordered for 85-95% of patients but only 12% of x-rays reveal a fracture. Clinical prediction rules, such as The Low Risk Ankle Rule (LRAR) exist to help clinicians safely reduce the frequency of radiography in these injuries. The LRAR has been shown to reduce imaging by up to 60% without missing any clinically significant fractures. We sought to introduce The LRAR into our department and study its outcomes on our practice. Aims: To introduce the LRAR into our department and study its effects on our radiography rate and length of stay (LOS). Methods: An audit of x-ray rates in ankle injuries in 2016 was performed to determine our department's baseline rate of radiography and LOS. We then conducted education sessions and created x-ray ordering prompts to encourage clinicians to use the LRAR. We introduced the LRAR, with a pilot period initially, and gathered data prospectively. Results: 969 patients presented in with an ankle injury in 2016, 90.7% of these patients had an x-ray. The median LOS was 109 min. 92 patients presented during the LRAR implementation period with an ankle injury. Nine patients had exclusion criteria from using the LRAR and the attending physician did not use the LRAR in four patients. Of the remaining 79 patients, 49 had a LRAR positive exam. Only one of these patients went on to have an x-ray, which was normal. The 30 patients with a LRAR negative exam all had an x-ray. Overall, our x-ray rate during the study period was 40/92 (43.4%), a reduction of 47.3%. The average LOS during the study was 101 min. No clinically significant fractures were missed. Conclusion: The LRAR can safely and effectively reduce the rate of radiography in ankle injuries, without missing any clinically significant fractures. (C) 2020 Elsevier Ltd. All rights reserved.

摘要： Background Investigations of myelin oligodendrocyte glycoprotein (MOG) antibodies are usually focused on demyelinating syndromes, but the entire spectrum of MOG antibody-associated syndromes in children is unknown. In this study, we aimed to determine the frequency and distribution of paediatric demyelinating and encephalitic syndromes with MOG antibodies, their response to treatment, and the phenotypes associated with poor prognosis. Methods In this prospective observational study, children with demyelinating syndromes and with encephalitis other than acute disseminated encephalomyelitis (ADEM) recruited from 40 secondary and tertiary centres in Spain were investigated for MOG antibodies. All MOG antibody-positive cases were included in our study, which assessed syndromes, treatment and response to treatment (ie, number of relapses), outcomes (measured with the modified Rankin scale [mRS]), and phenotypes associated with poor prognosis. We used Fisher's exact and Wilcoxon rank sum tests to analyse clinical features, and survival Cox regression to analyse time to antibody negativity. Findings Between June 1, 2013, and Dec 31, 2018, 239 children with demyelinating syndromes (cohort A) and 296 with encephalitis other than ADEM (cohort B) were recruited. 116 patients had MOG antibodies, including 94 (39%) from cohort A and 22 (7%) from cohort B;57 (49%) were female, with a median age of 6.2 years (IQR 3.7-10.0). Presenting syndromes in these 116 patients included ADEM (46 [68%]), encephalitis other than ADEM (22 [19%]), optic neuritis (20 [17%]), myelitis (13 [11%]), neuromyelitis optica spectrum disorders (six [5%]), and other disorders (nine [8%]). Among the patients with autoimmune encephalitis in cohort B (n=64), MOG antibodies were more common than all neuronal antibodies combined (22 [34%] vs 21 [33%]). After a median follow-up of 42 months (IQR 22-67), 33 (28%) of the 116 patients had relapses, including 17 (17%) of 100 diagnosed at first episode. Steroids, intr