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关键词： Paediatric tibial fractures   Ilizarov frame   Cast treatment   Heath related quality of life   Psychological functioning   Post-traumatic stress   Trauma  

摘要： Purpose: To compare quality of life in children and adolescents with tibial fracture during treatment with either a definitive long-leg cast or Ilizarov frame. Methods: A prospective, longitudinal cohort study was undertaken. Patients aged between 5 and 17 years with tibial fractures treated definitively using a long-leg cast or Ilizarov frame were recruited at first follow-up. Health related quality of life was measured at each clinic appointment during treatment using the Pediatric Quality of Life Inventory (PedsQL) [1];a validated measure of age-adjusted physical and psychosocial functioning. Psychological trauma symptoms were assessed using the Children's Revised Impact of Events Scale (CRIES) [2]. Results were analysed based on time from injury (less than 30 days, 30 to 120 days). Data regarding injury and treatment was recorded from the clinical records. Statistical analysis was undertaken using a Kruksal-Wallis test with a Tukey-Kramer subgroup analysis. Results: Twenty-five patients from each group were included in the final analysis. Injuries were more severe in the frame patients based on the AO/OTA classification and number of open fractures. No statistically significant differences were detected in any of the outcome scores between treatment groups at either time point. A significant improvement was found in the child reported physical and total domains in both treatment groups based on time from application (<30 days vs. >30 days, frame: p < 0.0001, cast: p = 0.003). There were no differences in the child reported psychosocial domain scores at any time point or between treatment groups. Parent reported scores only showed a significant physical improvement in the frame group (p < 0.0001). CRIES scores for psychological trauma in the intrusion and avoidance domain improved significantly in the cast group between time points (p < 0.05), Multivariate analysis identified polytrauma, mechanism of injury and time from injury but not treatment modality (cast or

摘要： Linked Article: Maslin et al. Br J Dermatol 2020; 182:300–303.

关键词： Antibiotics   Odontogenic infection   Paediatric   Management  

摘要： Purpose To investigate the outpatient and inpatient management of odontogenic infections among paediatric patients attending a university hospital. Methods A retrospective study (2013-2015) was carried out which involved retrieving relevant data from past records (manual/electronic) of paediatric patients (under 18-years-old) who presented with odontogenic infections to the Paediatric Dentistry and Oral and Maxillofacial clinic. Data collected was organised using descriptive statistics with SPSS version 12.0.1. Results A total of 153 patients were identified, of which 83.7% were managed as outpatients. Odontogenic infections were more common in females (52.9%) and preschool children (58.2%). The most cases were seen in 2014 and maximum number of cases per month was 12. Common presentations were pain (62.1%), intraoral swelling (37.9%) and spontaneous pus discharge from the tooth and/or surrounding tissues (67.3%) with higher involvement of primary right molars. Dental panoramic tomograph was the most common radiographic investigation done. Outpatients were commonly managed chairside with pulpal opening (46.1%) at the paediatric dental clinic and 7% underwent extraction under general anaesthesia in day-care setting. Inpatients were admitted for 3 days on average and most commonly definitive care was extraction under local/general anaesthesia (68%). There were 22.7% outpatients and 72.0% inpatients who were prescribed antibiotics. Conclusions Overall, treatment and medications prescribed adhered to current guidelines. There was a tendency to solely prescribe antibiotics in 8.6% of outpatients which is contrary to recommendations.

关键词： child   haemothorax   pneumothorax   thoracostomy   trauma  

摘要： Objective Thoracic trauma is a leading cause of paediatric trauma deaths. Traumatic cardiac arrest, tension pneumothorax and massive haemothorax are life-threatening conditions requiring emergency and definitive pleural decompression. In adults, thoracostomy is increasingly preferred over needle thoracocentesis for emergency pleural decompression. The present study reports on the early experience of thoracostomy in children, to inform debate regarding the best approach for emergency pleural compression in paediatric trauma. Methods Retrospective review of Ambulance Victoria and The Royal Children's Hospital Melbourne, Trauma Registry between August 2016 and February 2019 to identify children undergoing thoracostomy for trauma, either pre-hospital or in the ED. Results Fourteen children aged 1.2-15 years underwent 23 thoracostomy procedures over the 31 month period. The majority of patients sustained transport-related injuries, and underwent thoracostomies for the primary indications of hypoxia and hypotension. Two children were in traumatic cardiac arrest. Ten children underwent needle thoracocentesis prior to thoracostomy, but all required thoracostomy to achieve the necessary definitive decompression. All patients were severely injured with multiple-associated serious injuries and median Injury Severity Score 35.5 (17-75), three of whom died from their injuries. Thoracostomy in our cohort had a low complication rate. Conclusion In severely injured children, thoracostomy is an effective and reliable method to achieve emergency pleural decompression, including in the young child. The technical challenges presented by under review process children are real, but can be addressed by training to support a low complication rate. We recommend thoracostomy over needle thoracocentesis as the first-line intervention in children with traumatic cardiac arrest, tension pneumothorax and massive haemothorax.

