Spectrum Of Children Research Articles

Changes cytokine spectrum in children with bronchopulmonary diseases with bronchial obstruction

Changes cytokine spectrum in children with bronchopulmonary diseases with bronchial obstruction

Advantage of Computed Tomography (CT) Virtual Bronchoscopy in the Evaluation of Children with Suspected Foreign Body Airway

Background & Objectives: Foreign body aspiration (FBA) into the tracheo bronchial tree is a frequent and serious cause of respiratory distress and visit to the pediatrics emergency, principally in patients under 3 years of age. Most foreign bodies are not radio opaque and approximately one third of the children admitted will show normal chest X-ray. Virtual bronchoscopy is a relatively new and non-invasive procedure that provides a three dimensional view of the internal walls of the tracheobronchial tree through the reconstruction of axial images. The objectives of the study are, 1) to study the diagnostic accuracy and advantage of virtual bronchoscopy over rigid bronchoscopy in the evaluation of children with suspected FBA and to plan for early management as it is a non-invasive technique; 2) to study the clinical spectrum of children attending with suspected FBA. Methods: An observational study of 37 patients of age 12 yrs and below who underwent Virtual Bronchoscopy for suspected foreign body aspiration in the department of pediatrics and Otorhinolaryngology at MGM Hospital, Warangal is carried out for a period of 1.5 years during 2012-2013. Results: The common age of presentation was 1 - 3 years with male preponderance. History of foreign body was obtained in 64.86% of cases. Normal X-ray was found in 27.02% of cases. In 75.67% FB detected on rigid bronchoscopy was also revealed on virtual bronchoscopy. False positive percentage was 5.40% and false negative was 2.70%. Sensitivity and specificity was 96.5% and 75% respectively. Ground nuts were the commonest foreign bodies aspirated. Conclusion: Virtual bronchoscopy should be considered in cases with suspected foreign body aspiration, when chest X-ray is normal, to avoid needless rigid bronchoscopy. Virtual bronchoscopy is useful in screening cases of occult foreign body as it has sensitivity, specificity, and validity.

Bleeding spectrum in children with moderate or severe von Willebrand disease: Relevance of pediatric‐specific bleeding

The bleeding phenotype of children with von Willebrand disease (VWD) needs to be characterized in detail to facilitate diagnosis during childhood and aid in the planning and assessment of treatment strategies. The objective was to evaluate the occurrence, type, and severity of bleeding in a large cohort of children with moderate and severe VWD. We included 113 children (aged 0-16 years) with Type 1 (n = 60), 2 (n = 44), and 3 (n = 9) VWD with von Willebrand factor (VWF) antigen and/or VWF ristocetin cofactor levels ≤ 30 U/dL from a nation-wide cross-sectional study ("Willebrand in the Netherlands" study). Bleeding severity and frequency were determined using the International Society on Thrombosis and Hemostasis-Bleeding Assessment Tool (ISTH-BAT) with supplementary pediatric-specific bleeding symptoms (umbilical stump bleeding, cephalohematoma, cheek hematoma, conjunctival bleeding, postcircumcision and postvenipuncture bleeding). We found that all 26 postmenarche girls experienced menorrhagia. Other common bleedings were cutaneous (81%), oropharyngeal (64%), prolonged bleeding from minor wounds (58%), and epistaxis (56%). Pediatric-specific bleeding symptoms were present in 44% of patients. ISTH-BAT bleeding score was higher in index cases than in affected family members (median, 12.0 vs. 6.5, P < 0.001), higher in Type 3 VWD than in Type 2 or 1 (17.0 vs. 10.5 or 6.5, P < 0.001) and higher in children with severe (<10 U/dL) than moderate VWD (10-30 U/dL) (11.0 vs. 7.0, P < 0.001). Frequency of any bleeding, epistaxis, and oral cavity was higher in types 2 and 3 than in Type 1 VWD and was associated with VWF levels. We conclude that pediatric-specific bleeding symptoms occurred in a large proportion of children with moderate or severe VWD and should be included when evaluating children for VWD.

