Brain abscesses in Malawian children: value of CT scan

The clinical presentation and management of brain abscess in three HIV-uninfected Malawian children are reported. One case was associated with staphylococcal empyema and severe malarial anaemia and another case with chronic suppurative otitis media and mastoiditis. The third case had no identified extracranial focus of infection. These cases illustrate the difficulties of diagnosis and management of brain abscesses in the resource-poor setting where other causes of encephalopathy caused by infection are common, and highlight the value of neuroradiological imaging.     

CT scan patterns of pulmonary alveolar proteinosis in children

Background. To study computed tomographic (CT) findings in children with pulmonary alveolar proteinosis (PAP) more extensively. Objective. To describe the CT features at the time of diagnosis and after therapeutic broncho-alveolar lavage (BAL). Materials and methods. We retrospectively reviewed the CT scans of five children (aged 3 months to 4 years) examined because of incidental bronchitis (n = 1), disease in a sibling (n = 1) and relapsing fever, cough and dyspnoea (n = 3). Each patient had an initial CT scan. Two asymptomatic cases were not treated but were followed up by plain chest films. The other three had BAL and follow-up CT. Results. Initial CT in all cases showed a diffuse reticulomicronodular pattern associated in three cases with posterior bilateral alveolar infiltrates. CT in the two asymptomatic patients remained unchanged or slightly improved without BAL. After BAL, a variable decrease of lung infiltrates was observed. Conclusions. Correlation between the extent of alveolar consolidation and severity of disease was found. Anatomical and pathological considerations allow us to consider that the classical reticulomicronodular pattern is not due to an interstitial infiltration but to alveoli filled with the abnormal material characteristic of PAP. Received: 11 February 1998 Accepted: 26 June 1998     

Colorectal screening with single scan CT colonography in children

The purpose of this study was to evaluate the feasibility of single scan CT colonography (CTC) using polyethylene glycol electrolyte solution with contrast medium (PEG-C) bowel preparation in children. Seven patients suspected of colorectal elevated lesions were subjected to CTC. All patients underwent bowel preparation using polyethylene glycol electrolyte solution (PEG) at a dose of 32 ± 3 ml/kgBW before the day of CTC. The water-soluble contrast agent was given to the patients at a dose of 0.6 ± 0.1 ml/kgBW the next morning. After colonic air insufflation, the patient was scanned axially with a single run. After evaluation of multiplanar reformation images, 3-dimensional images (CT enema and virtual endoscopy image) were reconstructed. CT enema image was composed from air image and contrast-medium image. All studies were performed without complications. CTC showed the entire colon without blind spots in all patients with only single scan. In conclusion, the single scan CTC using PEG-C preparation is safe and less invasive compared to conventional CTC due to the shorter examination time and lower radiation dose.     

Medical home disparities between children with public and private insurance

ObjectiveTo compare the prevalence of a medical home for children with public versus private insurance and identify components of the medical home that contribute to any differences.MethodsWe performed a secondary data analysis of the 2007 National Survey of Children's Health. A medical home was defined as meeting each of 5 components: 1) usual source of care; 2) personal doctor/nurse; 3) family-centered care; 4) care coordination, if needed; and 5) no problems getting a referral, if needed. We estimated the national prevalence of the medical home and its components for children with public versus private insurance. Comparisons were made using logistic regression, unadjusted and adjusted for sociodemographic factors.ResultsA total of 67% of privately insured children met all 5 components of the medical home, compared with only 45% of publicly insured children (P < .001). The gap in medical home prevalence between public and private groups remained significant after controlling for sociodemographic characteristics (public vs private adjusted odds ratio [AOR] 0.82; 95% confidence interval [95% CI] 0.73–0.92). Over 90% of children in both groups reported having a usual source of care and a personal doctor/nurse. Only 58% of publicly insured children reported family-centered care, compared with 76% of privately insured children (P < .001). This difference was significant after adjustment for sociodemographic characteristics (public vs private AOR 0.87; 95% CI 0.77–0.99).ConclusionsSignificant medical home disparities exist between publicly and privately insured children, driven primarily by disparities in family-centered care. Efforts to promote the medical home must recognize and address determinants of family-centered care.     

Electroencephalographic correlation of clinical, radioisotopic brain scan, CT scan and postmortem diagnosis

Fifty three cases of different neurological disorders were studied in children and EEG correlation was done with clinical findings, RI brain scan, CT scan, carotid angiography, postmortem and operative findings. EEG was abnormal in 36/53 cases (67·92%), CT scan in 28/35 cases (80%), RI brain scan in 17/21 cases (80·95%), carotid angiography in 3/3 cases (100%) and postmortem and operative procedures were helpful in 10 cases. Out of 35 cases of CT scan, good EEG CT scan correlation was observed in 16 cases (45·71%) (including 3 cases of idiopathic epilepsy) and in 9 cases (25·71%), although the EEGs were abnormal, they did not correlate well with the abnormality revealed in CT scan. In the remaining 10 cases (28·57%), there was poor EEG CT scan correlation. Out of 21 cases of RI brain scan, good RI brain scan EEG correlation was observed in 17 cases (81%) and poor correlation in remaining 4 cases (19%). Carotid angiographic and EEG correlation in all 3 cases (100%); postmortem EEG correlation in 2/2 cases (100%) and operative procedures EEG correlation in 6/8 cases (75%). In 2 cases of infratentorial space occupying lesions EEG was normal. It is concluded that EEG is a fairly useful, noninvasive investigation in various neurological disorders in children.     

