Staphylococcal and streptococcal infections of the skin.

Acute pyogenic infections of the skin, caused by hemolytic streptococci and S. aureus, account for the vast majority of bacterial infections of the skin seen in ambulatory practice. In preschool children the principal manifestation is pyoderma, which is usually caused by Group A Streptococcus. In this age group pyoderma regularly responds to systemic penicillin therapy plus adjunctive local care to the lesions. However, in older age groups, the ability to distinguish streptococcal from staphylococcal skin infections on the basis of clinical features alone is poor, and penicillin treatment failures are more common. Safe, effective antibiotics that are effective against both staphylococci and streptococci are readily available. For this reason penicillinase-resistant semisynthtic penicillins and or erythromycin can be used to treat acute pyogenic skin infections in older age groups.     

儿童过敏原皮肤点刺试验53例分析

目的观察部分过敏性疾病儿童的过敏原皮肤点刺试验结果。方法对支气管哮喘、过敏性鼻炎及湿疹/荨麻疹3组儿童行皮肤过敏原点刺试验,试剂为北京协和医院诊断试剂厂生产吸入组与食物组共40种过敏原试剂。结果（1）支气管哮喘儿童随年龄增大,皮肤阳性率呈增高趋势,而湿疹/荨麻疹组不明显。（2）常见过敏原吸入组为屋尘（15.1%）、尘螨（28.3%）、蟑螂（17.0%）、家蝇（20.8%）等;食物组为螃蟹（9.4%）、海虾（7.5%）、鲤鱼（7.5%）等。近年蟑螂及家蝇过敏原阳性率增高。（3）哮喘儿童皮肤试验阳性率54.5%,阴性率45.5%,其致病原（变应原）有可能与病毒引起的气道变应性炎症有关。结论（1）哮喘儿童过敏原阳性率随年龄增长而增高;（2）过敏性疾病儿童常见过敏原主要为屋尘、尘螨、蟑螂及家蝇等;（3）哮喘儿童除常见过敏原引起外,推测还与病毒感染有关;（4）过敏性疾病可针对过敏原进行有关防治。     

Outcome in children under 5 years of age with constipation: a prospective follow-up study

Constipation in the pre-school child is common and causes considerable distress to children and their parents. There is a lack of information regarding prognosis in this group of patients although some are clearly at risk of developing long-term difficulties with defaecation. We have previously reported characteristics of children under 5 years of age referred to hospital over a one-year period with idiopathic constipation. We now report outcome data after 18 months of follow-up in 41 of the original cohort of 42 children. We have also summarised what we regard as good practice in managing constipation in this age group. Eighteen months after initial outpatient assessment, the symptoms of constipation were reported to have resolved in 36 (88%), although seven of these were still needing regular laxative treatment. It was our subjective impression that the five children who apparently did not improve came from families that had a greater degree of psychosocial problems and where compliance with treatment was suspect. This study shows that with simple treatment measures and ongoing support, an optimistic prognosis can be given to families from the outset. The minority of pre-school children who do not improve may benefit from a more intensive psychological approach to management.     

Personality and Behavioural Characteristics in Pediatric Migraine

SYNOPSIS
Personality and behavioural features in pediatric migraine were investigated in a comparison study of 20boys and girls with migraine, matched for age and sex with a "pain" control group of 20 children withmusculoskeletal pain, and with a "no-pain" control group of 20 children. When the amount of pain experiencedby children was controlled, the only discriminating variable was that of somatic complaints which includedvomiting, nausea, and perceptual disturbances, all migraine-related phenomena. The inclusion of the "pain" control group in this investigation yielded results which indicated that the behavioural and personality featuresthought to be characteristic of childhood migraine are common to a chronic pain disorder and in fact, themanifestation of many of these features correlate directly with the amount of pain experienced. It is suggestedthat the personality and behavioural characteristics evident in many children with migraine may result from therecurrent chronic pain episodes rather than in some way being causative of the pain.     

石家庄地区皮肤点刺试验结果与不同年龄儿童哮喘的情况分析及护理干预

目的 分析石家庄地区哮喘患儿的变应原,为预防、治疗和护理哮喘患儿提供可靠的客观依据.方法 对2008年2月至2009年9月门诊就诊和住院的哮喘患儿217例,按年龄分为3组,5个月≤年龄＜3岁48例,3岁≤年龄＜5岁57例,5岁≤年龄≤14岁112例,采用北京协和医院变应原生产研制中心研制的10种吸入性、7种食物性变应原点刺液进行皮肤点刺试验.结果 哮喘患儿变应原皮肤点刺试验总阳性率高达89.4%.结论 在过敏因素中吸入性变应原是石家庄地区儿童哮喘发作的主要因素,而尘螨、室尘等又是吸入性变应原中的主要变应原;在食物过敏因素中海虾是儿童哮喘发作不能忽略的重要因素.因此指导家长避免或减少患儿与尘螨、室尘、海虾的接触,是预防、治疗和护理儿童哮喘的最基本措施.     

