Recommendations For Management Of Children Research Articles

SIOP PODC Adapted treatment guidelines for low grade gliomas in low and middle income settings.

Effective treatment of children with low grade glioma (LGG) requires a functioning multi-disciplinary team with adequate neurosurgical, neuroradiological, pathological, radiotherapy and chemotherapy facilities and personnel. In addition, the treating centre should have the capacity to manage a variety of LGG and treatment-associated complications. These requirements have made it difficult for many centers in low and middle-income countries (LMIC) to offer effective treatment and follow up. This article provides management recommendations for children with LGG according to the level of facilities available.

Management of Pediatric Malignant Germ Cell Tumors: ICMR Consensus Document.

With the introduction of cisplatin, the outcome of children with malignant germ cell tumors (MGCT) has improved to nearly 90% 5 year survival. Over the years, through the results of various multinational co-operative trials, the chemotherapy and surgical guidelines for both the gonadal and extra-gonadal MGCTs have been refined to decrease the early and late morbidities and at the same time improve survival. Introduction of risk categorization has further added to this effort. There has been no recommendation on how the children with malignant germ cell tumors should be treated in India. The current manuscript is written with the objective of developing a consensus guideline for practitioners at a National level. Based on extensively reviewed literature and personal experience of the major pediatric oncology centres in India, the ICMR Expert group has made recommendations for management of children with MGCT India.

Management of Hepatoblastoma: ICMR Consensus Document

Dramatic advancement has been made in the management of children with hepatoblastoma (HB) over the past 3 decades owing to the improvement in diagnostic imaging, new chemotherapeutic agents, better surgical care and availability of liver transplantation. These advances are the end results of contributions from 4 major study groups across the globe including International Society of Pediatric Oncology - Liver Tumor Strategy Group (SIOPEL), Children's Oncology Group (COG), German Pediatric Hematology Oncology Group (GPOH) and Japanese Pediatric Liver Tumor Study Group (JPLT). The current manuscript is written with the objective of developing a consensus guideline for practitioners at a National level. Based on literature and personal experience over last 3 decades, the Indian Council of Medical Research (ICMR) Expert group has made recommendations for management of children with HB in resource-challenged nations including India.

SIOP PODC adapted treatment recommendations for standard-risk medulloblastoma in low and middle income settings.

Effective treatment of children with medulloblastoma requires a functioning multi-disciplinary team with adequate neurosurgical, neuroradiological, pathological, radiotherapy and chemotherapy facilities and personnel. In addition the treating centre should have the capacity to effectively screen and manage any tumour and treatment-associated complications. These requirements have made it difficult for many low and middle-income countries (LMIC) centres to offer curative treatment. This article provides management recommendations for children with standard-risk medulloblastoma (localised tumours in children over the age of 3-5 years) according to the level of facilities available.

Avaliação e recomendações nutricionais para crianças e adolescentes com fibrose cística

OBJETIVO: Revisar e discutir evidências sobre a avaliação do estado nutricional e as recomendações para o tratamento nutricional de crianças e adolescentes com fibrose cística. FONTES DE DADOS: Bancos de dados MEDLINE (versão PubMed) e Latin American and Caribbean Center on Health Sciences Information (LILACS), entre 1984 a 2009. Aplicou-se a combinação dos seguintes descritores: fibrose cística, estado nutricional, criança e adolescente - em inglês e português. SÍNTESE DOS DADOS: A fibrose cística é uma doença genética, de evolução crônica, progressiva e fatal. Resulta do defeito na proteína reguladora transmembrana que regula a condução de cloro e, consequentemente, o fluxo de sódio e água através da membrana apical das células epiteliais. Pacientes fibrocísticos são vulneráveis à desnutrição, que resulta do desequilíbrio entre ingestão alimentar, gasto e perdas energéticas. Novos conhecimentos sobre a fisiopatologia da doença, adquiridos nas últimas décadas, resultaram em mudanças significativas nas atuais recomendações energéticas e principalmente de lipídeos. A importância da nutrição no bem-estar e sobrevida dos fibrocísticos está bem estabelecida, assim como a associação entre a desnutrição e a deterioração da função pulmonar. Existem múltiplos fatores inter-relacionados que afetam o estado nutricional, tais como, mutação genética, insuficiência pancreática, ressecção intestinal, perda de sais e ácidos biliares, refluxo gastroesofágico, inflamação e infecções pulmonares, diabetes e condições emocionais. CONCLUSÕES: O monitoramento nutricional e o aconselhamento dietético são elementos chave no manejo de crianças e adolescentes com fibrose cística com o intuito de controlar a sintomatologia e a progressão da doença, proporcionando melhor qualidade de vida.

Specialist mental healthcare for children with epilepsy: child and adolescent mental health service liaison with neuroscience

Aims and MethodTo describe services used by children with epilepsy seen by a liaison psychiatry team in Scotland and to examine existing guidance. Case notes of all patients with epilepsy were systematically reviewed to determine service involvement.ResultsThe majority of patients attended joint psychiatry and neurology clinics. Scottish Intercollegiate Guidelines Network (SIGN) recommendations for the psychosocial management of children with epilepsy were met. Most patients were assessed by a clinical psychologist and received educational psychology input, individual and family treatment approaches. Half had social work involvement.Clinical ImplicationsA liaison model is presented for the management of children with more complex epilepsy and psychiatric disorders.

Contact Dermatitis: From Basics to Allergodromes

CME Educational Objectives 1. Outline the clinical presentations and pathophysiology of both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). 2. Review the most common allergens and products responsible for allergic contact dermatitis in children. 3. Discuss the recommendations for management of children with suspected contact dermatitis including guidelines for referral for patch testing.

Management of ingested foreign bodies in childhood and review of the literature.

The management of ingested foreign bodies in children is not standardised. During a 15-year period, we recorded 325 consecutive paediatric cases of accidental ingestion of foreign bodies or with symptoms suggesting oesophageal obstruction presented at the emergency department or the paediatric gastroenterology unit. The foreign bodies that had to be removed were, in decreasing order of frequency: coins, toy parts, jewels, batteries, sharp materials such as needles and pins, fish and chicken bones, and "large" amounts of food. Only 54% of the patients had transient symptoms at the moment of ingestion, such as retrosternal pain, cyanosis and dysphagia. A minority (28, 9%) of foreign bodies could be removed with a McGill forceps; 65 (20%) were removed with a magnet probe. Endoscopic removal was performed in 82 cases (25%). In the majority of cases (150, 46%) natural elimination occurred. The outcome of all patients was uneventful. Recommendations for management of children presenting with a history of suspected accidental ingestion of a foreign body for the community paediatrician are proposed.

The Wilms tumour gene, WT1, in normal and abnormal nephrogenesis.

The Wilms tumour gene, WT1, has been shown to play an important role in normal development of the kidney and gonad. Constitutional mutations predispose to both malformation and childhood tumours of these organs. There is a genotype-phenotype correlation, with missense mutations producing more severe abnormalities than complete absence of one allele. Two syndromes with early-onset protein-losing nephropathy can be distinguished according to the type of WT1 mutation. Children with apparently isolated diffuse mesangial sclerosis may also be WT1 mutation carriers. WT1 is not the major gene mutated in Wilms tumour, but has given important insights into the molecular genetics of this childhood embryonal kidney cancer. Recommendations for management of children suspected of having a WT1 mutation are discussed.