Ambulatory arrhythmia screening in symptomatic children and young adults: Comparative effectiveness of holter and telephone event recordings

Summary Effective initial identification of potential cardiac arrhythmias in symptomatic children is difficult due to the infrequency, brief duration, and vague nature of subjective complaints in the young. Although both telephone event and Holter monitoring are used for this purpose, no comparative studies of the initial screening efficacy of either have been performed. A total of 202 consecutive symptomatic children (age 11 days to 26 years, mean 10.2 years) were evaluated for potential cardiac arrhythmias with either 24-h Holter (97 patients) or telephone event (105 patients) recorders and grouped according to the presence or absence of congenital heart defects, normal or abnormal resting electrocardiogram (ECG), and presence or absence of cardiac surgery. The results showed 30% of all recordings (61% event; 14% Holter) failed to substantiate any arrhythmias in spite of subjective symptoms. Event recordings showed a better correlation of sensed symptoms with arrhythmias (32%) compared to Holters (5%) (p<0.01) with 73% of Holter recordings performed during both asymptomatic and arrhythmia-free 24-h periods. Holter monitoring was more effective in detecting nonsensed and asymptomatic events (8% versus 0.5%, (p<0.01), among high-risk children. This study demonstrates that although both monitoring devices are applicable to children, each has inherent limitations and usefulness. These must be considered in choosing either device to permit their most optimal and cost-effective application.     

Comparative study of the effectiveness of immuno-correcting therapy in insulin-dependent diabetes mellitus in children

Forty-seven children suffering from insulin-dependent diabetes mellitus were examined for criteria of the efficacy of the immunocorrecting drugs prodigiosan, sodium nucleinate, decaris and splenin. Certain differences were discovered in the clinicoimmunologic efficiency of the drugs enumerated. The treatment of choice should be conducted on an individual basis under control of the immunologic status with regard to the clinicometabolic effect. The necessity has been shown of including the immunocorrecting remedies into multimodality treatment of diabetes mellitus. Decaris and splenin have been found to possess the greatest immunocorrecting activity in respect of the cellular component of immunity and the highest clinicometabolic efficacy.     

Preventive interventions for preterm children: effectiveness and developmental mechanisms

This article provides an integrative review of the effectiveness of and possible developmental mechanisms associated with preventive interventions for preterm children. An analysis of randomized clinical trials carried out within the last 15 years was framed within a contemporary developmental model emphasizing the role of parental adjustments to preterm children's characteristics. Evidence suggested positive outcomes could be understood in terms of improvements in developmental pathways associated with parental sensitive-responsiveness and child participation in intensive intervention-oriented child care. Implications for the critical role of the Medical Home model for preventive interventions for preterm children were discussed.     

Comparative study of autonomic nervous system activity in malnourished and normal children in India

Information on the relationship between autonomic functions and malnutrition in children is scant. In the present study, autonomic function tests were conducted in 30 normal subjects and 30 malnourished children aged between 5 and 10 years. The tests performed included tests for parasympathetic functions (resting heart rate, standing-to-lying ratio, lying-to-standing ratio and Valsalva ratio) and tests to assess sympathetic function (hand grip test, galvanic skin resistance). The malnourished children had significantly lower mean weights-for-age (-2.6 Z vs -1.5 Z; p = 0.001), heights-for-age (-2.5 Z vs -1.5 Z; p = 0.001) and weights-for-height (-1.6 Z vs -0.8 Z; p = 0.001). Parasympathetic function tests evaluated were significantly affected in malnourished children. Resting heart rate was significantly higher in the malnourished group (90.6 vs 82.5/min; p = 0.001). The other parasympathetic function tests had significantly lower mean values than in the control group, namely, standing-to-lying ratio (1.25 vs 1.32; p = 0.026), lying-to-standing ratio (1.23 vs 1.29; p = 0.021) and Valsalva ratio (1.26 vs 1.28; p = 0.037). Of the sympathetic function tests conducted, there were no differences between the two groups for hand grip test but galvanic skin resistance was significantly higher in the malnourished subjects (190.1 vs 149.73; p = 0.001). It is concluded that autonomic nervous system function is significantly compromised in malnourished children.     

Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial

This study compared the relative effectiveness of two antimicrobial preparations, amoxicillin and amoxicillin-clavulanate potassium (Augmentin), in the treatment of acute maxillary sinusitis in children 2 to 16 years of age. Of 171 children with persistent (ten to 30 days' duration) nasal discharge or daytime cough or both, 136 (80%) had abnormal maxillary sinus radiographs. These children were stratified by age and severity of symptoms and randomly assigned to receive either amoxicillin, amoxicillin-clavulanate potassium, or placebo. After the exclusion of 28 children with throat cultures positive for group A Streptococcus and 15 who did not complete their medication, the remaining 93 children were evaluated: 30 received amoxicillin, 28 received amoxicillin-clavulanate potassium, and 35 received placebo. Clinical assessment was performed at three and ten days. On each occasion, children treated with an antibiotic were more likely to be cured than children receiving placebo (P less than .01 at three days, P less than .05 at ten days). The overall cure rate was 67% for amoxicillin, 64% for amoxicillin-clavulanate potassium, and 43% for placebo.     

