Oct. 5, 2016
Volume VII | Issue No. 40

The value of point-of-care ultrasound (POCUS) for detecting nail bed injury and fracture in the Emergency Department (ED)
Results following POCUS evaluation of 54 patients with mostly squeezed and crushed nail bed injury indicates a sensitivity and specificity of 93.4% and 100% respectively to ascertain injury.

POCUS is a promising tool to detect nail bed injury and distal phalanx fracture.

Accuracy of the history of injury obtained from the caregivers in infantile head trauma
Parents of infants that have suffered a traumatic intracranial hemorrhage frequently report varying mechanisms of injury.

From a study of 166 infants with severe infantile head trauma it appears the history obtained from the care giver should be treated with reserve, particularly where there are inconsistencies between history obtained and severity of observed injury.
Adverse drug reactions (ADRs) of systemic antihistaminics
Most frequently reported toxic side-effects of ADRs include skin eruptions and central nervous system problems (headache, somnolence, aggression and agitation).
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Clinical presentation of childhood leukemia
From a large (12,303 abstracts) MEDLINE and EMBASE search of apparently all existing data on childhood leukemias' clinical presentations, and frequency of sign and symptoms presenting at or prior to diagnosis it appears that:

1.    Five features are present in the >50% of children:
a.    Hepatomegaly (64%)
b.    Splenomegaly (61%)
c.    Pallor (54%)
d.    Fever (53%)
e.    Bruising (52%)

2.    33-55% of childhood leukemia present with:
a.    Recurrent infections (49%)
b.    Fatigue (46%)
c.    Limb pain (43%)
d.    Hepatosplenomegaly (42%)
e.    Bruising/petechiae (42%)
f.    Lymphadenopathy (41%)
g.    Bleeding tendency (38%)
h.    Rash (35%)

6% of children with leukemia are asymptomatic at diagnosis.
Video Feature  
Childhood leukemia
Childhood Leukemia
Should neonates with perinatal asphyxia receive a single dose of IV theophylline to prevent acute kidney injury (AKI)?
AKI occurs commonly (38%) in critically ill neonates and is probably an active contributor to their short and long-term adverse outcomes. "There are no FDA approved therapies to prevent or mitigate AKI".

The largest randomized placebo-controlled trial on theophylline on perinatal asphyxia to date indicates that treated neonates have a lower rate of AKI, less oliguria, less hematuria and less proteinuria without complications (no improvement in survival and no assessment of long-term outcomes).

IV theophylline for AKI in neonates looks promising but many unanswered questions remain.

Music and Health 
Stress in many forms may (but not always!) have adverse effects on health including post-traumatic stress disorder (PTSD). Interventions to alleviate these effects would be

Children undergoing haematopoietic stem cell transplant (HSCT) are at increased risk for stress related PTSD.
A randomized clinical pilot study of 24 children <16 years of age undergoing HSCT which measured heart rate (compared to a standard group) with and without music therapy (individualized and interactive) indicates that music therapy significantly reduces heart rate (which appears to be both a sensitive indicator of autonomic balance and the risk of future PTSD) for 4-8 hours post therapy.

Risk factors and characteristics of suicide attempts among adolescents

Suicide is now among the most frequent causes of death in adolescents.

A cross-sectional, case-control study of 381 adolescents aged 10-17 years after suicide attempts using questionnaires and medical/psychiatric records identifies the following issues:
  1.  Suicidal adolescents are 10 times more likely to report dissociated ("blocking out") relationships with parents, siblings and friends.
  2. 62.5% attempt unsuccessfully to talk to their parents about their problems and there is a significant relationship between this and self-mutilation and suicidal ideation.
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