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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

摘要： Tissue samples may be collected from children in the course of their clinical care, or when they participate in research. Those samples may be stored in research biobanks. However, as the removal of tissue from children in Australia is regulated by State and Territory legislation, clinicians and researchers require an understanding of the regulatory framework. Removal of tissue from children for purposes not authorised under legislation can result in offences being committed. In addition, ethical issues arise from the collection and storage of children's tissue for research purposes. Tissue used for genomic research also brings additional risks to participants. This paper describes the current law, discusses its inadequacies and raises some of the key ethical issues that Australian researchers need to know. This paper focuses on the removal and use of paediatric tissue for research purposes only.

关键词： Digital radiography   Exposure factors   Paediatric   Radiation dose   Extremities   Bone   Contrast-to-noise ratio   Image quality  

摘要： The proliferation of digital radiography (DR) has led to a re-evaluation of exposure parameters and image quality. Currently, there is a move towards reducing X-ray tube voltage (kVp) in paediatric exposures down to 40 kVp to achieve better images. However, the effect on patient dose of these modifications is uncertain. The main aims of this phantom study were to evaluate the effect of reducing the kVp in paediatric limb DR exposures on contrast-to-noise ratio (CNR) and patient dose. For this purpose, Monte Carlo simulations of radiographic exposures on a paediatric limb phantom were performed. The phantom included muscle tissue and bone segments of five different densities in the range of 1.12 to 1.48 g/cm(3). The overall thickness of the phantom varied between 1 and 12 cm. Dependence of the CNR at constant limb phantom muscle and bone doses and dependence of the CNR per unit of muscle and bone dose at constant detector dose on radiographic exposure factors and limb thickness were calculated. X-ray tube current-time product (mAs) values required to achieve equal detector dose versus limb thickness for different kVp were calculated, as well as muscle and bone doses for the limb phantom of varying thickness. Present work has shown that reducing the kVp in paediatric radiography of the extremities can result in a significant increase in radiation dose, particularly for thicker limbs. Low kVp radiography requires justification for use on the extremities.

关键词： Parry Romberg syndrome   Progressive facial atrophy   Epilepsy   Seizure   Paediatric  

摘要： Background: Parry-Romberg syndrome (PRS) is a rare disorder characterized by unilateral slow progressive facial atrophy that can be associated with neurologic manifestations, namely seizures. There is scarce data about seizures in paediatric patients with PRS. The aim of our work was to clarify the clinical features of paediatric patients with PRS and seizures. Methods: We performed a literature review based on a literature search using PubMed and EMBASE databases. We included original articles in which the main diagnosis was PRS and the patients were 17 years old or less when the first seizure occurred. Results: We included 40 patients. Most of the patients had previously normal development and had their first seizure in the first decade of life. Neurologic examination was abnormal in 56 % of patients. Seizures are typically focal, frequently with impaired awareness, and became refractory in about 40 % of patients. Few patients have generalized seizures. On electroencephalogram, epileptic discharges are generally focal, on the same side as the facial atrophy, without a predominant cerebral lobe localization. Brain MRI is almost always abnormal, typically with T2 subcortical hyperintensities, and sometimes brain atrophy or calcifications. In addition to the classic antiepileptic drugs, immunosuppressive drugs should be considered as potential epilepsy treatment. Conclusion: To the best of our knowledge, this is the first review dedicated to the characteristics of paediatric patients with PRS and epilepsy. Seizures are usually focal, became refractory in 40 %, and have a significant impact on the quality of life and neurodevelopment of patients.

关键词： Interventional cardiology   Paediatrics   Diagnostic reference levels   Radiation doses  

摘要： This work presents patient radiation dose data for paediatric interventional cardiology procedures in a large paediatric hospital in Chile. This will contribute to setting national diagnostic reference levels (DRLs) for Chile in the near future. The dosimetric data collection period was from January 2018 to December 2018. The local DRIs were calculated as the 3rd quartile of patient dose data distributions for kerma area-product (P-ka) values. The sample of collected clinical procedures (261) was divided into diagnostic and therapeutic procedures and grouped into five weight bands. The P-ka differences found between diagnostic and therapeutic procedures were not statistically significant when comparing the same weight bands, as a result of which we propose a single DRL value for both types of procedure. The local DRLs were 4.9 Gy cm(2) (< 5 kg), 6.6 Gy cm(2) (5- < 15 kg), 13.7 Gy cm(2) (15- < 30 kg), 30.7 Gy cm(2) (30- < 50 kg) and 29.7 Gy cm(2) (50- < 80 kg), respectively. The conclusion from comparing our results with other existing DRL values is that there is ample scope to continue optimizing by reducing patient dose values. Equipment performance, settings used and examination protocols should be reviewed as corrective actions and adapted to patient weight.

关键词： birth cohort   child   community   disease burden   infectious diarrhea  

摘要： Estimates of acute gastroenteritis (AGE) burden are difficult to compare between studies because of inconsistent definitions describing this illness. AGE definitions used in prospective, community-based childhood cohort studies were identified by searching databases for studies that collected daily observations of AGE symptoms. Disease definitions and refractory periods were extracted. Data from the Australian community-based Observational Research in Childhood Infectious Diseases birth cohort were used to calculate AGE incidence and duration using identified AGE definitions, and the World Health Organization definition for diarrhoea. Eight distinct AGE definitions were identified. All included loose stools and 7 included vomiting as symptoms. The refractory period separating episodes ranged from 1 to 21 days. When applied to the Observational Research in Childhood Infectious Diseases dataset, AGE incidence ranged from 0.8 to 2.6 episodes per child-year-at-risk, a 3-fold relative difference. Direct comparisons of rates from different cohorts can only be undertaken if a standard definition for AGE is adopted.