Gait dynamics in the wide spectrum of children with arthrogryposis

Gait dynamics in the wide spectrum of children with arthrogryposis

Psychiatric Disorders in Childhood and the Risk of Later Major Depressive Disorder

Introduction An association between psychiatric disorders in childhood and the later development of major depressive disorders (MDD) has been suggested. However, no prospective population-based cohort study has been able to directly compare the risks of MDD following a broad spectrum of child and adolescent psychiatric disorders. Aims To use a large, register-based cohort to establish whether or not psychiatric disorders in childhood lead to a higher risk of later MDD and, if so, which disorders are associated with the highest risks. Objectives To estimate and compare the risk of later MDD in children diagnosed with one of ten psychiatric disorders Methods Using Danish population-based registers all persons born in Denmark from 1990 through 2000 were identified and followed from their 5 th birthday through 2012. Cumulative incidences and incidence rate ratios of MDD following each of ten exposure disorders were calculated Results We followed 960,026 persons, contributing 8,778,331 person-years. Among these 7,787 were diagnosed with MDD (incidence=1.7/1000 pyrs). Diagnosis of any psychiatric disorder led to an absolute risk of MDD within eight years of 1.6% in males and 4.98% in females with early onset (ages 0-14) and 7.02% in males and 15.98% in females with late onset (ages 14-18). For all groups, anxiety and eating disorders were associated with the highest risks of MDD. Conclusions Most disorders were associated with a significantly increased risk of later MDD and children with anxiety and eating disorders carry the greater risk. Future research should focus on common pathways between depression and other psychiatric disorders.

Achalasia in Pediatric Population: Use of High-Resolution Manometry in Children, Achalasia in Pediatric Population

Achalasia is a rare esophageal motor disorder in the pediatric population, it is characterized by symptoms that mimic common diseases in children as gastroesophageal reflux disease (GERD), behavioral and eating disorders (ED). The clinical spectrum in children can range from typical symptoms such as progressive dysphagia, chest pain and weight loss, until nocturnal cough, recurrent pneumonia, asthma, stridor, aspiration, vomiting and feeding difficulties. Children may have delayed development and eating disorders. It is a disease that affects the physical, behavioral and psychosocial sphere. We report three cases of children with complex clinical presentation, an 11-year old boy with feeding difficulties initially diagnosed as eating disorder and behavioral disorder, a 14-year old girl with non-cardiac chest pain and a girl with Allgrove syndrome who presented dysphagia at 7 years old. In all three cases, the final diagnosis was established with esophageal manometry, with typical findings described in adults. The aim of the study is to describe the diagnosis and management of achalasia in pediatric populations.

Стан автономної нервової системи В дітей з есенціальною артеріальною гіпертензією

Мета. Вивчити особливості вегетативного забезпечення у дітей з есенціальною артеріальною гіпертензією. Матеріал і методи. Під спостереженням знаходились 25 дітей з есенціальною артеріальною гіпертензією (1-ша група) та 21 дитина групи контролю, які не відрізнялись за віковою та статевою ознаками. Вік дітей 1-ї групи становив 15,0 (12,0–16,0) року, групи контролю — 16,0 (10,0–17,0) року. Стан вегетативної нервової системи вивчали за допомогою аналізу варіабельності серцевого ритму у фоновій пробі, яка дозволяла оцінити вихідний вегетативний тонус, та ортостатичній пробі, що дає можливість оцінити вегетативну реактивність. Реєстрацію кардіоінтервалограм проводили на комп’ютерному апаратному комплексі «Полі-Спектр» («Нейрософт»). Артеріальну гіпертензію визначали згідно з 95-м перцентилем розподілу артеріального тиску (The Fourth Report on Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents, США).Результати. Дітям з есенціальною артеріальною гіпертензією притаманне вірогідне зниження загальної варіабельності серцевого ритму. Часові та спектральні параметри, що характеризують загальну варіабельність серцевого ритму, у фоновій пробі у дітей 1-ї групи були вірогідно нижчими, ніж у дітей групи контролю: так, RRNN — на 25,0 % меншим, SDNN — на 77,2 % меншим, ТР у 2,3 раза меншим. Параметри, що відповідають за парасимпатичну активність, у 1-й групі також були вірогідно нижчими, ніж у групі контролю: RMSSD — у 2,83 раза, NN50 — у 14,9 раза, HF — у 5,31 раза. Активність симпатичної автономної нервової системи у дітей 1-ї групи була відносно вищою, ніж у дітей групи контролю, на що вказує абсолютне зниження парасимпатичної активності та підвищення індексу вегетативного балансу LF/HF у 2,21 раза порівняно з групою контролю (р = 0,029). Спектральний показник VLF, що вказує на нейрогуморальну регуляцію серцевої діяльності, за даними розподілу потужностей у спектрі кардіоінтервалограм дітей 1-ї групи в 1,65 раза перевищував аналогічний показник групи контролю.Висновки. 1. Для дітей з есенціальною артеріальною гіпертензією притаманне суттєве зниження варіабельності серцевого ритму за рахунок послаблення тонічних впливів парасимпатичної нервової системи та відносне підвищення активності симпатичних та нейрогуморальних впливів на регуляцію серцево-судинної діяльності. 2. Підвищення ригідності серцевого ритму внаслідок зниження парасимпатичних автономних впливів є ознакою розвитку кардіоваскулярної автономної нейропатії у дітей з артеріальною гіпертензією.

