General Paediatric Department Research Articles

Гигиеническая оценка суточного рациона питания студентов медицинского вуза

It is difficult to overestimate the relevance of the study of the actual nutrition of students of higher education institutions, as nutrition is the most important component of healthy lifestyle. The aim of the study was to perform hygienic assessment of the medical university students’ daily dietary intake. The study involved 1200 students of the 1st, 2nd and 3rd years at the department of general medicine, pediatric department and dental department. The method of studying actual nutrition with the help of an electronic food diary, where the subjects entered information about the foods consumed during the day, was chosen to record actual nutrition facts. Data processing showed that the daily nutritional intake of students at all the studied faculties was characterized by reduced caloric content, reduced intake of nutritional substances, lack of systematization of meals and eating mainly in the evening. Thus, hygienic assessment of the medical students’ daily dietary intake revealed shortcomings in the organization of nutrition of this population group, which should be eliminated in order to preserve and improve the health of future specialists. In subsequent studies, one would need to assess the nutrition of different gender groups in order to trace the emerging nutritional stereotypes in groups of young men and women, taking into account the differences in age and the chosen specialty.

A STUDY TO ASSESS, MONITOR, AND REPORTING OF ADVERSE DRUG REACTIONS IN A TERTIARY CARE TEACHING HOSPITAL: HIMS, HASSAN

Objective: An adverse drug reaction (ADR) is an unwanted, undesirable effect of a medication that occurs during usual clinical use. ADR should be quickly identified and managed to limit their detrimental effects on the patient. This study was undertaken to characterize the pattern of ADRs reported through spontaneous reporting system at ADR reporting unit in a tertiary care teaching hospital. Methods: A prospective, observational study was conducted over 3 years between September, 2017 and August, 2019. The ADRs reported were from patients admitted inpatient department of hospital. Evaluation of patient demographics, drug and ADR characteristics, and outcome of the ADRs. Causality and severity assessment was done by the World Health Organization system and Naranjos scale. Results: 82 cases of ADRs were reported during the study period. More number of ADRs was from General Medicine and Pediatric departments, in which the most affected organ systems were the skin and the gastrointestinal tract. The antibiotic classes mostly accounted were cephalosporins. None of the ADR was fatal. Conclusion: ADRs to antibiotics are common and will be resulted in increased health-care cost due to the need of some interventions and increased length of hospital stay. The health-care system should promote proper documentation and periodic reporting to regional pharmacovigilance centers to ensure drug safety.

Diagnostic challenges in children with celiac disease. A five-year experience with new guidelines in a General Pediatrics Department

Background. The clinical characteristics of patients with celiac disease cover a wide range of signs and symptoms. Our study aimed to describe the main clinical features and investigations performed on our celiac patients diagnosed in the past five years. Material and methods. We collected data from medical records of patients aged 0 to 18 years diagnosed with celiac disease. We included in the analysis patients newly diagnosed with celiac disease, in our department, between January 2017 and August 2022. Results. In this period, 30 children were diagnosed with celiac disease in our general pediatrics department. The mean age at diagnosis ± standard deviation was 6.3±4.2 years (median age=4.3 years). The period between onset of symptoms ranged between 3 months to 5 years (median=6 months). Twenty children (66%) had features of classical celiac disease. Thirteen/30 patients (43.3%) were found to have iron deficiency anemia at diagnosis. In 23/30 (76%) of the children, the values of the IgA-TGA were more than 10 times the upper limit of the normal values. Nineteen children were diagnosed between 2017 and 2019. Fifteen of these 19 patients (79%) were diagnosed based on positive levels of antibodies and duodenal biopsy samples showing Marsh 2 or 3 features, and 4/19 (21%) based on positive IgA-TGA and AEM and a genetic test showing HLA DQ2 and/or DQ8. Conclusions. Classical celiac disease remains the predominant phenotype in our patients. Adherence to new guidelines allowed in the past 2 years a diagnosis without histological examination of biopsy fragments in most of the patients.

2011. Use of Biofire®Filmarray gastrointestinal panel on clinical decision making and infection control in a General Pediatric Department.

