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Specialty: Pediatrics
Source: Archives of Disease in Childhood - Education and Practice
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Total 17 results found since Jan 2013.
Know your stroke mimics
A developmentally normal and previously well 15-year-old boy, presented to hospital with a 4-hour history of gradually worsening, throbbing, left-sided headache spreading across his whole head. Four hours prior, he could not read properly or string words together and felt tired. He developed a headache followed by expressive aphasia, agitation and vomiting. A right-sided lower facial droop was noted that resolved in a couple of hours. He played a rugby match in the morning and there was a history of minor head injury without loss of consciousness. He started to develop self-resolving apnoeic episodes each lasting for 30&nd...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2023 Category: Pediatrics Authors: Hanna, D., Holland, J., Lichtblau, N., Maduakor, C., Khan, F., Kerr, T. Tags: Epilogue Source Type: research
Unusual case of stroke in childhood
You receive a prealert call from a paramedic team stating they are managing a 12-year-old girl with acute left-sided weakness. As you prepare for the patient’s arrival, you go through a list of potential differentials. Question 1 Which of the following is not part of the differential list? Haemorrhagic stroke. Hypoglycaemia. Bell’s palsy. Migraine. Todds’ paresis. Question 2 What is the recommended time to CT following this type of presentation to the emergency department? 15 min. 40 min. 60 min. 120 min. The time to CT is only applicable to adult patients. The family report intermittent frontal headaches...
Source: Archives of Disease in Childhood - Education and Practice - September 19, 2022 Category: Pediatrics Authors: Mawhinney, D. C., Mullen, S., Clarke, N. Tags: Epilogue Source Type: research
What is machine learning?
The term machine learning (ML) is emerging more often in the medical literature. There are successful clinical applications of ML with the specialties of ophthalmology and radiology leading the way. For example, in ophthalmology the diagnosis of diabetic retinopathy and retinopathy of prematurity,1 and in radiology the diagnosis of stroke or cancers from digital images is promising.2 This success is expected to expand into other medical disciplines including general paediatrics and its subspecialties. Therefore, healthcare practitioners and researchers are most likely to benefit from getting familiar with ML terminology in...
Source: Archives of Disease in Childhood - Education and Practice - September 19, 2022 Category: Pediatrics Authors: Baloglu, O., Latifi, S. Q., Nazha, A. Tags: Research in practice Source Type: research
Fifteen-minute consultation: Recognition of sickle cell crises in the paediatric emergency department
Children with sickle cell disease can develop life-threatening and painful crises that require prompt assessment and efficient management by healthcare professionals in the emergency or acute care setting. Due to migration patterns and improved survival rates in high-prevalence countries, there is an increased tendency to encounter these patients across the UK. These factors warrant regular revisions in sickle cell crisis management, along with education for medical personnel and patients to improve clinical care and patient management. The focus of this article is on the initial assessment and management of acute paediatr...
Source: Archives of Disease in Childhood - Education and Practice - May 19, 2022 Category: Pediatrics Authors: Patel, S., Dadnam, C., Hewitson, R., Thakur, I., Morgan, J. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research
Public health for paediatricians: population screening
Introduction The concept of population screening—proactive identification of a condition, disease or predisease state in individuals who presume themselves to be healthy but may benefit from early treatment—is a simple one. The translation of this into a screening programme often raises ethical, conceptual and practical challenges. For clinicians used to dealing with patients symptomatically, there are several key differences to understand between treating patients symptomatically compared with the approach to supporting the delivery of a screening programme. There is a range of definitions of screening, which ...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Streetly, A., Madden, V. Tags: Drugs: CNS (not psychiatric), Stroke, Hypertension, Pregnancy, Reproductive medicine, Child health, Neonatal health, Screening (epidemiology), Health promotion, Screening (public health) Source Type: research
Using animal models to improve care of neonatal encephalopathy
Introduction Neonatal encephalopathy (NE) is responsible for a significant burden of disability and death worldwide.1 The use of animal models in the study of perinatal hypoxia-ischaemia (HI) has a history of over 200 years; studies initially showed that the premature animal is more tolerant of asphyxia than a term animal, which is in turn more resistant to asphyxia than an adult.2 3 In the 1950s to the 1970s, studies in the primate model showed that the pattern of brain injury was clearly influenced by the severity and type of HI; these studies led to a description of two patterns of injury, namely acute total asphyx...
