Continuation of linear growth failure and its association with cognitive ability are not dependent on initial length‐for‐age: a longitudinal study from 6 months to 11 years of age

Aim: To examine linear growth and its association with cognitive ability at age 11 years among full‐term singletons with varying degree of stunting or without stunting at age 6 months. Methods: A total of 1516 Filipino term‐born singletons were followed bimonthly from age 6 to 24 months and took cognitive and academic achievement tests at 11 years. The tests were factor‐analysed to give a summary cognitive ability score. Linear regression was used to examine associations and adjust for covariates. Results: Mean height‐for‐age Z‐score (HAZ) was ?1.0 at age 6 months and ?2.4 at 24 months. HAZ at 6 months, change in HAZ from 6 to 24 months and change in HAZ from 24 months to 11 years were positively associated with cognitive ability at 11 years (each p < 0.001). The association was seen in all categories of HAZ at 6 months. Conclusion: In this setting where linear growth retardation was common, association between linear growth after age 6 months and cognitive ability in adolescence was not dependent on initial HAZ. Prevention of growth stunting may benefit all children regardless of their initial HAZ.     

Salmonella mycotic aneurysm: a rare cause of fever and back pain in elderly

An 85-year-old man with history of hypertension presented with fever, cough and abdominal pain. Unfortunately fever and leukocytosis persisted despite treatment. Blood cultures obtained on admission grew Salmonella enteritidis. Subsequently he developed increasing back pain and transoesophageal echocardiography (TOE) was performed, demonstrating a complex ulcer at the aortic arch with multiple small mobile strandlike densities suggestive of vegetation. Contrast thoracic CT scan confirmed an ulcerated atherosclerotic plaque which progressively increasing in size over 3 months despite antibiotics. Therefore, a stent was deployed in view of high risk of perforation and he was placed on prolonged antibiotics. Post-stenting CT scan a few months later showed a patent stent with the aneurysm remained stable in size. Cardiovascular infections develop in approximately 25 % of patients with Salmonella bacteremia. Most patients with Salmonella aortitis have preexisting atherosclerosis at the site of the subsequently infected aneurysm. The diagnosis of S. aortitis can be challenging, because the clinical course may be indolent and the symptoms are nonspecific. A high index of suspicion is required to make the diagnosis of S. aortitis, especially in patients with Salmonella bacteraemia, fever, back pain and/or abdominal pain. This case highlights the usefulness of TOE in the evaluation of diseases involving the thoracic aorta, leading to a successful intervention.     

Dosimetry of blood irradiation with radiochromic film

It has been shown that radiochromic film is an ideal dosimeter for assessment and verification of delivered dose to irradiated blood products. Using a parallel opposing two-field technique on a medical linear accelerator, blood is irradiated to diminish the risk of transfusion-associated graft vs. host disease (TA-GVHD). The blood products are irradiated in a Perspex blood box to an applied dose of 29.5-31.7 Gy. Verification of applied dose has been performed with thimble ionization chambers and radiochromic film. Radiochromic film results have matched absorbed dose measurements from ionization chambers at all sites within the 'active' treatment volume within +/-6% for a 95% confidence limit. Using a sample of 100 in-vitro measurements, radiochromic film has measured the average applied dose to blood products to be 30.95+/-2.6 Gy for two standard deviations. Like currently available 'irradiated' film labels, the radiochromic film also serves as a visible reminder that the blood products have been irradiated.     

Comparison of craniofacial skeletal characteristics of infants with bilateral choanal atresia and an age-matched normative population: computed tomography analysis.

Choanal atresia (CA) results from the developmental failure of the posterior nasal cavity to communicate with the nasopharynx. Computed tomographic (CT) scanning is often used as a diagnostic tool for CA as it is able to provide information regarding the extent and type of atresia. Studies have used CT measurements to analyze the skeletal deformities of children with CA. Computed tomographic analysis of the complete craniofacial skeletal characteristics of children with CA has not been previously reported. This study analyzed the craniofacial skeletal characteristics of infants with bilateral choanal atresia (BCA) and compared them with age-matched standards. Eight patients with BCA under the age of 3 months were evaluated. Fourteen cranio-orbitozygomatic variables were used to represent the craniofacial skeletal configuration. The measurements from the control group were compared with the available values of age-matched normal controls. Statistically significant differences between the means of the sample group and control group were demonstrated in 10 of 14 variables. The sample group means were consistently smaller than the control group mean. Detailed knowledge of the underlying anatomy of infants with BCA will help in the development of treatment strategies and will provide data for evaluation of operative intervention on craniofacial growth.     

Orthokeratology practice in children in a university clinic in Hong Kong*

Purposes: The aim of this study was to analyse clinical data of children undergoing orthokeratology (ortho‐k) and to investigate patients’/parents’ perspective on ortho‐k via telephone interviews. Methods: Clinical records of children undergoing ortho‐k from a university optometry clinic were reviewed and the effects of ortho‐k on refraction, vision and cornea were investigated. A telephone interview was conducted to solicit patients’/parents’ perspective of the treatment. Results: One hundred and eight files were reviewed. Median age of the children was nine years (range six to 15); mean (±SD) pre‐treatment refractive sphere was ‐3.56 ± 1.49 D and the median refractive cylinder was ‐0.50 D (range zero to ‐4.25 D). Significant refractive spherical reduction (58 per cent), improvement in unaided vision and corneal topographical changes were noted after only one night of wear. No significant change in astigmatism was found. Corneal staining was the most commonly observed complication with ortho‐k and more than 80 per cent of patients were advised to apply ocular lubricants to loosen the lens before lens removal. Ortho‐k was mainly undertaken for myopic control and about 90 per cent of the respondents reported good/very good unaided vision after ortho‐k and ranked the treatment as satisfactory or very good. Lens binding and ocular discharge were the most frequently reported problems during the treatment. Conclusion: Under close monitoring, overnight ortho‐k is effective and safe for reducing low to moderate myopia and the treatment is well accepted by the children.     

Sliding scale insulin: will the false idol finally fall?

Despite a lack of evidence that sliding scale insulin has any clinical benefit, and some evidence that it may even be detrimental, sliding scale insulin is still commonly prescribed in hospitals today. Adopting a proactive rather than a reactive approach to managing diabetes by the use of ‘supplemental insulin’, given in conjunction with either considered adjustments to the patient's regular anti‐diabetic therapy or the provision of basal insulin, is a more effective and safer means of improving glycaemic control in hospital. There are now randomized trial data to support this approach. These data, together with the recognition that there is no evidence base for the use of sliding scale insulin, coupled with changes to insulin prescribing charts in Australia, should lead to the demise of sliding scale insulin use in hospital.     

Fresh-frozen plasma transfusion strategy in trauma with massive and ongoing bleeding. Common (sense) and sensibility

During trauma resuscitation involving massive transfusion, the best fresh-frozen plasma to packed red blood cells ratio is unknown. No randomised controlled trial (RCT) is available on this subject, although there are plenty of observational studies suggesting that the ratio should be about 1:1. This ratio also makes more physiological sense, and we suggest that in patients with massive and ongoing bleeding, it is a sensible strategy with which to start resuscitation.