Abstract Background The new Biofire® Filmarray Gastrointestinal Panel (BFGI-BioMérieux, France) offers advantage against conventional cultures of gastrointestinal tract specimens with rapid detection and a broader pathogen identification. Aim of this study is to evaluate the use of BFGI and compare detection of pathogens in GI samples with conventional cultures in hospitalized children with gastroenteritis. Methods A retrospective study was conducted in a General Tertiary level Pediatric Department from Jan 2020 to Apr 2022. Children were included if an appropriate GI tract specimen was obtained for clinical evaluation and was assessed by BFGI. Results were compared with conventional cultures. Demographic, clinical, laboratory data, treatment and the effect of the BFGI on clinical decision making were analyzed. Results Fifty-eight children were included, 27(46%) females, with mean age 5.1 (IQR 9.35). Thirty-one (53%) had an underlying condition, or a prolonged hospital stay. All children had diarrhea, 44% had fever and 25% had vomits. The most common pathogens were Norovirus (8/58), Campylobacter (7/58) and Enteropathogenic Escherichia coli (EPEC, 6/58), followed by Clostridium difficile, Rotavirus and Salmonella spp. Five of the Norovirus cases were detected within a 10-day period, in children that were hospitalized for other reasons, indicating an intrahospital outbreak. In five patients there was a co-infection with 2 or more pathogens. In 35 patients a stool culture (salmonella and shigella) was performed. All cultures were negative. In 20 (57%) patients, culture results were in accordance with a negative BFGI, but in the rest 15 (42%) patients the PCR detected at least one pathogen. Only 17 patients were treated with antimicrobials, because of age < 3 months or the severity of disease/ comorbidities. A macrolide was prescribed in all campylobacter cases (clarithromycin, 57%, azithromycin, 43%). Conclusion In this cohort of hospitalized patients with gastroenteritis, BFGI offered a rapid and more precise result, in comparison to cultures. It helped recognize a norovirus outbreak in the department and improve the infection control measures. Finally, it assisted the clinical decision making leading to more rational and targeted antibiotic administration. Disclosures All Authors: No reported disclosures.

66 Optic neuritis in children

IntroductionOptic neuritis (ON) are rare in children. They are due to inflammation of the optic nerve which results in a sudden drop in visual acuity, or amputation of the visual field. They are often secondary to an infectious disease or vaccination, but they can be part of auto-inflammatory, demyelinating or systemic diseases. The features of optic neuritis in children are different from adults as regards high rate of bilateral involvement, poor visual acuity, and papillitis.AimOur aim is to describe the clinical and therapeutic outcomes of patients diagnosed with optic neuritis in the general pediatrics department at the CHU of Bab el Oued in Algiers.MethodsIt is a retrospective, descriptive study of patients who were treated for optic neuritis in our hospital over a period of three years (January 2018 to April 2021).ResultsThere were 7 cases, 4 girls and 3 boys with F: M of 1.3:1, mean age of 10 years and age range of 6–13 years. The first manifestation was a decrease in visual acuity in all cases, 12 eyes affected, with bilateral involvement in 5 patients. Visual acuity decrease was severe < 3/10 in 80% of cases. The visual field was pathological in 2 cases (narrow, central scotoma). All patients had headaches.Retrobulbar involvement was confirmed by visual evoked potentials in all patients, they showed demyelinating involvement. Three patients presented papillitis.The diagnostic work-up included cerebral imaging which showed old nodular abnormalities of signal of the subcortical white matter in one patient.CSF analysis revealed anti-MOG antibodies in only one case. The infection investigations were negative in all cases except positive COVID 19 serology in one caseThe diagnosis retained in our patients were 2 cases of Behcet's disease, 1 monophasic neuritis, 1 optic neuritis with anti-MOG, 1 CRION, 1 case linked to COVID 19 in the absence of another plausible cause. In one case, no diagnosis was retained.Seventy percent of the patients benefited from treatment with corticosteroids pulse, only 2 did not receive treatment, the short-term evolution was favorable in 5 patients with a total recovery of visual acuity, one patient has evolved into atrophy of the left optic nerve and kept visual acuity low to 1/10 of the left eye.The medium-term evolution was marked by recurrence in 3 patients, 5 episodes in the 2 patients with Behcet's disease and 8 episodes in CRION which required the use of immunosuppressive treatment and biotherapy for Behcet's disease and plasmapheresis for CRION.ConclusionDespite the fact that our small series of patients is not representative, we found similar characteristics described in children in other studies. The average onset age was 10 years, with a female predominance, the severe decrease in visual acuity with frequent bilateral involvement. The diagnosis of ON is clinical and must be considered in any sudden drop in visual acuity. The diagnosis of the underlying pathology is often difficult but it’s important in order to propose an adequate specific treatment. The treatment of children's ON is controversial and usually extrapolated from adults. Most practitioners use corticosteroids pulse. The visual prognosis seems good in children, particularly in the case of bilateral involvement, but depends essentially on the aetiology.

