Acute viral bronchiolitis; Physicians' perspective on definition and clinically important outcomes
"Two key limitations tamper interventional research on bronchiolitis; the absence of a clear definition of disease, and the heterogeneous choice of outcome measurements in current clinical trials".
A nationwide online survey of Portuguese Pediatricians and General Practitioners (GPs) indicates that most pediatricians agree with a definition that includes coryzas, wheezing and/or rales (c/f 38.15% of GP's); however <5% of physicians agree with "age" (<12 months) and "first episode wheeze" being included.
It appears that physician definition of bronchiolitis (at least among Portuguese physicians) has "considerable variability and often mismatch those of clinical trials". Apparently there is still a need for a standardized definition of acute bronchiolitis.
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Lactate vs. carboxyhemoglobin level in prognosis of carbon monoxide (CO) poison
"Co poisoning results in various neuropsychological impairments including delayed encephalopathy and death". Differing initial clinical presentations may occur with similar carboxyhemoglobin levels.
From a study of 288 hospitalized CO poisoned children (mean age 8.6 years) which examined and correlated CO, lactate, creatine kinase (CK) - MB and cardiac Troponin I Levels and prognosis, it appears that severe poisoning is more sensitively diagnosed by a lactate level > 3.85 mml/L; this rather than CO levels might be used in the decision to utilize hyperbaric oxygen for treatment.
Child affected by parental relationship distress (CAPRD)
A new and important relationship condition - "CAPRD" was introduced in DSM-5, as published literature establishes the deleterious effects on children that parental relationship distress causes". "Parental distress" includes parental intimate partner distress; intimate partner violence; acrimonious divorce and to "unfair disparagements of one parent by another". Child responses include:
New onset or exacerbation of psychological (behavioral, cognitive and affective) symptoms.
Internal loyalty conflicts.
Parental alienation with loss of parent-child relationship.
Predicting outcome of childhood bacterial meningitis with a single measurement of C-Reactive Protein (CRP)
"CRP is a marker of inflammation". Two prospective randomized double-blind studies compared a third or fourth day single CRP blood level to prognosis in Latin American and Angolan children.
While initial CRP values are of prognostic value, third or fourth day measurements appear more significantly associated with seizures, slow recovery and low Glasgow Coma Scale score; with hearing impairment 3-7 times more likely with CRP value > 62mg/L.
Suction rectal biopsy to diagnose Hirschsprung Disease (HD) in children
HD is diagnosed by a rectal biopsy, with suction rectal biopsy (SRB) the preferred technique in neonates". Variations in yield inchildren has caused concern. A retrospective cohort of 56 children (median 3.9 years) evaluated by SRB for possible HD revealed an 80.4% overall success rate (patients <5 years: 54.3%; > 5years: 90.5%).
SRB is effective in children requiring evaluation for possible HP.