CT in children with abdominal cancer: should we routinely include the pelvis?

Background: It has been suggested that the pelvis should not be habitually included on abdominal CT examinations, but the potential benefit of such a practice in childhood abdominal malignancies is unknown. Objective: To estimate the yield and potential diagnostic benefit of abnormal findings on CT of the pelvis in children with malignant primary tumours in the upper abdomen. Materials and methods: From a paediatric tertiary referral hospital we retrospectively included patients having abdominal CT for primary upper abdominal tumours (1997–2004), the scan range routinely including the pelvis. We reviewed and tabulated any pelvic abnormality, and calculated group proportions with 95% confidence intervals. Results: We identified 230 children (2 days to 17 years old, median 2.9 years). Six (2.6%; 95% CI 0.5–4.7%) had abnormalities in the pelvis that would not have affected clinical management. Four (1.7%; 95% CI 0.1–3.4%) had findings that might have influenced staging, but only one was not detected by other modalities within 1 week of the CT. Conclusions: Our data suggest that diagnostically significant findings in the pelvis are rare; consequently, the habitual inclusion of the pelvis on abdominal CT for primary malignant tumours in the abdomen is not justified.     

Vitamin D status in diabetic Egyptian children and adolescents: a case–control study

Background

Recently, studies suggesting that vitamin D deficiency correlates with the severity and frequency of Type 1 (insulin-dependent) diabetes mellitus (T1DM) and that vitamin D supplementation reduces the risk of developing T1DM have been reported.

Objective

In this study, we aimed to assess vitamin D status in Egyptian children and adolescents with T1DM.

Methods

This was a case–control study including 80 T1DM diagnosed cases aged 6 to 16 years and 40 healthy children with comparable age and gender as the control group. For all subjects, serum 25 (OH) D levels were measured by ELISA, Serum parathyroid hormone (PTH) and serum insulin were measured by an electrochemiluminesce immunoassay. Serum glucose, Glycosylated hemoglobin (HbA1c) levels and homeostasis model assessment of insulin resistance (HOMA-IR) were also assessed.

Results

Compared to the control group, serum vitamin D levels were not significantly lower in diabetic subjects (24.7?±?5.6 vs 26.5?±?4.8 ng/ml; P?>?0.05). Among diabetic cases 44(55%) were vitamin D deficient; meanwhile 36(45%) cases had normal vitamin D level (P?<?0.01). In addition, 26(32.5%) diabetic cases had 2ry hyperparathyroidism and 54(67.5%) cases had normal parathyroid hormone level; meanwhile, none of the control group had 2ry hyperparathyroidism (P?<?0.01). Furthermore, we found a significant difference between vitamin D deficient diabetic cases and those with normal vitamin D level as regards HOMA-IR and diabetes duration (P?<?0.01).

Conclusion

Public health message on the importance of vitamin D status; especially in diabetic children and adolescents, should be disseminated to the public.

     

Antidotes for nerve agent poisoning: should we differentiate children from adults?

PURPOSE OF REVIEW: Chemical terrorism presents a threat to the civilian population, including children. Nerve agent antidotes are available in prepackaged autoinjectors that can be delivered rapidly following an exposure. The published evidence on the use of nerve agent antidotes consists of case reports, extrapolation from pediatric organophosphate poisonings, and expert opinion. This review examines the evidence supporting the use of nerve agent antidotes in children. RECENT FINDINGS: The use of adult formulated atropine and pralidoxime autoinjectors will deliver doses above current recommendations for infants and children. Data demonstrate, however, that atropine overdose is generally well tolerated in young children. Children symptomatic of nerve agent poisoning will likely need both supraphysiologic doses and frequent re-dosing of atropine. SUMMARY: Based on limited data, the Mark 1 autoinjector kit (Meridian Medical Technologies, Columbia, Maryland, USA) appears to be the most efficacious antidote delivery system following a nerve agent attack. Symptomatic children under 1 year of age should be given a full atropine dose from the Atropen (Meridian Medical Technologies) (0.5 mg) or Mark 1 kits (2 mg), while children over 1 year of age should be given a full dose of both atropine and pralidoxime from the Mark 1 kit when more accurate weight-based dosing of antidotes is impossible.     

Should we screen children with severe acute malnutrition for celiac disease?

The clinical features of severe acute malnutrition (SAM) often overlap with the common manifestations of celiac disease. In this observational pilot study, 76 children fulfilling the case definition of SAM were investigated for celiac disease, tuberculosis and HIV. Celiac disease was diagnosed in 13.1% of SAM children while tuberculosis and HIV were diagnosed in 9.3% and 4%, respectively.     

When and how should we treat epilepsy in children?

This article draws on recent guidelines and evidence to briefly look at the diagnosis (and misdiagnosis) of epilepsy in children and aims to address the issue of when to treat, when not to treat and how to treat epilepsy by seizure and syndrome type with the use of illustrative cases.Key to the management of epilepsy is individualizing treatment, taking into consideration not only seizure type or epilepsy syndrome but also co-medication, co-morbidity, lifestyle factors, and the preferences of the child and family.Anti-epileptic drugs frequently have adverse effects and it is imperative to consider the risk versus benefit balance for each child.     

Total colectomy for ulcerative colitis in children: when are we operating?

Purpose

Ulcerative colitis (UC) in children is frequently severe and treatment-refractory. While medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. Our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric UC patients.

Methods

We conducted a retrospective cohort study using the Pediatric Health Information System database. We identified all patients under age 18 discharged between January 1, 2004 and September 30, 2011 with a primary diagnosis of UC. Primary outcome was odds of total colectomy.

Results

Of 8,688 patients, 240 (2.8 %) underwent colectomy. Compared with non-operative patients, a greater proportion of colectomy patients received advanced therapies during admission, including corticosteroids (84.2 vs. 71.3 %) and biological therapy (25.4 vs. 13.6 %). Odds of colectomy were increased with malnutrition (OR 1.86), anemia (OR 2.17), electrolyte imbalance (OR 2.31), and Clostridium difficile infection (OR 1.69). TPN requirement also independently predicted colectomy (OR 3.86). Each successive UC admission significantly increased the odds of colectomy (OR 1.08).

Conclusion

These data identify factors associated with progression to colectomy in children hospitalized with UC. Our findings help to identify factors that should be incorporated into future studies aiming to reduce the variability in surgical treatment of childhood UC.