54 Kawasaki disease: experience in a general paediatric department of the CHU de Annaba Algeria

Abstract Background Kawasaki disease (adeno-cutaneous-mucosal syndrome) is an acute febrile systemic vasculitis, affecting with predilection infants. Of unknown aetiology, its diagnosis is based on clinical criteria validated by the CDC and updated by the American Heart Association. Its prognosis is linked to the presence of coronary complications. Its prevalence in Algeria remains unknown, the increase in the number of cases in recent years has raised questions about its situation in our department. Objective To study the epidemiological, diagnostic, therapeutic, biological and evolutionary aspects of this disease. Materials and methods The authors report the results of a retrospective study of 2 years and 4 months, concerning 15 cases of Kawasaki disease hospitalized and treated in the pediatric department of the University Hospital of Annaba. The information was obtained from the hospitalization records. Results 15 cases of Kawasaki disease were identified during the study period. Almost half of the patients were between 2 and 5 years of age, with an average age of 26.3 months (range: 11 months-9 years). A clear male predominance was noted (SR: 2). The reasons for hospitalization were dominated by fever (73%), skin involvement (66%) and stomatitis (40%). The clinical examination showed the frequency of the classical criteria of the disease with almost constant fever (100%), polymorphous skin rash 93.33%, oral-pharyngeal involvement 93.33%, involvement of hands and feet 40%, conjunctivitis 53.33% and adenopathies 46.67%. Biologically, the blood count showed anaemia (93.33%), hyperleukocytosis (66.67%) and hyperplateletosis (46.67%); an accelerated blood count in all our patients and an elevated CRP in 86.67% of cases. Doppler ultrasound performed in all patients returned normal in 73.33% of cases and found 2 cases of mitral insufficiency and 1 case of 8 mm coronary aneurysm. All our patients were treated with human immunoglobulins (2 g/kg IV) associated with aspirin 80–100 mg/kg/d in 4 doses. The evolution was favorable for all our patients. Conclusion Kawasaki disease is a pediatric vasculitis whose severity is related to coronary complications, which are prevented by early administration of IG and aspirin. It is therefore imperative to think of the disease in front of a prolonged fever associated with cutaneous and mucosal clinical signs and a biological inflammatory syndrome.

Prevalence and clinical presentation of adenoid hypertrophy among children attending at pediatric outpatient department of a tertiary care general hospital of Dhaka

Background: Adenoid hypertrophy (AH) and it consequences are common in the entire childhood period. This study was aimed to estimate the prevalence, to enumerate the presence of risk factors and pattern of presentations of AH among children attending at pediatric outpatient department.&#x0D; Methods: This cross-sectional study was conducted at the general pediatric outpatient department (OPD) of BIRDEM General Hospital-2 (Women and Children), Dhaka from January 2017 to December 2020. All the children aged 1-18 years attending the OPD who had known risk factors or sign-symptoms of AH were underwent a lateral nasopharyngeal x-ray to confirm the presence of enlarged adenoid. Those children who had enlarged adenoid were analyzed in this study.&#x0D; Results: A total of 20234 children attended the general pediatric OPD during the study period, of them, 463 had evidences of enlarged adenoid on lateral nasopharyngeal x-ray, giving a prevalence of 2.3%. The mean age of presentation was 100.6±58 months. Among the AH cases 86% had allergic sensitivity to house dust, 60% had allergic rhinitis, 55.5% had history of recurrent tonsillitis and 55.3% children were exposed to cigarette smoke especially at home. Most common presentation of AH was mouth breathing especially during sleep time (90.5%). Other common presenting features were nasal obstruction (83.6%), nasal discharge (73%), drooling of saliva (72.4%), daytime somnolence (65.2%) and snoring during sleep (61.8%). According to our study AH may be asymptomatic in 5% cases. However, it may be presented with complications such as OSA (obstructive sleep apnea) (26.6%), adenoid facies (13.8%) and otitis media with effusion with or without hearing impairment (12.5%). Eighty two (17.7%) need referral to ENT OPD for adenoidectomy. Most common indication for adenoidectomy was obstructive sleep apnea (41.5%).&#x0D; Conclusion: Prevalence of adenoid hypertrophy among children attending at pediatric outpatient department was 2.3%, of them 17.7% had indication for adenoidectomy. Allergic sensitivity to house dust was the most common risk factors. Most common two clinical presentations were mouth breathing and nasal obstruction and most common complication was obstructive sleep apnea.&#x0D; BIRDEM Med J 2022; 12(2): 111-116

Discrepancies Between the Management of Fever in Young Infants Admitted From Urban General Emergency Departments and Pediatric Emergency Departments.

