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??Kawasaki disease is an acute self-limited vasculitis. Timely and accurate diagnosis and treatment can significantly reduce the incidence of coronary artery dilatation or coronary artery aneurysm.However??there are difficulties in the diagnosis and treatment of Kawasaki disease for the time being. We need to make efforts to further improve the accuracy of diagnosis??early predict and identify the high risk population of refractory Kawasaki disease and coronary aneurysm??and optimize the initial treatment of stratified patients according to the coronary risk they are facing. We should constantly promote the experience of long-term follow-up management of Kawasaki disease so as to improve the level of diagnosis and treatment.     

UK treatment of malaria

Imported malaria has become an increasingly significant cause of mortality and morbidity in children travelling to areas of the world endemic for malaria. Malaria is one of the commonest imported tropical diseases in the UK, with children accounting for 15-20% of all cases. Over 80% of all cases of malaria are due to Plasmodium falciparum infection, which can cause severe or life-threatening multi-organ disease in children. The clinical features of malaria in children are often non-specific, resulting in missed or delayed diagnosis. Children are more likely than adults to deteriorate rapidly and to develop severe malaria, particularly cerebral malaria. Malaria should be suspected in all children with a history of travel to a malaria-endemic country who present with fever. Diagnosis is usually made with repeated thick and thin blood films. Delays in diagnosis are associated with an increased risk of developing severe malaria and death. Appropriate antimalarial therapy and supportive care should be instituted as soon as possible, particularly in children with severe malaria. Advice should be sought from an appropriate specialist.     

肺动脉高压治疗的一种新途径--雾化吸入一氧化氮供体有效性的研究进展

一氧化氮(nitric oxide,N0)是血管内皮细胞释放的内皮依赖性的舒张因子(endothelium—derived relaxing factor EDRF)。NO具有极其广泛的生理作用,而它通过增加血管平滑肌细胞内eGMP的浓度扩张肺血管作用最为重要。这一研究的发现使得近十年来肺动脉高压(pulmonary hypertension,PH)的治疗领域取得了惊人的进步,即证实了     

Comprehensive community effectiveness of health care. A study of malaria treatment in children and adults in rural Burkina Faso

Malaria is one of the most important causes of morbidity and mortality in children in sub-Saharan Africa, yet community effectiveness of treatment is not well understood. This study presents a quantitative estimate of community effectiveness of malaria treatment in Burkina Faso, based on population surveys, observational studies of health services and user surveys. Analysis of seven steps in the process of treating malaria reveal the following: (1) 21% of people with malaria attend health centres; (2) 31% of them have a sufficient history taken; (3) 69% receive a complete clinical examination; (4) 81% receive the correct dosage of drugs prescribed; (5) 91% purchase the drugs; (6) 68% take the drugs as prescribed; (7) the drugs are estimated to be 85% effective. Taking all the steps into account, overall community effectiveness is estimated to be 3%. Statistically significant differences in age and gender are seen in some steps. Quinine is prescribed too frequently. Critical issues in educating health care workers include complete history-taking and clinical examination, rational indication for quinine and adjusted drug dosages for children. We identify utilization and diagnostic quality as offering the greatest potential for improvement in overall community effectiveness.     

Bridging the knowledge-resuscitation gap for children: Still a long way to go

The American Heart Association, along with the International Liaison Committee on Resuscitation, recently made changes to the paediatric resuscitation guidelines.Knowledge translation (KT) is imperative, but there is a lack of sufficient evidence for appropriate methodologies for implementation of these guidelines. Paediatric resuscitation presents many challenges; cases happen infrequently, affording few opportunities for implementation of the new guidelines, and are highly stressful and filled with uncertainty. Some KT strategies have shown some success in causing a notable degree of change in behaviour, but none have shown a striking difference when used alone.Previous efforts to disseminate current guidelines centred on development of courses for health care providers and preparing paediatric residents and paediatricians for circumstances they could encounter with paediatric acute illness. None of the studies assessing these techniques measured direct patient outcomes, and only a few demonstrated some long-term knowledge acquisition among trainees. The purpose of the present review was to illuminate the challenges, offer future directions for KT and outline potentially more effective methodologies and strategies to overcome current barriers.     

Acute neurological complications after pediatric cardiac surgery: still a long way to go

IntroductionThere has been an increasing concern over the neurological complications associated with congenital heart disease and cardiac surgery.Material and methodsWe performed a retrospective, case-control, observational review of the postoperative period in the intensive care unit of patients undergoing cardiac surgery over the past 10 years. We selected 2 control patients for each case, matched for surgical complexity.ResultsA total of 900 patients were reviewed. We found 38 neurological complications (4.2%), of which 21 (55.3%) were in the peripheral nervous system and 17 (44.7%) in the central nervous system. The complications involving the central nervous system (1.9% of total) consisted of 8 seizures, 4 cerebrovascular accidents, 4 hypoxic-ischemic encephalopathy events, and 1 reversible neurological deficit. At the time of discharge, 35.3% were symptomatic and 17.6% had died. Patients with neurological complications had a longer bypass time (P=.009), longer aortic cross time (P=.012), longer hospitalization in intensive care (P=.001), longer duration of mechanical ventilation (P=.004) and an increased number of days under inotropic support (P=.001).ConclusionsOur incidence of neurological complications after cardiac surgery is similar to that previously described. Clinical seizures are the most common complication. Central nervous system complications are associated with a higher morbidity and hospitalization time. Units caring for patients with congenital heart disease must implement neurological monitoring during and after cardiac surgery to prevent and to detect these complications earlier.     

Gender gap and Indian Academy of Pediatrics: still a long way to go!

We conducted this study to document the female participation in the administrative and academic affairs of the Indian Academy of Pediatrics (IAP). Of 45 IAP Presidents till date, 7 (15.6%) were women. Females comprised 6% (2/31), 8.8% (3/31), 5.4% (2/37), and 2.3% (1/44) of IAP executive board members in 1990, 1995, 2000, and 2005, respectively. Only once (out of 10), a woman was appointed as the Editor-in-Chief of Indian Pediatrics; of 4 Editor-in-chiefs of IJPP till date, none was a female. Of 181 heads of the department of Pediatrics at different medical colleges, 58 (32%) are women. Overall female authorship in articles published in Indian Pediatrics has increased from 23.1% (133/576) in 1990 to 43% (154/358) in 2005 (P < 0.001). We conclude that there is a definite increase in the female participation in academic matters of IAP; however, the gender gap is persisting in the administrative domain.     

儿童脑型疟128例的诊断和治疗

目的了解儿童脑型疟临床特征和降低其病死率。 方法对1996～1997年住院128例儿童脑型疟的临床特征、诊断治疗、病死原因进行分析。 结果1～5a儿童发生率66％,痊愈113例,后遗症4例,死亡11例,死亡率8．6％。临床特征有发热、咳嗽、吐泻、惊厥、意识障碍等。血片见疟原虫可确诊,首次阴性应反复多次检查。惊厥、意识障碍者应排除其他疾患。 结论及时正确诊断,尽早抗疟治疗,对抗药性及有并发症等治疗是降低儿童脑型疟病死率的关键。