Source: Archives of Disease in Childhood - Education and Practice - September 19, 2016 Category: Pediatrics Authors: Lingam, I., Avdic-Belltheus, A., Robertson, N. J. Tags: Clinical trials (epidemiology), Neurological injury, Stroke, Child health, Neonatal and paediatric intensive care, Neonatal health, Experiments in vivo, Trauma, Injury Research in practice Source Type: research
Highlights from this issue
I often find myself concentrating on the Best Practice/Fifteen Minute Consultation style papers in this Epistle, and then feeling a little guilty about it because this is the section I edit myself, so I'm drawn to the papers as I already know them well. This month I can feel less guilty, but more pleasure than usual, as I've had help with a couple. We've all experienced that situation when someone discovers we're a healthcare professional and takes this as a cue to share something astoundingly intimate. I think that the trickiest occasion this happened to me was at a wedding, just before the speeches. The only upside was t...
Source: Archives of Disease in Childhood - Education and Practice - May 17, 2016 Category: Pediatrics Authors: Wacogne, I. Tags: Stomach and duodenum, Epistle, Stroke, Child health, Screening (epidemiology), Medical humanities, Screening (public health) Source Type: research
Different stroke(s)
A 13-year-old boy with mild learning difficulties presented to his district general hospital after an unwitnessed episode of collapse with vomiting but no loss of consciousness. He had 3 days of lethargy and intermittent occipital headaches waking him from sleep. Two days later, after another ‘funny turn’, he represented with right-side paraesthesia, weakness and word-finding difficulty. He had three previous ‘collapses’ over the last 6 months, including symptoms of transient dizziness, slurred speech, dribbling, difficulty swallowing and left-facial paraesthesia from which he had recovere...
Source: Archives of Disease in Childhood - Education and Practice - May 17, 2016 Category: Pediatrics Authors: Mundada, V., Krishnakumar, D., Chitre, M., Das, T. Tags: Oncology, Eye Diseases, Drugs: cardiovascular system, Echocardiography, Headache (including migraine), Infection (neurology), Neurooncology, Pain (neurology), Stroke, Hypertension, Ophthalmology, Valvar diseases, Radiology, Rheumatology, Dermatology, Clin Source Type: research
Stroke
This 18-month-old girl developed left-sided focal seizures, left arm and leg weakness 3 days after an uncomplicated appendicectomy. She had been previously well, and the surgery was uneventful. An urgent cranial MR scan was performed under general anaesthetic within 12 h of the onset of symptoms. Look at the selected images from this study and answer the following questions. Read on to confirm the answers and learn more about the use of diffusion-weighted imaging (DWI) in this condition. Questions There is evidence of acute intracerebral haemorrhage. (True or false?) The abnormality is in the left middle cerebral...
Source: Archives of Disease in Childhood - Education and Practice - May 17, 2016 Category: Pediatrics Authors: Williams, H. Tags: Oncology, Illuminations, Epilepsy and seizures, Stroke, Child health, Other anaesthesia Source Type: research
Answers to Illuminations questions
Answers (1) False, (2) False, (3) True, (4) False, (5) True, (6) False, (7) True, (8) True. This patient has an acute, non-haemorrhagic right middle cerebral territory infarct. There was involvement of the right precentral and postcentral gyri (motor and sensory areas) on other images. The axial T2-weighted image (figure 1) demonstrates high signal in swollen/oedematous ischaemic cortex with effacement of the sulci. There is also restricted diffusion in the affected area, with corresponding high/increased signal (bright) on DWI (figure 2), and low signal (dark) on the apparent diffusion coefficient (ADC) map (figure 3). In...
Source: Archives of Disease in Childhood - Education and Practice - May 17, 2016 Category: Pediatrics Authors: Williams, H. Tags: Oncology, Journalology, Echocardiography, Epilepsy and seizures, Headache (including migraine), Infection (neurology), Neurooncology, Stroke, Child health, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Competing interests (ethics) Illum Source Type: research
Answers to Epilogue questions
AnswersQuestion 1: C Unenhanced CT examination of the brain revealed extensive thrombosis in the superior sagittal, straight and left transverse sinuses (figure 1). The CT angiogram (figure 2) confirmed venous thrombosis and an arterial infarct. It revealed complete occlusion of left internal carotid artery and segmental vasculopathy, affecting multiple intracranial and extracranial vessels of both the anterior and posterior circulation along with an aneurysmal ascending aorta. The contrast-enhanced CT scan demonstrated a filling defect of the superior sagittal sinus with minimal peripheral contrast enhancement, known as t...