The Spectrum of Children's Palliative Care Needs: a classification framework for children with life-limiting or life-threatening conditions

ObjectivesThis paper examined the potential of a new classification framework, The Spectrum of Children's Palliative Care Needs, to facilitate identification of children with palliative care needs for the purposes of...

Variability of disease spectrum in children with liver phosphorylase kinase deficiency caused by mutations in the PHKG2 gene

Liver phosphorylase b kinase (PhK) deficiency (glycogen storage disease type IX), one of the most common causes of glycogen storage disease, is caused by mutations in the PHKA2, PHKB, and PHKG2 genes. Presenting symptoms include hepatomegaly, ketotic hypoglycemia, and growth delay. Clinical severity varies widely. Autosomal recessive mutations in the PHKG2 gene, which cause about 10–15% of cases, have been associated with severe symptoms including increased risk of liver cirrhosis in childhood. We have summarized the molecular, biochemical, and clinical findings in five patients, age 5–16years, diagnosed with liver PhK deficiency caused by PHKG2 gene mutations. We have identified five novel and two previously reported mutations in the PHKG2 gene in these five patients. Clinical severity was variable among these patients. Histopathological studies were performed for four of the patients on liver biopsy samples, all of which showed signs of fibrosis but not cirrhosis. One of the patients (aged 9years) developed a liver adenoma which later resolved. All patients are currently doing well. Their clinical symptoms have improved with age and treatment. These cases add to the current knowledge of clinical variability in patients with PHKG2 mutations. Long term studies, involving follow-up of these patients into adulthood, are needed.

Regional differences in trait-like characteristics of the waking EEG in early adolescence

BackgroundThe human waking EEG spectrum shows high heritability and stability and, despite maturational cortical changes, high test-retest reliability in children and teens. These phenomena have also been shown to be region specific. We examined the stability of the morphology of the wake EEG spectrum in children aged 11 to 13 years recorded over weekly intervals and assessed whether the waking EEG spectrum in children may also be trait-like. Three minutes of eyes open and three minutes of eyes closed waking EEG was recorded in 22 healthy children once a week for three consecutive weeks. Eyes open and closed EEG power density spectra were calculated for two central (C3LM and C4LM) and two occipital (O1LM and O2LM) derivations. A hierarchical cluster analysis was performed to determine whether the morphology of the waking EEG spectrum between 1 and 20 Hz is trait-like. We also examined the stability of the alpha peak using an ANOVA.ResultsThe morphology of the EEG spectrum recorded from central derivations was highly stable and unique to an individual (correctly classified in 85% of participants), while the EEG recorded from occipital derivations, while stable, was much less unique across individuals (correctly classified in 42% of participants). Furthermore, our analysis revealed an increase in alpha peak height concurrent with a decline in the frequency of the alpha peak across weeks for occipital derivations. No changes in either measure were observed in the central derivations.ConclusionsOur results indicate that across weekly recordings, power spectra at central derivations exhibit more “trait-like” characteristics than occipital derivations. These results may be relevant for future studies searching for links between phenotypes, such as psychiatric diagnoses, and the underlying genes (i.e., endophenotypes) by suggesting that such studies should make use of more anterior rather than posterior EEG derivations.

Adherence of Randomized Trials Within Children's Surgical Specialties Published During 2000 to 2009 to Standard Reporting Guidelines

Randomized clinical trials (RCTs) are uncommon in pediatric surgical specialties and the quality of reporting is unknown. Our primary purpose was to analyze published surgical RCTs involving children to measure adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Published RCTs from January 1, 2000 through December 31, 2009 were reviewed. The trials were evaluated for the presence of 7 CONSORT guidelines and also graded according to the Jadad scale. Two hundred and twenty-eight trials were included. Five trials metall 7 CONSORT criteria (2%) and 53 had a Jadad score of ≥3 (23%). Slightly more than 50% of all trials specified primary outcomes and <25% described power calculations according to CONSORT. Adherence to CONSORT guidelines for allocation concealment, randomization description, and attrition details was even lower. There were significant differences between surgical specialties with regard to CONSORT adherence to the majority of the guidelines. Pediatric general surgery had the largest number of published RCTs. Pediatric orthopaedic surgery had the highest proportion of trials with a Jadad score ≥3 (40%). Adherence to CONSORT guidelines is low across the spectrum of children's surgical specialties, although significant differences do exist. Future RCTs in children's surgical specialties should specifically focus on areas of low adherence to reporting guidelines.