Most pediatric emergency visits occur in general emergency departments (GED). Our study aims to assess whether medical decision making regarding the management of febrile infants differs in GEDs from pediatric EDs (PED) and deviates from pediatric expert consensus. We conducted a retrospective chart review on patients younger than 60 days with fever admitted from 13 GEDs versus 1 PED to a children's hospital over a 3-year period. Adherence to consensus guidelines was measured by frequency of performing critical components of initial management, including blood culture, urine culture, attempted lumbar puncture, and antibiotic administration (<29 days old), or complete blood count and/or C-reactive protein, blood culture, and urine culture (29-60 days old). Additional outcomes included lumbar puncture, collecting urine specimens via catheterization, and timing of antibiotics. A total of 176 patient charts were included. Sixty-four (36%) patients were younger than 29 days, and 112 (64%) were 29 to 60 days old. Eighty-eight (50%) patients were admitted from GEDs.In infants younger than 29 days managed in the GEDs (n = 32), 65.6% (n = 21) of patients underwent all 4 critical items compared with 96.9% (n = 31, P = 0.003) in the PED. In infants 29 to 60 days old managed in GEDs (n = 56), 64.3% (n = 36) patients underwent all 3 critical items compared with 91.1% (n = 51, P < 0.001) in the PED. This retrospective study suggests that providers managing young infants with fever in 13 GEDs differ significantly from providers in the PED examined and literature consensus. Inconsistent testing and treatment practices may put young infants at risk for undetected bacterial infection.

Prevalence of Candida species in Urinary Tract Infections from a Tertiary Care Hospital at Lucknow, Uttar Pradesh, India: A Retrospective Study

Introduction: The presence of Candida in urine, called Candiduria. Immunocompromised individuals are more susceptible to this infection and it can cause life-threatening complications. Candida albicans is most common isolate in Urinary Tract Infections (UTI) but in recent years this is shifting to non-albicans groups. Researchers found that azole is the drug of choice against Candida infections but due to excess use of these drugs resistance is developing more frequently for azole group drugs and drug resistant isolates are increasing gradually. A unique virulence factor i.e biofilm production, similarly like bacterial species is a crucial factor which contributes to the resistance against antifungal drugs. Aim: To assess the prevalence of Candida spp. in UTI retrospectively. Materials and Methods: The present retrospective study was conducted in Department of Microbiology, T.S Misra Medical College, Lucknow, Uttar-Pradesh, India from January 2018 to February 2020. A total of 1576 urine samples were collected from different wards of hospitals and Intensive Care Unit (ICU) with age group 0-80 years. Out of 1576 urine samples received, 786 had fungal growth, from which 176 Candida spp. were isolated. Candidauria and Candida UTIs data were collected from Institute's microbiology records retrospectively. The obtained results were statistically analysed in numbers and percentages using MS Excel 2013 version. Result: The prevalence of Candida species was 11.2%. The age group between 21-30 years was more prevalent. Diabetes mellitus was the main co-morbidity factor in Candiduria patients. The incidence rate was high in ICU patients 161 (91.5%) than non ICU patients (8.5%). Most the samples were isolated from general medicine (45.3%) and Obstetrics and Gynaecology department (34.8%) followed by general surgery (15.5%) and pediatric department (4.4%). Conclusion: Present study found the high prevalence of candiduria and the isolates were biofilm producers with increasing resistance against most common drugs fluconazole which is a major concern for the treatment and management aspects. In immunocompromised patients, it is important to identify the species of Candida isolates as well as their antifungal susceptibility pattern to assist the clinicians in treating the patients with candiduria.

Retrospective audit of antibiotic use in a university general pediatrics department using hospital pharmacy dispensing data.

