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关键词： Nail Diseases   Brittle nails   congenital hypertrophy   Toenails   Ingrown Nails   Nail Loss   Nail Abnormality  

摘要： Background Very few studies have been conducted to establish the nature and prevalence of nail disorders in children. Objectives To determine the frequency of various nail conditions in the paediatric setting and to report their management and follow-up. Methods This was a retrospective study between 2007 and 2017 of children under 18. All the patients were evaluated in our paediatric nail clinic at the dermatology department of Queen Fabiola Children's University Hospital. The data were synthesized from information obtained through medical records as well as from photographs taken during consultation. Follow-up was completed by phone interview. Results Three hundred and one patients were included. The majority of nail abnormalities involved the toenails (57.6%). The most common clinical signs were, in descending order, Beau's lines, pachyonychia, subungual hyperkeratosis and onycholysis. The most frequent diagnoses were fever-related Beau's lines or onychomadesis (9.7%), trachyonychia (8.4%), longitudinal melanonychia (8.1%) and congenital malalignment of the great toenail (8.1%). The main diagnoses by age group were as follows: congenital hypertrophy of the lateral nail folds (21.4%) [0-2 years old];fever-related Beau's lines or onychomadesis (21%) [2-6 years old];trachyonychia (22%) [6-12 years old];and juvenile ingrown nail (21.4%) [12-18 years old]. Management included clinical observation for 119 patients and specific advices for 108 patients. A treatment was prescribed for 134 patients, topical in 76.5% of cases. Follow-up demonstrated complete healing in 50.6% of patients and improvement in 19.7%. Conclusion The most frequent nail disorders are benign, and their distribution varies with age. Management mainly involves conservative care, and the prognosis is favourable in the majority.

关键词： Arab   children   clinical trials   off-label medicines   parents   unlicensed medicines  

摘要： Objectives The present study aimed to explore views and attitudes of parents towards the use of unlicensed and off-label medicines in children, paediatric clinical trials, and the role of pharmacists in the safety and effectiveness of medicines. Methods A cross-sectional electronic survey was conducted over social media networks in the Arab world to assess parents' views and attitude towards use of unlicensed/off-label medicines and clinical trials in children. Validated questionnaire was adopted to achieve the study goals. Key findings A total of 4740 respondents completed the online questionnaire. 55.2% have no previous knowledge of use of unlicensed medicines in children. Most of parents thought that they should be told about the use of such medicines, with the doctor (55.0%) selected as the person who should tell parents. Respondents thought that the use of medicines in children was extremely safe or safe. However, this proportion is decreased dramatically (P < 0.001;McNemar test). Views of parents towards clinical trials vary according to child health (child in good health 14.8% versus child suffering of life-threatening condition 50.4%). The majority of respondents thought that pharmacist has a significant role in assuring the safety and efficacy of medicines. Conclusions Limited parents' knowledge about the use of medicines in children and the importance of clinical trials. General consensus about pharmacists' role in ensuring medicines' safety and efficacy.

关键词： Anaesthesia   children   clear fluids   fasting guidelines   milk   preoperative   solids  

摘要： Preoperative fasting period is the prescribed time prior to any procedure done either under general anaesthesia, regional anaesthesia or sedation, when oral intake of liquids or solids are not allowed. This mandatory fasting is a safety precaution that helps to protect from pulmonary aspiration of gastric contents which may occur any time during anaesthesia. We searched PUBMED for English language articles using keywords including child, paediatric, anaesthesia, fasting, preoperative, gastric emptying. We also hand searched references from relevant review articles and major society guidelines. Association of Paediatric Anaesthesiologists of Great Britain and Ireland (APAGBI), the French Language Society of Paediatric Anaesthesiologists and the European Society of Paediatric Anesthetists recommends clear fluid intake upto one hour prior to elective surgery unless specific contraindications exists. Current guidelines recommend fasting duration of 4 hours for breastmilk, 6 hours for milk and light meals and 8 hours for fatty meals. The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend that oral intake can be initiated within hours of surgery in most patients. While fluids can be started almost immediately, the introduction of solids should be done more cautiously.

关键词： Hearing Loss   Pediatrics   Incidence   Hearing Tests   Screening   Ghana  

摘要： Background Paediatric hearing loss rates in Ghana are currently unknown. Methods A cross-sectional study was conducted in peri-urban Kumasi, Ghana;children (aged 3-15 years) were recruited from randomly selected households. Selected children underwent otoscopic examination prior to in-community pure tone screening using the portable ShoeBox audiometer. The LittlEars auditory questionnaire was also administered to caregivers and parents. Results Data were collected from 387 children. After conditioning, 362 children were screened using monaural pure tones presented at 25 dB. Twenty-five children could not be conditioned to behavioural audiometric screening. Eight children were referred based on audiometric screening results. Of those, four were identified as having hearing loss. Four children scored less than the maximum mark of 35 on the LittleEars questionnaire. Of those, three had hearing loss as identified through pure tone screening. The predominant physical finding on otoscopy was ear canal cerumen impaction. Conclusion Paediatric hearing loss is prevalent in Ghana, and should be treated as a public health problem warranting further evaluation and epidemiology characterisation.