石家庄地区皮肤点刺试验结果与不同年龄儿童哮喘的情况分析及护理干预

目的 分析石家庄地区哮喘患儿的变应原,为预防、治疗和护理哮喘患儿提供可靠的客观依据.方法 对2008年2月至2009年9月门诊就诊和住院的哮喘患儿217例,按年龄分为3组,5个月≤年龄＜3岁48例,3岁≤年龄＜5岁57例,5岁≤年龄≤14岁112例,采用北京协和医院变应原生产研制中心研制的10种吸入性、7种食物性变应原点刺液进行皮肤点刺试验.结果 哮喘患儿变应原皮肤点刺试验总阳性率高达89.4%.结论 在过敏因素中吸入性变应原是石家庄地区儿童哮喘发作的主要因素,而尘螨、室尘等又是吸入性变应原中的主要变应原;在食物过敏因素中海虾是儿童哮喘发作不能忽略的重要因素.因此指导家长避免或减少患儿与尘螨、室尘、海虾的接触,是预防、治疗和护理儿童哮喘的最基本措施.     

EB病毒DNA载量与儿童肝肾损害的研究

目的 探讨EB病毒DNA载量与肝、肾功能的关系。方法 收集2016年4月～7月入院147例EB病毒DNA阳性患儿,检测其EB病毒DNA载量和生化指标; 收集健康对照组80例。按照DNA载量的高低,分为低载量组80例,中载量组41例,高载量组26例,分析比较不同DNA载量与肝功能、年龄、性别的关系。结果 EB病毒DNA低载量组、中载量组、高载量组肝损害率分别为17.50%,43.90%和61.54%; 肾损害率分别为3.75%,12.2%和37.5%。DNA载量越高,发生肝、肾损害的概率越大,差异具有统计学意义(χ2=20.58,8.38; P值均<0.05); 低年龄组DNA载量(4.93±0.75)高于中年龄组(4.60±0.83)与大年龄组(4.63±0.84),差异具有统计学意义(Z=-2.73,P=0.006),中年龄组DNA载量对数与高年龄组DNA载量对数间差异无统计学意义(Z=-0.27,P=0.788)。女患儿组DNA载量对数(4.55±0.62)低于男患儿组DNA载量对数(4.93±0.86),差异具有统计学意义(Z=-2.42,P=0.015)。患儿组清蛋白低于对照组,差异具有统计学意义(Z=-3.31,P<0.005)。结论 小儿感染EB病毒,EB病毒DNA载量越高,发生肝肾损害的可能性越大。     

A study of serum antibodies to isolated milk proteins and ovalbumin in infants and children.

Serum antibodies to cow milk proteins and ovalbumin were measured quantitatively. Food hypersensitivity of the immediate type was determined to be present or absent by skin tests and double-blind food challenges. Elevated levels of antibodies to milk proteins in sera characteristic of infants fed cow milk were found to decline with age, so that sera from children who were 6 to 15 years of age (inclusive), not hypersensitive to food, had significantly lower levels than the infants. In contrast, sera from age-matched children, who were shown to have hypersensitivity to some food, were found to have levels of antibodies to milk proteins as elevated as in infancy. Hypersensitivity was not necessarily to milk but often to some other food. This persistence of greater antibody production to milk throughout childhood in those hypersensitive to some food indicates a fundamental difference from those without hypersensitivity to food, either in permeability, in immunological reactivity of the gut or in development of immunological unresponsiveness. Implications for pathogenesis of clinical disorders are discussed.     