Pathogenic spectrum and bacterial resistance of severe community-acquired pneumonia

Objective To study the distribution of pathogenic spectrum in children with severe community-acquired pneumonia(CAP) and bacteria antibiotic resistance.Methods One hundred and ninety-three children with severe CAP were enrolled from Mar 2011 to Feb 2012.Sputum specimens were collected for bacterial culture and drug sensitive test.Meanwhile mycoplasma pneumonia and chlamydia trachomatis were detected by fluorescent quantitative polymerase enzyme technology.Antigen of virus were detected by immunofluorescence assay.Results A total of 96 cases (49.7％) were bacteria positive in 193 children with severe CAP.The top four bacteria strains were klebsiella pneumoniae,staphylococcus aureus,escherichia coli and streptococcus pneumoniae.Most of gram-negative bacteria were resistant to ampicillin,cefazolin,ceftriaxone,ceftazidime,and compound sulfamethoxazole,but were sensitive to piperacillin/tazobactam,imipenem,ciprofloxacin,levofloxacin,amikacin.Gram-positive bacteria were resistant to penicillin and erythromycin,but sensitive to vancomycin.Fifty-three cases (27.5 ％,53/193) were virus Positive,81.1％ of which were less than 1 year old.Respiratory syncytial virus accounted for the most prevalent pathogen,followed by adenovirus,influenza virus A.Mycoplasma pneumoniae were positive in 4 patients (2.1％,4/193),chlamydia trachomatis were positive in 3 patients (1.6％,3/193).Mixed infection was found in 23 cases (11.9％,23/193).There were 14 cases (7.2％,14/193) with undetected pathogens.Conclusion Bacterium is the major pathogen in children with severe CAP and the virus is the second.The initial antibiotics administration of piperacillin/tazobactam or carbapenem and vancomycin should be chosen for severe bacteria pneumonia. Key words: Severe pneumonia; Community-acquired pneumonia; Etiology; Bacteria; Bacterial resistance ; Children

Clinical Spectrum in Children With Pyridoxine-Dependent Epilepsy

Research Article| May 01 2013 Clinical Spectrum in Children With Pyridoxine-Dependent Epilepsy AAP Grand Rounds (2013) 29 (5): 55. https://doi.org/10.1542/gr.29-5-55 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Clinical Spectrum in Children With Pyridoxine-Dependent Epilepsy. AAP Grand Rounds May 2013; 29 (5): 55. https://doi.org/10.1542/gr.29-5-55 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: epilepsy, pyridoxine dependency syndrome, seizures, pyridoxine Source: Perez B, Gutierrez-Solana LG, Verdu A, et al. Clinical, biochemical, and molecular studies in pyridoxine-dependent epilepsy: antisense therapy as possible new therapeutic option. Epilepsia. 2013; 54(2): 239– 248; doi: https://doi.org/10.1111/epi.12083Google Scholar Researchers in Spain and India studied the clinical, biochemical, and genetic spectrum in children with pyridoxine-dependent epilepsy (PDE). The disease was confirmed based on the presence of α-aminoadipic semialdehyde (α-AASA) in urine and pipecolic acid (PA) in plasma and/or cerebrospinal fluid, and by DNA analysis. A total of 12 children were included in the case series. Onset of seizures varied from the neonatal period to the first months of life. Seizures were focal or multifocal, clonic or myoclonic, and generalized tonic; 50% of study patients had status epilepticus. Seizures were controlled transiently with conventional antiepileptic drugs (AED) for 15 or more days in 8 of 12 patients, leading to a delay in diagnosis. The effective dose of pyridoxine (vitamin B6) to suppress seizures ranged from 10 to 30 mg/kg per day. Refractory neonatal seizures were the main indications for suspecting and starting treatment for PDE. Neurologic symptoms in addition to seizures included hypotonia, irritability, and psychomotor retardation. EEG abnormalities were variable in the study children; the EEG was normal in 1 patient. All EEGs became normal after pyridoxine therapy. MRI abnormalities included mega cisterna magna, Dandy Walker syndrome, ventriculomegaly, and corpus callosum dysgenesis. Six study children, followed for more than 5 years, had evidence of cognitive dysfunction. Delay in treatment and dysgenesis of the corpus callosum were risk factors for neurodevelopmental delay. Treatment with pyridoxine failed to normalize IQ. The authors conclude that, despite pyridoxine therapy, there remains a need to reduce persistent neurologic damage in PDE, and that the diagnosis of PDE should be considered in infants with intractable or poorly controlled seizures. Dr Millichap has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. PDE is an autosomal recessive inherited disorder caused by mutations in the ALDH7A1 gene, which encodes antiquitin protein. The clinical spectrum of antiquitin deficiency extends from ventriculomegaly detected on fetal ultrasound, through abnormal fetal movements, to the onset of seizures after birth.1 Clinical diagnosis of PDE can be challenging, because (1) there may be some response to AEDs, (2) response to pyridoxine may not be instantaneous, and (3) structural brain abnormalities may coexist.1 PDE should be considered in the differential diagnosis of any infant with intractable seizures, including patients with MRI abnormalities such as corpus callosum dysgenesis or Dandy Walker syndrome. In suspected cases of PDE, the use of biochemical and DNA tests for antiquitin deficiency is recommended together with a clinical trial of pyridoxine.1 The long-term outcome of PDE is often poor. In a Dutch PDE cohort of 14 patients,2 mental development was delayed in the majority of children, with a median IQ of 72; only 5 walked at 2... You do not currently have access to this content.

The Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY): Practicability and discriminative validity

BackgroundBasic symptom (BS) criteria have been suggested to complement ultra-high risk (UHR) criteria in the early detection of psychosis in adults and in children and adolescents. To account for potential developmental particularities and a different clustering of BS in children and adolescents, the Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY) was developed. AimsThe SPI-CY was evaluated for its practicability and discriminative validity. MethodThe SPI-CY was administered to 3 groups of children and adolescents (mean age 16; range=8–18; 61% male): 23 at-risk patients meeting UHR and/or BS criteria (AtRisk), 22 clinical controls (CC), and 19 children and adolescents from the general population (GPS) matched to AtRisk in age, gender, and education. We expected AtRisk to score highest on the SPI-CY, and GPS lowest. ResultsThe groups differed significantly on all 4 SPI-CY subscales. Pairwise post-hoc comparisons confirmed our expectations for all subscales and, at least on a descriptive level, most items. Pairwise subscale differences indicated at least moderate group effects (r≥0.37) which were largest for Adynamia (0.52≤r≥0.70). Adynamia also performed excellent to outstanding in ROC analyses (0.813≤AUC≥0.981). ConclusionThe SPI-CY could be a helpful tool for detecting and assessing BS in the psychosis spectrum in children and adolescents, by whom it was well received. Furthermore, its subscales possess good discriminative validity. However, these results require validation in a larger sample, and the psychosis-predictive ability of the subscales in different age groups, especially the role of Adynamia, will have to be explored in longitudinal studies.

The Permanency Plan Game Show: An Intersubjective Case Study of a Foster Care Child and Her Caregivers

The Adoption and Safe Families Act (ASFA) supports permanency decisions that do not reflect the reality of relationships that exist along a spectrum for children in foster care, biological caregivers, and foster parents. A case example, conceptualized through an intersubjective lens, demonstrates the ways in which the permanency planning process may affect clinical social workers’ capacities to maintain an awareness of the third. Therapists may collude with the system's efforts to define relationships in a context of complementarity and become immersed in the game show dynamic that emerges when parents and children await the court's decision regarding their relational future.

A Proposed Comprehensive Classification of Tuberculosis Disease Severity in Children

Tuberculosis (TB) in children has conventionally been classified as pulmonary TB (PTB) and extrapulmonary TB (EPTB) disease, including disseminated TB (TB meningitis and miliary disease). There is no existing approach that comprehensively characterizes the spectrum and severity of pediatric TB. This limits accurate classification of patients and comparison across cohorts. To develop a classification of pediatric TB that reflects the spectrum and severity of clinical disease better than currently available approaches. We propose a framework for the standard classification of TB disease severity in children. From a literature search, the following sources of information were used: clinical data, bacteriologic, histopathologic, and imaging data (including information from chest radiography, computerized tomography, and bronchoscopy). Each individual disease entity was systematically considered. Based on the extent and the presence of complications, each entity was then classified as "severe" or "nonsevere." As an initial application, we compared the proposed classification with the convention (PTB, EPTB) in a cohort of HIV-infected and -uninfected infants with culture-confirmed TB. Agreement between the 2 systems was poor. The proposed comprehensive disease classification system may more accurately reflect the clinical TB disease spectrum in children, is relevant to clinical management, and may be valuable to inform research on diagnostic tools and TB treatment strategies in children. Prospective studies are required to evaluate this approach in representative pediatric populations, correlating TB disease severity with diagnostic yield, treatment response, and application in existing and novel treatment strategies.