关键词： Bibliometrics   Pediatric palliative care   Scientific   publications  

摘要： However, the Pediatric Palliative Care is organized both through political measures with the creation of specific teams, and through pediatric-specific training. We wanted to evaluate to what extent these evolutions are reflected in the publications referenced on this subject. (C) 2019 Elsevier Masson SAS. All rights reserved.

关键词： Juvenile Angiofibrome   Surgery   Le Fort  

摘要： Introduction and objectives: The juvenile nasopharyngeal angiofibroma is a highly vascularised benign neoplasm of complex treatment in its surgical preparation, surgery to be performed, risks and recurrences. The aim of the study was to analyze the management and surgical treatment for the pathology of juvenile nasoangiofibroma. Materials and methods: We reviewed the clinical histories and images of the patients who underwent surgery with a pathology result of juvenile nasoangiofibroma in the period from January 2008 to December 2016. Results: Sixty-one cases were treated;all of them treated using the same surgical access by means of a Le Fort I osteotomy. All of the patients were male, with an average age of 13.3 years. The Andrew-Fish classification was used for staging the cases, most were staged as grade II and I. Conclusions: The described approach provided extensive surgical access, which was adequate for the different stages of the tumour. It requires experience to be able to resect the tumour with the least possible bleeding. (C) 2018 Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello. Published by Elsevier Espana, S.L.U. All rights reserved.

摘要： This commentary is on the original article by Tantsis et al. on pages 1108-1116 of this issue.

关键词： 儿科学   研究  

ISBN: (纸本)9787539069661

摘要： 本书介绍了儿科临床疾病的原因与发病机制、临床表现、诊断与鉴别诊断、系统治疗，阐述了儿科领域的基本理论、基本知识和基本技能，以及儿科的常见病、多发病等。还突出了近年来一批新观念、新理论、新技术在临床上的应用，内容丰富、实用性强。

关键词： child behaviour   dental anxiety   dental fear   distraction  

摘要： Objective To determine whether distraction techniques (DT) reduce children's/adolescent's anxiety and fear during dental treatment. Methods Randomized controlled trials (RCTs) in which any type of DT were used to manage dental anxiety and dental fear in children/adolescents were included. A systematic search of PubMed, Web of Science, Scopus, Cochrane Library, Lilacs, and Google Scholar was conducted. Two independent reviewers selected studies, extracted data, assessed methodological quality of studies using the Cochrane Collaboration's Risk of Bias tool (CCRBT), and approached certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Data were analysed descriptively. Results Twenty studies covering several types of DT (audio, audiovisual, instruments camouflage, biofeedback, dental operating microscope, toys) were included. Qualitative analysis showed with very low certainty of evidence that DT effectively reduced dental anxiety and fear depending on the distraction type, instrument used to measure dental anxiety and dental fear, and dental procedure. CCRBT evaluation identified many methodological issues in included studies. Conclusion There is a very low certainty of evidence that DT can be effective in managing children's/adolescents' dental fear and anxiety during dental treatment. The heterogeneity of methodologies and findings in the studies, however, suggests more robust, and well-executed RCTs are needed.

关键词： Pelvis radiography   Paediatric dose reduction   Digital radiography  

摘要： Purpose: Within paediatric pelvis imaging there is a lack of systematic dose optimisation studies which consider age and size variations. This paper presents data from dose optimisation studies using digital radiography and pelvis phantoms representing 1 and 5-year-old children. Material and method: Dose optimisation included assessments of image quality and radiation dose. Systematic variations using a factorial design for acquisition factors (kVp, mAs, source-detector distance [SDD] and filtration) were undertaken to acquire AP pelvis X-ray images. Perceptual image quality was assessed using a relative and absolute visual grading assessment (VGA) method. Radiation doses were measured by placing a dosimeter at the radiographic centring point on the surface of each phantom. Statistical analyses for determining the optimised parameters included main effects analysis. Results: Optimised techniques, with diagnostically acceptable image quality, for each paediatric age were: 1-year-old;65 kVp, 2 mAs and 115 cm SDD, while, 5-year-old;62 kVp, 8 mAs and 130 cm SDD both included 1 mm Al +0.1 mm Cu additional filtration. The main effect analysis identified situations in which image quality and radiation dose increased or decreased, except for kVp which showed peak image quality when exposure factors were increased. A set of minimum mAs values for producing diagnostic image quality were identified. Increasing SDD, unlike the other exposure factors, showed no trends for producing non-diagnostic images. Conclusion: The factorial design provided an opportunity to identify suitable acquisition factors. This study provided a method for investigating the combined effect of multiple acquisition parameters on image quality and radiation dose for children.