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关键词： mandibular fracture   paediatric mandibular fracture   diagnosis delay   missed diagnosis   mandibular fracture symptoms  

摘要： The purpose of this study was to clarify the frequency of missed mandibular fractures and to identify possible predictive factors for missed diagnosis. This was a retrospective study that included patients <20 years of age with a recent mandibular fracture. The outcome variable was missed mandibular fracture, which was determined when a fracture was not suspected or diagnosed during the patient's first assessment in primary healthcare. The primary predictor variable was age group (i. e. children <13 years or teenagers/adolescents aged 13-19 years). The explanatory variables were sex, mechanism of injury, and type of facial facture. Other variables were clinical symptoms and findings. Mandibular fracture was missed at first contact in 27 of 182 patients (14.8%). Fracture was missed significantly more often in patients <13 years than in older patients (33.3% vs. 8.8%, P < 0.001). The only significant symptom or clinical finding that was associated with missed fractures was skin wound of the jaw (P = 0.009). There was no association between missed fracture and sex or mechanism of injury. Mandibular fractures in children are often missed at the first healthcare contact. Careful examination is necessary in paediatric mandibular injuries, particularly in the youngest age groups. Consultation should be smooth between paediatric trauma units and maxillofacial surgeons.

摘要： Background The gastrointestinal microbiota has an important role in mucosal immune homoeostasis and may contribute to maintaining mucosal healing in Crohn's disease (CD). Aim To identify changes in the microbiota, metabolome and protease activity associated with mucosal healing in established paediatric CD. Methods Twenty-five participants aged 3-18 years with CD, disease duration of over 6 months, and maintenance treatment with biological therapy were recruited. They were divided into a low calprotectin group (faecal calprotectin <100 mu g/g, "mucosal healing," n = 11), and a high calprotectin group (faecal calprotectin >100 mu g/g, "mucosal inflammation," n = 11). 16S gene-based metataxonomics,H-1-NMR spectroscopy-based metabolic profiling and protease activity assays were performed on stool samples. Results Relative abundance ofDialisterspecies was six times greater in the low calprotectin group (q = 0.00999). Alpha and beta diversity, total protease activity and inferred metagenomic profiles did not differ between groups. Pentanoate (valerate) and lysine were principal discriminators in a machine-learning model which differentiated high and low calprotectin samples using NMR spectra (R(2)0.87,Q(2)0.41). Mean relative concentration of pentanoate was 1.35-times greater in the low calprotectin group (95% CI 1.03-1.68,P = 0.036) and was positively correlated withDialister. Mean relative concentration of lysine was 1.54-times greater in the high calprotectin group (95% CI 1.05-2.03,P = 0.028). Conclusions This multiomic study identified an increase inDialisterspecies and pentanoate, and a decrease in lysine, in patients with "mucosal healing." It supports further investigation of these as potential novel therapeutic targets in CD.

关键词： respiratory neurobiology and sleep   sleep apnoea   ventilation  

摘要： See related article

关键词： constipation   functional   Hirschsprung disease   paediatric   slow–   transit constipation  

摘要： Constipation is a common problem in childhood. The most common type of constipation is functional, accounting for 90-95% of all cases. The aim of this review is to provide clinical scenarios with treatment using evidence-based information, and management strategies and a clinical algorithm to guide the management of constipation in children. Recent guidelines and online information sites are detailed. Clinical red flags and organic causes of constipation are included. Four clinical scenarios are presented: case (1) 4-month-old child with constipation since birth and likely Hirschsprung disease;case (2) 6-month-old infant with infant dyschezia;case (3) 4-year old with functional constipation;and;case (4) 9-year old with treatment resistant constipation. Children with functional constipation need a thorough history and physical exam to rule out the presence of any 'red flags' but do not require laboratory investigations. Management includes education and demystification, disimpaction followed by maintenance therapy with oral laxatives, dietary counselling and toilet training. Treatment options differ between infants and children. Disimpaction and maintenance regimens for common laxatives are presented. On treatment failure or on suspicion of organic disease the patient should be referred for further evaluation. The radionuclide intestinal transit study (scintigraphy) is a useful modality for evaluation and planning of management in treatment-resistant children. Treatment options for treatment-resistant patients are presented. High-level evidence (meta-analyses) for pharmalogical and non-pharmalogical treatment modalities are reviewed and an algorithm for assessment and treatment are presented.