关键词： Myasthenia   Paediatric   Remission  

摘要： Our aim was to identify clinical outcomes, serological features and possible prognostic indicators of paediatric myasthenia gravis (MG). We collected 74 MG patients with disease onset before the age of 16 years (73% pre-pubertal onset defined as <= 10 years), seen regularly at two UK specialist centres, over a period of 11 years. The cohort was multi-ethnic, with a high number of non-Caucasians (52%). Ocular presentation was seen in 38 (51%) and only 8 (21%) of these generalised. Fifty-two (70%) patients had antibodies to the acetylcholine receptor (AChR) measured by radioimmunoprecipitation, 10 (14%) had antibodies only to clustered AChRs detected by a cell based assay, 3 (4%) had muscle-specific kinase and one (1%) low-density lipoprotein receptor-related protein 4 antibody. Only 8 (11%) had no detectable antibodies. Seventeen patients attained drug free remission (Kaplan Meyer survival curve estimates 25% by 7 years). Several factors were associated with a higher likelihood of free remission: onset age <= 10 years, Asian and Caucasian races, lack of AChR antibodies on RIA, and normal repetitive nerve stimulation at diagnosis. However, in a multifactorial regression analysis, the antibody status was the only significant predictor for drug free remission, with 60% of patients with antibodies only to clustered AChR achieving this outcome. Complete drug free remission is not uncommon in paediatric MG and several factors appear to influence this outcome with antibody status being the most important. These factors can be easily evaluated at diagnosis, and may help to determine whose patients are likely to require more intensive treatments. (C) 2019 Elsevier B.V. All rights reserved.

关键词： Methylphenidate   Atomoxetine   Lisdexamphetamine   Guanfacine   Cardiovascular side effects   Sudden death   Congenital heart defects   Acquired heart disease  

摘要： Introduction: Approved drugs for attention deficit hyperactivity disorder (ADHD) in Spain are methylphenidate, lisdexamphetamine, atomoxetine and guanfacine. Due to adverse cardiovascular effects, mainly increased blood pressure and heart rate, its use in patients with known or undiagnosed heart disease may be controversial. Objective: To obtain a consensus document from the Spanish Society of Paediatric Cardiology and Congenital Heart Diseases (SECPCC) and experts from other Agencies and Societies as a guide for the paediatric cardiologist and physicians who treat children and adolescents with ADHD. Methodology: An analysis was performed on the bibliography and Clinical Practice Guidelines, technical data sheets approved by the Spanish Agency of Medicines and Health Devices, and the Spanish Ministry of Health Guidelines. A Working Group was formed, with a Coordinator, as well as members of the Clinical Cardiology Working Group and Arrhythmia Group of the SECPCC. This Group produced a preliminary document that was reviewed by a group of external experts and a group of internal experts of the SECPCC with a consensus being reached on the final document. Results: The recommendations of the SECPCC and the group of experts are presented on cardiovascular evaluation prior to treatment in children and adolescents with no known cardiovascular disease and with known cardiovascular disease. The recommendations of the SECPCC and the group of experts are also presented on the use of medications for ADHD in children and adolescents with cardiological symptoms with no evidence of heart disease, congenital heart disease, cardiomyopathy, Marfan syndrome and other aortic diseases, hypertension, and arrhythmias. (C) 2020 Asociacian Espanola de Pediatria. Published by Elsevier Espana, S.L.U.

关键词： paediatric   quality of life   QoL   temporomandibular joint ankylosis   TMJ  

摘要： A comprehensive evaluation of treatment outcomes in paediatric temporomandibular joint (TMJ) ankylosis patients should include the assessment of quality of life (QoL) along with the traditional clinical indicators. This longitudinal retrospective descriptive study evaluated the impact on QoL of interpositional arthroplasty for the treatment of TMJ ankylosis in 18 patients between 8 and 10 years of age. The subjects completed the Child Perceptions Questionnaire (CPQ 8-10) while their parents/primary caregivers completed the Parental/Caregiver Perceptions Questionnaire (PCPQ), once before and then at 3 months after the surgery. There was a significant improvement in mean cumulative scores for both questionnaires. Significant improvements were seen in the oral symptoms, functional limitation (P < 0.02), and social wellbeing domains (P < 0.05) of the CPQ, and in the oral symptoms and functional limitation (P < 0.05) domains of the PCPQ. The improvements in the physical domains were considered important for treatment success by both groups. The psychosocial domains were observed to be largely unaffected by the condition. The level of agreement between the two groups was higher for physical domains as compared to psychosocial domains. This study indicates that QoL outcomes in paediatric TMJ ankylosis patients are largely influenced by the physical factors, while the psychosocial factors play a secondary role.