儿童过敏性紫癜早期肾损伤的危险因素分析

目的分析儿童过敏性紫癜(HSP)早期肾损伤的相关危险因素。方法回顾性分析2012年4月至2016年1月收治的196例HSP患儿的临床资料,按是否发生早期肾损伤(确诊至90d内)分为肾损伤组与无肾损伤组,比较2组血清免疫球蛋白、尿微量清蛋白及相关临床资料的差异,筛选影响儿童HSP早期肾损伤发生的高危因素。结果肾损伤组年龄、关节症状、紫癜反复发作、持续皮疹、消化道出血、腹痛与无肾损伤组比较,差异有统计学意义(χ2值或t值分别为11.345、16.223、11.275、43.211、12.592、17.771,P0.05);肾损伤组白细胞计数、血小板计数、免疫球蛋白A(IgA)水平、尿微量清蛋白水平与无肾损伤组比较,差异有统计学意义(t=33.750、60.442、9.451、8.458,P0.05)。多因素回归分析显示,年龄(OR=2.703)、紫癜反复发作(OR=2.721)、持续皮疹(OR=1.782)、消化道出血(OR=11.472)、腹痛(OR=2.046)、IgA水平(OR=1.221)、尿微量清蛋白(OR=3.214)均为儿童HSP早期肾损伤的独立危险因素。结论年龄、紫癜反复发作、持续皮疹、消化道出血、腹痛、IgA水平、尿微量清蛋白均与儿童HSP早期肾损伤密切相关。     

应用基因测序方法检测哮喘儿童的PTEN基因突变

目的分析10号染色体上缺失的磷酸酶与张力蛋白同源基因（phophatase and tensin homolog deleted onchromosone 10,PTEN）突变与儿童哮喘的相关性,及其与外周血嗜酸性粒细胞（eosinophils,EOS）的关系,进一步探讨儿童哮喘的发病机制,并为其新治疗方法的研发提供一定理论依据。方法设定30例哮喘患儿（临床缓解期）为哮喘组,30例健康儿童为对照组。均于清晨空腹抽取外周静脉血,制备血涂片后提取全基因组DNA。对其PTEN基因第5、第8外显子（exon 5,exon 8）进行基因测序分析,同时进行外周血EOS计数。计量资料采用χ2 test,计数资料采用t检验进行统计分析。结果 83.3%（25/30）哮喘组儿童有PTEN基因第8内含子（intron 8）突变,对照组无基因突变。外周血EOS计数在哮喘组明显高于对照组,差异显著（P〈0.05）;发生基因突变的哮喘患儿外周血EOS计数高于无突变的哮喘患儿,差异显著（P〈0.05）。结论哮喘儿童绝大部分存在PTEN基因第8内含子突变,其与EOS的数量相关,PTEN基因可能通过抑制EOS的活化和趋化在哮喘发病中发挥作用。     

Lack of association between antiphospholipid antibodies and migraine in children

Anticardiolipin antibodies are found frequently in those suffering from migraine, but it is not clear if this association is real or coincidental. Moreover, there are no data on the prevalence of anticardiolipin antibodies in children. In this study, 40 patients were divided into two groups according to the type of migraine: group I included 22 cases (15 females and 7 males, mean age+/-SD 13.7+/-8.9 years) suffering from migraine with and without aura; group II consisted of 18 children (10 females and 8 males, age 14.7+/-6.9 years) having migraine with prolonged aura or migrainous infarction, also called complicated migraine. We studied two groups of children as controls: a group of 35 children (25 females and 10 males, mean age 13.9+/-7.1 years) with juvenile chronic arthritis (group III) and a group of 40 healthy sex- and age-matched children who did not suffer from migraine or any other neurological disease (group IV). No statistically significant differences in levels of anticardiolipin antibodies were found between group I and II and controls. Our data demonstrate that, in children with migraine, anticardiolipin antibodies are not more frequent than in healthy controls, and suggest that anticardiolipin antibodies are not implicated in the pathogenesis of migraine.     

The molecular basis of hereditary 1,25-dihydroxyvitamin D3 resistant rickets in seven related families.

Hereditary 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] resistant rickets (HVDRR) is an autosomal recessive disease caused by target organ resistance to the action of 1,25(OH)2D3, the active form of the hormone. The defect in target cells is heterogenous and commonly appears to be a mutation in the gene encoding the vitamin D receptor (VDR). We have studied cultured skin fibroblasts and Epstein-Barr virus transformed lymphoblasts of seven family branches of an extended kindred having eight children affected with HVDRR. We have previously shown that cells from three affected children in this group contain an "ochre" nonsense mutation coding for a premature stop codon in exon 7 within the steroid-binding domain of the VDR gene. In the current studies, we found that cells from affected children failed to bind [3H]1,25(OH)2D3 and had undetectable levels of VDR as determined by immunoblots using an anti-VDR monoclonal antibody. Measurement of VDR mRNA by hybridization to a human VDR cDNA probe showed undetectable or decreased abundance of steady-state VDR mRNA. Parents, expected to be obligate heterozygotes, showed approximately half the normal levels of [3H]1,25(OH)2D3 binding, VDR protein, and mRNA. The mutation at nucleotide 970 (counting from the mRNA CAP site) results in the conversion of GTAC to GTAA, which eliminates an Rsa I restriction enzyme site and facilitates identification of the mutation. We found that polymerase chain reaction (PCR) amplification of exons 7 and 8 from family members and subsequent Rsa I digestion allows detection of the specific genotype of the individuals. When Rsa I digests of PCR-amplified DNA are subjected to polyacrylamide gel electrophoresis, children with HVDRR exhibit a homozygous banding pattern with loss of an Rsa I site. Parents exhibit a heterozygotic DNA pattern with detection of both normal and mutant alleles. In summary, our data show that the genetic abnormality is a point mutation within the steroid-binding domain of the VDR in all seven related families with HVDRR. Analysis of restriction fragment length polymorphism at the 970 locus of PCR-amplified DNA fragments can be used to diagnose this mutation in both affected children and parents carrying the disease.     