Antibiotics are among the most frequently prescribed drugs in children’s hospitals, which is why regular monitoring of antibiotic use in hospitals is of great importance. This retrospective audit (60 months, January 2014 – December 2018) analyzes the antibiotic consumption at a university inpatient department of general pediatrics including neonatal and pediatric intensive care based on pharmacy dispensing data in units of grams per 100 patient days and in Defined Daily Doses per 100 patient days.The results provide potential targets for Antibiotic Stewardship interventions. Conversely, this audit elicits methodological limitations of the method of antibiotic surveillance in pediatrics recommended by the Robert Koch Institute, Berlin.

The evolution of cardiac care for children in Washington, DC.

Cardiac surgery for CHD was pioneered in Washington, DC by Charles Hufnagel and Edgar Davis working at Georgetown University and Children's Hospital of the District of Columbia. Children's Hospital, now Children's National Hospital, had been established just 5 years after the end of the Civil War. In the 1950s, Davis and Hufnagel undertook many open-heart operations using the technique of surface cooling, hypothermia, and circulatory arrest. Hufnagel and Lewis Scott, who founded the cardiology department at Children's, were trained in Boston by Gross and Nadas. Judson Randolph, also a trainee of Gross, introduced cardiac surgery using cardiopulmonary bypass and established the General Pediatric Surgery department at Children's in the 1960s. The transition of hospital staffing from community-based private physicians to full-time hospital employees was often controversial but was complete by the turn of the millennium. The 21st century has seen continuing growth of the new Children's National Heart Institute and consolidation of several congenital cardiac programmes in Washington, DC.

Peripheral Venous Catheter-related Bloodstream Infections in Hospitalized Children: The Role of Gram-negative Bacteria.

Peripheral venous catheter (PVC) is the most used vascular access device in medicine, allowing administration of intravenous fluids and medications. Known complications associated with PVC include extravasation, phlebitis and rarely bloodstream infection (BSI). Data regarding PVC-related BSI in children are lacking. Our aim was to evaluate the epidemiology, clinical and microbiologic characteristics of pediatric inpatients with PVC-related BSI. A retrospective study was conducted in a pediatric tertiary care center. Children with BSI, admitted to general pediatric departments during 2010-2019, were identified and their medical records examined. Patients with BSI and phlebitis were further characterized and included in the analysis. We excluded patients with central venous catheters, other identified source of infection and with BSI upon admission. Data collected included patients' demographics and clinical and microbiologic characteristics. Twenty-seven children with PVC-related BSI were identified and included in the study, consisting of 0.2% of the total BSI cases. Patient's median age was 24 (range, 1.5-213) months, 14/27 (52%) were female and 6 (22%) were previously healthy while 21 (78%) had prior medical conditions. Sixteen (59.3%) patients had Gram-negative BSI and 6 (22.2%) Gram-positive bacteria. Polymicrobial infection occurred in 4 (14.8%) patients and Candida albicans in 1 (3.7%) patient. The most common isolated bacteria were Klebsiella spp and Staphylococcus aureus. Longer dwell-time was a predictor of Gram-negative bacteria. PVC-related BSI due to Gram-negative bacteria was more common than to Gram-positive bacteria. Clinicians should consider an initial broad-spectrum antibiotic coverage for PVC-related BSI in hospitalized pediatric patients.

Severe Bandemia Is Not Associated With Increased Risk for Adverse Events in General Pediatric Emergency Department Patients.

Introduction: The presence of band cells > 10% of the total white blood cell (WBC) count (“bandemia”) is often used as an indicator of serious bacterial illness (SBI). Results from studies of bandemia as a predictor of SBI were conflicting and little is known about the relationship between severe bandemia (SB) and clinical outcomes from SBI in children. We hypothesized that SB (band level > 20%) is not associated with adverse outcomes in an emergency department (ED) pediatric population.Methods: Medical records from children between the ages of two months and 18 years with SB who presented to a tertiary referral regional hospital were studied. Outcomes were categorized as severe adverse events (SAEs) or moderate adverse events (MAEs). Multivariate logistic regressions were used to assess the association between SB and outcomes.Results: We analyzed 102 patients. Mean age (standard deviation, SD) was 5.25 (0.5) years, 18 (18%) had MAE, 21 (21%) had SAE, and no patients died. Mean band levels were similar between groups: no adverse events 28 (10) vs. SAE 31 (9) vs. MAE 27 (8), p=0.64. Multivariate logistic regressions showed SB was not associated with any adverse events (odds ratio (OR) 1.04, 95% confidence interval (CI) 0.9-1.1, p=0.27). Non-normal X-ray (XR) (OR 17, 95% CI 3.3-90, p<0.001) was associated with MAE, while non-normal computerized tomography (CT) scan (OR 15.4, 95% CI 2.2-100+, p=0.002) was associated with SAE.Conclusion: SB was not associated with higher odds of adverse events among the general ED pediatric population. Clinicians should base their clinical judgment on the overall context of history, physical examinations, and other laboratory and imaging data.