Comparative study of the effectiveness of cefixime and penicillin V for the treatment of streptococcal pharyngitis in children and adolescents.

An open label randomized trial conducted in rural Kentucky compared the efficacy and safety of cefixime (CFX), 8 mg/kg once daily, with those of penicillin V (PEN), 250 mg 3 times daily, in 110 pediatric patients with Group A beta-hemolytic streptococcal pharyngitis. Forty-eight CFX and 47 PEN patients were evaluable for efficacy. At the end of therapy bacteriologic eradication was 45 of 48 (94%) and 36 of 47 (77%) in the CFX and PEN V groups, respectively (P < 0.05). Up to 6 weeks posttherapy 10 (21%) CFX patients and 21 (45%) PEN patients had positive Group A beta-hemolytic Streptococcus cultures (P < 0.05). Concordant serotypes were identified from 4 of 7 CFX and 15 of 17 PEN patients with positive repeat cultures. All discordant serotypes (5 of 31) were identified at greater than 19 days posttherapy. Symptomatic treatment failures (concordant serotypes) occurred in 1 (2%) CFX and 8 (17%) PEN patients (P < 0.05). Drug-related adverse experiences consisted of 2 cases of mild diarrhea and loose stools in the CFX group and none in the PEN group. No clinically significant laboratory test abnormalities occurred in either group. CFX, once daily, was as safe as and significantly more effective than PEN given 3 times daily for the treatment of Group A beta-hemolytic streptococcal pharyngitis.     

Practitioner review: The effectiveness of systemic family therapy for children and adolescents

BACKGROUND: Systemic family therapy has become a widely used intervention in child and adolescent mental health services over the last twenty years. METHODS: This paper reviews the development of systemic family therapy, briefly describes the theory and techniques associated with the most prominent contemporary strands of systemic practice, and examines the empirical justification for using systemic family therapies with children and adolescents. RESULTS: There is a paucity of well-designed randomised controlled trials of systemic therapies with children and adolescents and those trials that do exist evaluate older structural and strategic therapies. Methodological limitations of existing research include the use of unrepresentative participants, small sample sizes and wide age ranges. There is a lack of credible no-treatment or alternative treatment controls, tests of clinical as opposed to statistical significance, and conceptually relevant outcome measures that examine underlying interactional mechanisms. The term 'family therapy' encompasses a wide range of interventions and it is not always clear what treatment intervention has been delivered. Nevertheless, there is good evidence for the effectiveness of systemic family therapies in the treatment of conduct disorders, substance misuse and eating disorders, and some support for their use as second-line treatments in depression and chronic illness. CONCLUSIONS: Systemic family therapy is an effective intervention for children and adolescents but further well-designed outcome studies are needed using clearly specified, manualised forms of treatment and conceptually relevant outcome measures.     

Extraordinary cause of complete colonic obstruction in children: Urinary retention

Complete colonic obstruction in children may occur secondary to congenital, and acquired factors related to the gastrointestinal system. Herein, we report an extraordinary presentation of complete colonic obstruction due to extensive urinary retention in a 3‐year‐old boy. The possible underlying mechanism was detected as urinary infection in a child with horseshoe kidney. The treatment of the bladder symptoms and urinary infection relieved the obstruction of the colon. To our knowledge, especially in children, colonic obstruction due to urinary retention has not been reported in the literature.     

Massage in children with cancer: effectiveness of a protocol

Objectivesmassage can help relieve pain, although empirical evidence is scarce and contradictory. This study aims to assess the effectiveness of a massage protocol in relieving pain in children hospitalized with cancer.Methodsa randomized, controlled, and single-blind trial was performed in a sample of 52 children aged between 10 and 18 years who were hospitalized in a pediatric cancer ward. The intervention consisted of the implementation of a massage protocol with three sessions of 20 to 30 minutes on alternate days over a one-week period. The effectiveness of the protocol was evaluated by assessing pain using the Brief Pain Inventory (BPI), while the effectiveness of each massage session was measured using the Visual Analogue Scale (VAS).Resultsthe massage protocol was only effective in reducing the interference of pain in walking (p < 0.05), although it also contributed to relieve pain and its impact on the children's activities. After each massage session, the intensity of the pain experienced by the child decreased (p < 0.001).Conclusionsdespite the small sample size, massage therapy appears to be a useful intervention in reducing pain in children with cancer. However, there are still questions regarding the effectiveness of this massage protocol. The authors recommend its use due to its contribution to the promotion of the child's well-being and quality of life.