Relations in Families with a Mentally Retarded Child from the Perspective of the Siblings

Nowadays most handicapped children in Sweden live with their families. In this study some of the consequences of the normalisation of their lives are analysed, focusing on young siblings of mentally retarded children. Sixteen siblings, aged 5–11, were tested with the Family Relations Test and Kvebaek Family Sculpture Technique, as were siblings in a control group in which each child was chosen to match a sibling in the target group with respect to age and family constellation. The results show few differences between the two groups. According to the Family Relations Test, however, the emotional involvement in the eldest non-retarded sibling differs statistically significant from that of the corresponding child in the control group and especially so with respect to negative incoming feelings. Young siblings also show a tendency to unconsciously place the mentally retarded child at larger distances from themselves than they place the other siblings with respect to the Kvebaek Family Sculpture Technique. The results indicate that siblings of mentally retarded children have another frame of reference when judging family relations compared with that of the children in the control group. Thus siblings of mentally retarded children seem to adapt to changes in the family because of the mentally retarded child and qualitatively alter their thinking in relation to the family members.     

Effects of skin grafting on successful prosthetic use in children with lower extremity amputation

The use of skin grafts after lower extremity amputation in pediatric patients remains a controversial decision. A skin graft may help to preserve residual limb length and knee joint function; however, the literature suggests that it may make the patient more susceptible to complications. Directly contrasting children with and without skin grafts on their residual limbs will provide important data for the clinician making this decision. This study compares amputation characteristics, complications, and functional outcomes of these two populations. A retrospective chart analysis was performed on 45 pediatric patients who underwent lower extremity amputation between 1997 and 2006. Patients were divided into two groups: the graft group had skin grafts on their residual lower extremity limb(s) and the no graft group had no skin grafts present on the residual lower extremity limb(s). The mean time from amputation to follow-up was 4.5 years in the graft group and 7.0 years in the no graft group (P = .07). The average age at amputation for the graft group was 9.4 +/- 1.4 years and 5.9 +/- 1.1 years for the no graft group (P = .04). The graft group had a significantly longer hospital stay with 91 inpatient days vs 31 inpatient days in the no graft group (P = .03). There was no increased incidence of surgical revisions or reported problems with prosthetic wear in the graft group. Both groups achieved comparable levels of independence with ambulation. The presence of skin grafts on a child's amputated limb does not adversely affect functional outcome and does not lead to greater prosthetic complications for the child.     

Assessment of the convergent validity of pain intensity in the Pain Sensory Tool

The purpose of this study was to examine the convergent validity of the Pain Sensory Tool with the Poker Chip Tool. Both tools were used to assess children's pain intensity (ages 5 to 14 years). A total of 104 hospitalized Taiwanese children with acute pain were asked to participate in this study. All children were required to use both the Pain Sensory Tool and the Poker Chip Tool to measure their pain. The results of Pearson correlation revealed a coefficient of.79 to.88. The convergent validity of the Pain Sensory Tool with the Poker Chip Tool was therefore supported. No significant differences in preferences of using the PST and the PCT were found by age group and sex. The findings of this study also demonstrated that the Poker Chip Tool can be used to measure Taiwanese children's pain intensity. In addition, the Pain Sensory Tool and the Poker Chip Tool were reliable instruments to measure pain intensity of Taiwanese children (ranged from 5 to 14 years of age). However, 27 % of five-year-old children failed to understand the instructions of the PST although these children were dropped from the study. This raises concerns about the validity of the PST for five-year-old children. It is not clear whether these five-year-old children were outliers or whether the PST is difficult for younger children. The authors suggested duplicating this study and specifying the five-year-old age group for the validity test.     