Novel mutation in STXBP2 prevents IL-2–induced natural killer cell cytotoxicity

We have identified dizygotic twins with a novel syntaxin-binding protein 2 (STXBP2) mutation, where cytotoxicity cannot be restored with IL-2. This defines STXBP2 as an absolute requirement for NK cell cytotoxic function.

Opportunities for chemoprophylaxis in children with culture-confirmed tuberculosis.

Chemoprophylaxis is an effective strategy to prevent progression of tuberculosis (TB) in vulnerable children who have had contact with an infectious source of TB. However, many operational gaps prevent implementation of routine chemoprophylaxis in high-burden settings. The TB exposure status and disease spectrum in children diagnosed with culture-confirmed TB are described and missed opportunities for chemoprophylaxis are highlighted. All children <13 years of age diagnosed with culture-confirmed TB at a tertiary referral hospital between March 2003 and February 2007 were included. Clinical data were collected from retrospective review of files. TB was classified as pulmonary and extra-pulmonary; disseminated TB included miliary disease and TB meningitis. During the study period, 614 children (327, 53·3% boys, median age 32 months) were diagnosed with culture-confirmed TB. Contact with an infectious adult source case was documented in 333 (54·2%), 237 (71·2%) of whom were <5 years of age, and 24 (7·2%) were HIV-infected and ≥5 years of age. Of those eligible for chemoprophylaxis, missed opportunities were identified in 156/221 (70·6%) children; 127 (81·4%) were <3 years of age, 39 (25%) had disseminated TB and 8 (5·1%) died. The TB source case was the mother or father in 74/156 (47·4%) children. Opportunities for initiation of chemoprophylaxis in vulnerable children following TB exposure are often missed. Awareness should be increased among health-care workers and in the community at large regarding the importance of chemoprophylaxis in young and HIV-infected children. Health system strengthening is required to improve delivery of chemoprophylaxis to vulnerable children in close contact with newly diagnosed infectious TB cases.

Redefining the Guillain-Barré spectrum in children: neuroimaging findings of cranial nerve involvement.

GBS and its MFS variant are acute polyneuropathies that are considered to represent a continuum rather than distinct entities, due to the overlap in their clinical features. Enhancement of the CE roots represents the neuroradiologic hallmark of GBS, while findings of neuroimaging studies in MFS are usually unremarkable. Our purpose was to evaluate the MR imaging findings of polyneuropathy in 17 children affected by GBS and its MFS variant. Fourteen of our 17 patients demonstrated CE enhancement, with predominant involvement of the anterior roots. Of 6 patients who underwent MR imaging of the brain, 5 had cranial nerve involvement. In children affected by GBS-MFS, involvement of the CE roots may be considered part of a more extensive autoimmune neuropathy, as demonstrated by enhancement of cranial nerves. Brain MR imaging should be considered in the routine evaluation in pediatric patients with GBS-MFS for the evaluation of the cranial nerves.

‘We are the ones that talk about difficult subjects’: nurses in schools working to support young people’s mental health

As health professionals in an educational setting, nurses in schools occupy a unique place in the spectrum of children’s services. Yet the service is often overlooked and has been described as invisible. This paper draws on findings from a study, funded by the Scottish Government’s National Programme for Improving Mental Health and Well‐being, which explored the role of school nurses in promoting and supporting the mental health of children and young people. The school nursing service throughout the United Kingdom is at a pivotal point as its role is being redefined to align with moves across the National Health Service towards a public health model. This paper therefore offers a timely overview of the mental health work of school nurses, and raises key issues for future work. Interviews were conducted with 25 school nurse managers across Scotland. Interviewees claimed that the contribution of nurses in schools was distinctive, owing to the quality and consistency of relationship that they could offer, and the autonomy that the service allowed young people. However, significant challenges were reported in making this contribution, and tensions were evident in the conceptualisation of their role. The framework of resilience is used to discuss the findings on the significance of building relationships in promoting mental health.