A STUDY OF CLINICAL AND SUBCLINICAL CHARACTERISTICS IN ACUTE DIARRHEA IN CHILDREN FROM 2 MONTHS TO 5 YEARS IN HUE CENTRAL HOSPITAL

Background: Mortality of diarrhea have decreased significantly starting in 2000, from about 1.2 million deaths among children under 5 years old to 526,000 in 2015 - a 57% reduction. Despite this, diarrhea remains the second most common cause of death among children under 5, closely following pneumonia. Objectives: To describe clinical and subclinical characteristics of acute diarrhea in children from 2 months to 5 years of age. Subjects and methods: 148 patients from 2 months to 5 years of age who were diagnosed with acute diarrhea for treatment in General Pediatrics Department 1 - Pediatric Center - Hue Central Hospital from April 2018 to April 2019. Set up a cross-sectional study. Results: The group of 2 - 24 months of age accounted for the highest proportion (83.1%), no dehydration (84.5%), dehydration (15.5%), no severe dehydration. The common electrolyte disturbance is hyponatremia (15.5%) and hypokalemia (32.4%). Conclusion: Acute diarrhea in children usually lasts less than 7 days; The common symptoms are vomiting, fever, inflammation of the upper respiratory tract; Laboratory tests showed that peripheral leukocytes were usually not increased and most of them were caused by Rotavirus. Key words: clinical, subclinical, acute diarrhea

Real-life study of the role of high-flow nasal cannula for bronchiolitis in children younger than 3 months hospitalised in general pediatric departments

We aimed to describe the real-life role of high-flow nasal cannula (HFNC) for bronchiolitis in infants under 3 months of age admitted to three general pediatric departments during the 2017–2018 epidemic period. We retrospectively assessed the clinical severity (Wang score) for every 24-h period of treatment (H0–H24 and H24–H48) according to the initiated medical care (HFNC, oxygen via nasal cannula, or supportive treatments only), the child's discomfort (EDIN score), and transfer to the pediatric intensive care unit (PICU). A total of 138 infants were included: 47±53 days old, 4661±851.9 g, 70 boys (50.7%), 58 with hypoxemia (42%), Wang score of 6.67±2.58, 110 (79.7%) staying for 48 consecutive hours in the same ward. During the H0–H24 period, only patients treated with HFNC had a statistically significant decrease in the severity score (n=21/110; −2 points, P=0.002) and an improvement in the discomfort score (n=15/63; −3.8 points, P<0.0001). There was no difference between groups during the H24–H48 period. The rate of admission to the PICU was 2.9% for patients treated for at least 24 h with HFNC (n=34/138, 44% with oxygen) versus 16.3% for the others (P=0.033). Early use of HFNC improves both clinical status and discomfort in infants younger than 3 months admitted for moderately severe bronchiolitis, whatever their oxygen status.

COVID-19 threat and frontline paediatric care professionals.

COVID-19 threat and frontline paediatric care professionals.

Reducing time between referral and diagnosis in paediatric outpatient neurodevelopmental and behavioural clinics.

This study investigated the impact of a transdisciplinary advanced allied health practitioner (AAHP) in a public hospital general paediatric outpatient department for children referred for concerns with neurodevelopment, learning and/or behaviour. It was hypothesised that time from referral to initial consultation and diagnosis was reduced for children initially assessed by AAHP. It was also hypothesised that children seen by AAHP were less likely to require a medical specialist appointment. De-identifiable data were gathered from hospital records both retrospectively and prospectively for each group. Data were collected from: 75 children who attended a medical consultation only clinic in 2014; 75 children who attended an AAHP clinic and a medical officer in 2014 and 75 children who attended an AAHP clinic and a medical officer 2 years after establishment in 2016/2017. On average, 52% children were managed independently by the AAHP. Wait time from referral to consultation significantly decreased from 169 days to 48 days. Similarly, time from referral to diagnosis significantly reduced by almost a half, from 57.2 to 30.59 weeks. This study provides preliminary evidence that utilisation of transdisciplinary AAHPs in general paediatric outpatient departments may reduce waitlists, reduce amount of medical specialist appointments required and provide earlier diagnosis for children with neurodevelopmental, behavioural and/or learning difficulties.