Electroencephalographic correlation of clinical,radioisotopic brain scan,CT scan and postmortem diagnosis

Fifty three cases of different neurological disorders were studied in children and EEG correlation was done with clinical findings, RI brain scan, CT scan, carotid angiography, postmortem and operative findings. EEG was abnormal in 36/53 cases (67·92%), CT scan in 28/35 cases (80%), RI brain scan in 17/21 cases (80·95%), carotid angiography in 3/3 cases (100%) and postmortem and operative procedures were helpful in 10 cases. Out of 35 cases of CT scan, good EEG CT scan correlation was observed in 16 cases (45·71%) (including 3 cases of idiopathic epilepsy) and in 9 cases (25·71%), although the EEGs were abnormal, they did not correlate well with the abnormality revealed in CT scan. In the remaining 10 cases (28·57%), there was poor EEG CT scan correlation. Out of 21 cases of RI brain scan, good RI brain scan EEG correlation was observed in 17 cases (81%) and poor correlation in remaining 4 cases (19%). Carotid angiographic and EEG correlation in all 3 cases (100%); postmortem EEG correlation in 2/2 cases (100%) and operative procedures EEG correlation in 6/8 cases (75%). In 2 cases of infratentorial space occupying lesions EEG was normal. It is concluded that EEG is a fairly useful, noninvasive investigation in various neurological disorders in children.     

Vitamin D insufficiency common in newborns, children and pregnant women living in Newfoundland and Labrador, Canada

Vitamin D deficiency is associated with poor bone health, colorectal cancer, type 1 diabetes and multiple sclerosis. Two national health-related societies in Canada have made recommendations for vitamin D supplementation, yet little research has been reported on the vitamin D status of Canadians. Lifestyle changes, such as sunscreen use, spending less time outdoors and insufficient intake of vitamin D-containing foods as well as northern latitude, may be affecting human vitamin D status. A cross-sectional analysis of 25-hydroxyvitamin D [25-(OH)D] was conducted in pregnant women, newborns (umbilical cord blood) and children. Samples were analysed by liquid chromatography mass spectrometry. Published ranges for 25-(OH)D were used to determine vitamin D status. The prevalence of 25-(OH)D deficiency for the three groups studied revealed most concentrations in the 25-(OH)D deficiency or insufficiency ranges. There were significant differences in all groups studied between seasons, with the exception of maternal blood and female cord blood samples. 25-(OH)D insufficiency was common in all groups for winter and summer, more so in winter. 25-(OH)D insufficiency was common in the three groups studied. The Newfoundland and Labrador population may be at increased risk for vitamin D insufficiency because of factors such as northern latitude and lifestyle issues. Further research on the vitamin D status of this population is important, considering the potential adverse health-related outcomes and the recommendations on supplementation being made.     

New recommendations for influenza vaccination for children and pregnant women

This year the Advisory Committee on Immunization Practices of the United States Centers for Disease Control and Prevention has updated recommendations for use of influenza vaccine. Previously, use of influenza vaccine focused primarily on the elderly as well as younger persons with underlying conditions that place them at high risk for severe disease and complications from influenza infection. The new recommendations also emphasize the benefits of influenza vaccination for young, healthy children who are at high risk for hospitalization with influenza infection. These changes are the result of recent reports demonstrating that otherwise healthy young children aged 6 to 24 months are hospitalized for influenza and its complications at rates comparable to those for whom influenza vaccination is already recommended, including the elderly.     

Home visitation for pregnant women and parents of young children.

Many of the most pervasive, intractable, and costly problems faced by high-risk women and young children in our society today are a consequence of adverse maternal health-related behaviors (such as cigarette smoking, drinking, and drug use during pregnancy), dysfunctional infant care giving, and stressful environmental conditions that interfere with individual and family functioning. These problems include low birth weight, child abuse and neglect, childhood injuries, unintended and closely spaced pregnancy, and reduced economic self-sufficiency on the part of parents. Evidence is accumulating that these problems can be reduced with comprehensive programs of prenatal and infancy home visitation by nurses. While we are witnessing a renaissance of interest in home visitation as a means of addressing these problems, the recommendations of various health and human service advisory groups about the structure of proposed home-visitation initiatives are uncoordinated and frequently inconsistent with the empirical evidence. Home visitation is a promising strategy, but only when the program meets certain standards. The more successful programs contain the following: (1) a focus on families at greater need for the service, (2) the use of nurses who begin during pregnancy and follow the family at least through the second year of the child's life, (3) the promotion of positive health-related behaviors and qualities of infant care giving, and (4) provisions to reduce family stress by improving the social and physical environments in which families live.