关键词： concussion   paediatrics   saccades   vision therapy  

摘要： "Saccadic intrusions in paediatric concussion."Clinical and Experimental Optometry, 103(6), pp. 929–930

关键词： Patient comfort   Paediatric nursing   Intensive care units   Infant welfare   Discomfort factors  

摘要： Introduction: The care of critically ill children is usually invasive and aggressive, requiring numerous traumatic procedures that may cause fear, pain, and discomfort. Objectives: The aim of this study was to analyse the level of discomfort of patients admitted to the paediatric intensive care unit of a specialist children's hospital and to determine the sociodemographic and clinical variables that influence the degree of discomfort experienced by critically ill paediatric patients. Methods: We performed a descriptive observational cross-sectional study that included a total of 311 children with a median age of 5.07 y (interquartile range = 0.9-11.7). A team of 10 paediatric critical care nurses assessed the degree of discomfort once for each shift (morning, afternoon, and night) on 2 successive days using the COMFORT Behavior ScaledSpanish version. Results: In total, 49.8% (n = 155) of the patients were free of discomfort (score <10 points) vs. 50.2% (n = 156) who experienced discomfort. There was a significant negative correlation between discomfort and the length of stay in days (Rho = 0.16;p = 0.02), that is, the longer the stay, the less discomfort the patient felt. The correlation between age and degree of discomfort was found to be both positive and significant (Rho = 0.230, p < 0.001);the greater the age, the greater the discomfort. In comparison of all children who received analgosedation (n = 205), with discomfort levels of 10.77 2.94, with those who did not receive analgosedation (n = 106), with discomfort levels of 11.96 2.80, we did find a statistically significant difference (c2 =-4.05;p < 0.001). Conclusions: Half of the patients admitted to the paediatric intensive care unit experienced discomfort. Age and analgosedation were the two most important variables involved with a high degree of discomfort. Clinical care practices must consider these factors and try to plan activities designed to relieve discomfort in all critically ill paediatric patients

关键词： Myelin-oligodendrocyte glycoprotein   Acquired demyelinating syndromes   Children   Cell based assays   Biomarkers   Neurofilament  

摘要： A first episode of acquired demyelinating disorder (ADS) in children is a diagnostic challenge as different diseases can express similar clinical features. Recently, antibodies against myelin oligodendrocyte glycoprotein (MOG) have emerged as a new ADS biomarker, which clearly allow the identification of monophasic and relapsing ADS forms different from MS predominantly in children. Due to the novelty of this antibody there are still challenges and controversies about its pathogenicity and best technique to detect it. In this manuscript we will discuss the recommendations and caveats on MOG antibody assays, role in the pathogenesis, and additionally discuss the usefulness of other potential new biomarkers in MOG-antibody associated disorders (MOGAD). (C) 2020 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

关键词： education   paediatric   undergraduate   United Kingdom  

摘要： Introduction The quality assurance of undergraduate dental education in the UK is regulated by the General Dental Council who describe the competencies expected of the newly qualified dentist or "safe beginner." Whilst the literature has explored the level of undergraduate training in a number of dental specialties within the UK, there is a paucity of information on the UK curriculum for undergraduate paediatric dental teaching. Aims This study aimed to assess the undergraduate teaching of paediatric dentistry within dental schools in the UK. Methods An anonymous questionnaire was distributed to all 16 UK dental schools via email. Results Twelve questionnaires were completed, giving a response rate of 75%. First exposure to both academic teaching and clinical teaching in paediatric dentistry ranged from years 1-4. Whilst there were broad similarities between units with regard to core components of the curricula, there were notable differences including the teaching of regenerative endodontics (75%) and the use of the titanium trauma splint (58%). Silver diamine fluoride was only used clinically in one unit (8%), and non-vital pulpotomy was taught by two units (16%). There was also considerable heterogeneity in assessment methods between universities. Conclusion The undergraduate paediatric dental curriculum is broadly similar between UK dental schools. However, there are discrepancies in assessment methods and the teaching of new advances.

关键词： Myelin-oligodendrocyte glycoprotein   Children   Treatment   Rituximab   IVIG   Corticosteroids  

摘要： In recent years, the understanding about the different clinical phenotypes, diagnostic and prognostic factors of myelin oligodendrocyte glycoprotein-antibody-associated disorders (MOGAD) has significantly increased. However, there is still lack of evidence-based treatment protocols for acute attacks and children with a relapsing course of the disease. Currently used acute and maintenance treatment regimens are derived from other demyelinating central nervous system diseases and are mostly centre-specific. Therefore, this part of the Paediatric European Collaborative Consensus attempts to provide recommendations for acute and maintenance therapy based on clinical experience and evidence available from mainly retrospective studies. In the acute attack, intravenous methylprednisolone (IVMP) leads to a favourable outcome in the majority of patients and can be followed by tapering of oral steroids up to a maximum of three months to maintain the benefit of acute treatment by suppressing disease activity. Intravenous immunoglobulins (IVIG) and plasmapheresis constitute second-line therapies in case of insufficient response to IVMP. After a first relapse, maintenance treatment should be started in order to prevent further relapses and the possibility of permanent sequelae. Four first-line therapies consisting of rituximab (RTX), azathioprine, mycophenolate mofetil or monthly IVIG have been identified by the consensus group. In case of further relapses despite maintenance treatment, the consensus group recommends treatment escalation with RTX or IVIG, followed by combining those two, and ultimately adding maintenance oral steroids. Many open questions remain which need to be addressed in further international prospective evaluation of MOGAD treatment. This international collaboration is essential to expand the state of current knowledge. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of European Paediatric Neurology Society.