Self-reported immunity and opinions on vaccination of hospital personnel among paediatric healthcare workers in Denmark

BackgroundDenmark has no general recommendations for vaccination of healthcare workers (HCWs). We explored the self-reported immunity to varicella, measles, mumps, and rubella, reasons for receiving the influenza vaccine or not, and opinions on vaccination of HCWs against varicella, MMR, pertussis, diphtheria, and influenza among staff from departments with a high risk of exposure to infectious agents. MethodsFrom May 2019 to August 2019, a structured questionnaire was distributed to clinical and non-clinical HCWs at a tertiary and a general paediatric department in Denmark. Self-reported immunity was defined as either previous infection or vaccination against the disease. ResultsOf 619 employed HCWs, 555 (90%) were included. A large proportion were unsure of or denied previous vaccination or infection with measles (20.1%), mumps (30.2%), rubella (21.4%), varicella (12.1%), pertussis (44.1%), and diphtheria (32.1%). Non-clinical personnel and employees born in 1974–1983 had the lowest level of self-reported immunity. Mandatory vaccination of non-immune HCWs was approved by 54–68.9% of participants, and any kind of vaccination (mandatory or as an offer at hospitals) was approved of up to 95.3% of all participants depending on the disease. During the season 2018/19, 214 (38.6%) HCWs received the influenza vaccine, including 20.3% of non-clinical staff, 34.8% of nurses and 56.5% of doctors (P < 0.001). Reasons for lack of vaccine uptake were mainly employees considering themselves rarely sick, the vaccine was not regarded as necessary, forgetfulness or lack of time. Only 37.8% was in favour of mandatory influenza vaccination. ConclusionsA large proportion of paediatric HCWs were not aware of their immune status against important vaccine-preventable diseases. >90% supported vaccination of HCWs, with two out of three supporting mandatory MMR, pertussis and diphtheria vaccination. Better information and an official immunisation policy of non-immune HCWs in Denmark is warranted.

The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children.

The clinical applicability and yield of brain magnetic resonance imaging (MRI) in the setting of an inpatient pediatric department has not been investigated. The authors performed a retrospective chart review of nontraumatic/nonneurosurgical children who underwent brain MRI during their hospitalization in a general pediatric department over a 5-year period. Of the 331 children who underwent brain MRI, 148 (45%) had abnormal findings. High-risk headaches and focal seizures were significantly correlated with findings on brain MRI. Diagnostic and therapeutic yields were most significant in acute demyelinating events, acute cerebrovascular disorders, high-risk headaches when supported by neurologic and ophthalmologic findings, focal seizures with evidence of multifocal epileptic activity on an electroencephalogram and ophthalmic complaints when accompanied by cranial nerve palsy and optic nerve impairment. Since the contributions of a brain MRI in hospitalized children is pivotal in specific clinical situations, a judicious decision-making process should be done before its scheduling, in order to optimize clinical care.

Arthralgia in Egyptian children

Abstract Background Children presenting with joint pains are a very common occurrence in any general pediatric outpatient department. About 15% of general pediatric consultations are for myriad pains of the musculoskeletal system. Aim of the work To screen Egyptian children presenting to a tertiary center for different causes of arthralgia. Subjects and Methods This is a descriptive study that was conducted on 200 pediatric patients (86 males and 114 females) presenting with arthralgia at the Children’s hospital Ain shams University from August 2017 till April 2018. Patients with chronic illness, skeletal deformity, past history of acute rheumatic fever, and any patient with acute febrile illness were excluded. All patients were subjected to full medical history, examination, laboratory investigation as complete blood picture, erythrocyte sedimentation rate, c reactive protein, electrocardiography and echocardiography. Results Around 18% of patients with arthralgia were proved to have post streptococcal arthralgia, 35% had collagen diseases, 10% with malignant conditions. no identifiable cause could be found in 36% of the patients and two patients diagnosed as acute rheumatic fever. Conclusion Arthralgia is a common symptom in the pediatric age group. Although it is a benign condition, sometimes it accurs due to serious illness like malignancy or collagen diseases.