Source: Archives of Disease in Childhood - Education and Practice - May 17, 2016 Category: Pediatrics Authors: Mundada, V., Krishnakumar, D., Chitre, M., Das, T. Tags: Journalology, Eye Diseases, Stroke, Diet, Ophthalmology, Child and adolescent psychiatry (paedatrics), Radiology, Disability, Rheumatology, Dermatology, Clinical diagnostic tests, Radiology (diagnostics), Competing interests (ethics), Metabolic disorders Source Type: research
Hypothermia did not improve mortality or disability in severe traumatic brain injury
Study design Design: Randomised controlled trial (RCT). Allocation: Concealed web based algorithm to stratified by study site and age. Blinding: Treating doctors not masked—investigators assessing outcome were masked. Study question Setting: Multinational, multicentre paediatric intensive care unit—75% patients from three paediatric intensive care units (Davis, California; Dallas, Texas; Pittsburgh, Pennsylvania) in USA. Patients: Age 0–17 years non-penetrating brain injury; Glasgow coma scale (GCS) score 3–8 (motor score <6), available for randomisation within 6 h of injury. Excluded i...
Source: Archives of Disease in Childhood - Education and Practice - May 14, 2014 Category: Pediatrics Authors: Tasker, R. C. Tags: Clinical trials (epidemiology), Epidemiologic studies, Coma and raised intracranial pressure, Neurological injury, Stroke, Hypertension, Pregnancy, Reproductive medicine, Child health, Neonatal and paediatric intensive care, Neonatal health, Trauma, Injur Source Type: research
Fitting and flailing: recognition of paediatric antiphospholipid syndrome
We present two cases of paediatric APS, who presented with primary neurological events, and discuss approaches to diagnosis, interpretation of screening investigations, including antinuclear antibodies (ANA), anti-extractable nuclear antigen (ENA) antibodies and lupus anticoagulant. Possible approaches to the management of paediatric APS are discussed.
Source: Archives of Disease in Childhood - Education and Practice - January 13, 2014 Category: Pediatrics Authors: Freeman, H., Patel, J., Fernandez, D., Sharples, P., Ramanan, A. V. Tags: Immunology (including allergy), Drugs: cardiovascular system, Stroke, Screening (epidemiology), Screening (public health) Problem solving in clinical practice Source Type: research
Fifteen minute consultation: headache in children under 5 years of age
Headache occurring in children under the age of 5 years may cause a high level of anxiety in both parents and medical professionals. Crucial to a consultation about this problem will be to actively seek out clues to sinister pathologies, and investigate or reassure as appropriate. Making a positive diagnosis of a primary headache disorder where one exists is also important; however, in young children, headache does not always conform to well-established diagnostic criteria. This short guide provides a practical overview using the scenario of a new referral to the outpatient clinic.
Source: Archives of Disease in Childhood - Education and Practice - September 5, 2013 Category: Pediatrics Authors: McCrea, N., Howells, R. Tags: Headache (including migraine), Pain (neurology), Stroke, Child health Best practice Source Type: research
How to use... lupus anticoagulants
Introduction Lupus anticoagulants (LA) were first detected in patients with systemic lupus erythematosus (SLE) in 1952 by Conley and Hartmann.1 They identified patients in whom the activated partial thromboplastin time (APTT) was prolonged and which did not correct on the addition of normal plasma. Although Conley and Hartmann's original description was in association with a haemorrhagic disorder, subsequent reports from the 1960s highlighted patients with thrombotic events in the presence of LA.2 The term ‘lupus anticoagulant’ was introduced by Feinstein and Rapaport in 1972.3 It has, however, caused some conf...
Source: Archives of Disease in Childhood - Education and Practice - March 14, 2013 Category: Pediatrics Authors: Sen, E. S., Beresford, M. W., Avcin, T., Ramanan, A. V. Tags: Liver disease, Immunology (including allergy), Hepatitis and other GI infections, Travel medicine, Epilepsy and seizures, Headache (including migraine), Stroke, Pregnancy, Reproductive medicine, Rheumatology Interpretations Source Type: research