The effective management of atopic dermatitis in school-age children

The terms atopic eczema and atopic dermatitis (AD) are synonymous. In this article, the latter term is used. AD can affect all age groups but is most commonly associated with children. It is a dry-skin condition, the severity of which can vary from person to person. It is not contagious. In mild forms of the condition the skin is dry, hot and itchy, while in more severe cases the skin can be broken, raw and bleeding, or produce vesicles and papules that may become eroded.     

The effectiveness of using a bath oil to reduce signs of dry skin: A randomized controlled pragmatic study

BackgroundDry skin (xerosis cutis) is increasingly recognized as a relevant health problem in daily life and in health and nursing care. The use of bath additives such as oils is common to reduce dry skin, but empirical evidence supporting this practice is limited.ObjectivesThe aim of this study was to investigate the effectiveness of using a bath oil additive in improving skin barrier function and ameliorating dry skin in comparison to non-oil containing skin cleansers for bathing or showering.DesignSingle centre randomized observer blind pragmatic parallel group trial.SettingsOutpatient/community care.ParticipantsVolunteers showing clinically mild to moderate dry skin recruited from the city of Berlin.MethodsHealthy children and adults were randomly assigned to use either a commercially available bath oil or to continue using their regular non-oil containing skin cleansers every other day over a study period of 28 days. Skin barrier parameters and the severity of dry skin were assessed at baseline and at two follow-up visits at the study centre. Transepidermal water loss was the primary outcome.ResultsAll sixty participants randomized completed the trial. Median age was 32.5 (IQR 8.3 to 69) years. At the end of study the mean transepidermal water loss in the intervention group was statistically significant lower compared to the control group (mean difference −1.9 (95% CI −3.1 to −0.8) g/m²/h). Stratum corneum hydration was statistically significantly higher in the intervention group at the end of the study. Skin surface pH and roughness were comparable in both groups and remained unchanged, while both groups showed a trend to improvement in dry skin symptomsConclusionsThis pragmatic trial provides empirical evidence that the regular use of the investigated bath oil is effective in improving the skin barrier function in children and adults with mild dry skin when used in routine skin care and supports its use as a basic element for the management of a broad spectrum of dry skin conditions.Trial registrationClinicalTrials.gov Identifier NCT02557698.     

Field testing of the ACCESS materials: a portfolio of materials to assist health workers to identify children with disabilities and offer simple advice to mothers

Children in less-developed countries with mild to moderate disabilities often remain unidentified until school age. Delayed identification leads to less successful interventions for most children and risks secondary disabilities. The disability group at the Centre for International Child Health was funded to address this issue by developing a screening portfolio. The field testing of this portfolio is reported here. The results collected through quantitative analysis of the children brought for screening, and the fact that the field workers identified disabilities in children over the age of 2 years with over 82% accuracy when compared with professionals, suggests that health workers can be taught to use the portfolio effectively. Among younger children the accuracy is poorer. Field workers can additionally be trained to give advice to mothers and/or refer where appropriate. Equally important, results from focus group discussions with both health workers and parents, and questionnaires to health workers, demonstrate that both groups found the process clear and useful. Parents liked the process and found the advice materials helpful. Several health workers made comments about how the portfolio's use helped to develop positive attitudes towards disability and improved their own self-confidence.     

The literacy abilities of 11 year-old students from socially disadvantaged backgrounds

This study investigated the literacy skills of all children in Year 6 of a Queensland school in a socially disadvantaged area who were exposed to a “whole language” approach to the learning of written language. Standardized tests of non-word spelling and reading comprehension (including written sentence responses) revealed a large group of children with literacy difficulties. This group of 11-year-old children, and a group of matched controls, were further assessed on measures of phonological awareness and letter sound knowledge. The results indicated that the means of both groups were below those of the standardization populations, and that the children had particular difficulty writing short answers to questions. The group of children identified as performing poorly on the non-word spelling test was heterogeneous. Some had poor phonological awareness skills, some had limited sound-letter correspondence knowledge, some children had problems with both skills. The data demonstrated the need for assessment to identify the specific sub-skills with which individuals have difficulty, in order to allow for appropriate intervention rather than a generic phonological awareness intervention package for all children with literacy difficulties irrespective of age or social status.     

Oil on troubled waters: emollients and eczema

While most of us will have suffered from episodes of dry skin (xerosis) at some stage in our lives, this is usually confined to the occasional mildly annoying episode. However, for others, particularly those with eczema, this forms part of a chronic, very distressing situation that often has a significant impact on their quality of life. Despite the fact that many children and adults have eczema, it is still often considered to be a minor skin condition that children will 'grow out of'. However, an increased research focus towards examining the impact of eczema on the individual has shown that eczema is anything but a minor problem.