Use of Fogarty catheter as bronchial blocker for lung isolation in children undergoing thoracic surgery: A single centre experience of 15 cases

Background and Aim:Various devices such as single lumen tubes, balloon?tipped bronchial blockers, and double?lumen tubes can be used for lung isolation in children, but no particular device is ideal. As such, there is a wide variation in lung isolation techniques employed by anaesthesiologists in this cohort of patients. This study aims to describe our experience with Fogarty catheters for lung isolation in children. Methods: This was a single centre, retrospective review of 15 children, below the age of 8 years, undergoing thoracic surgeries and requiring lung isolation. Demographic details, clinical parameters, complications during Fogarty catheter placement, number of attempts for placement, time taken for satisfactory lung isolation, and intraoperative complications were collected. Results: Successful lung isolation was achieved in all 15 children with Fogarty catheters of various sizes with the help of flexible bronchoscopy. Desaturation and bradycardia were the commonest complications seen during placement of the catheters but resolved with bag?mask ventilation. On average, 2 attempts were required for successful Fogarty placement. The mean time for successful lung isolation was 6.9 ± 1.3 minutes. The commonest intraoperative complication noted was desaturation, which resolved with an increase in FiO2 and positive end expiratory pressure. 2 children had migration of the device proximally to the trachea causing airway obstruction. The devices were successfully repositioned in both cases. Conclusion: Fogarty catheters can be used for successful lung isolation in children less than 8 years of age, undergoing thoracic surgery

Species distribution and clinical profiles of coagulasenegative staphylococci (CoNS) isolated from blood cultures among paediatric patients in Hospital Kuala Lumpur

@#Introduction: Coagulase-negative staphylococci (CoNS) is often considered as a culture contaminants but it can potentially be pathogenic to patients with risk factors. A combination of species identification and clinical criteria has been suggested in determining true CoNS bacteraemia. Objectives: To identify the species distribution, antibiotic susceptibility patterns and clinical profiles of CoNS isolated from blood cultures among paediatric patients in Hospital Kuala Lumpur (HKL). Methods: This study involved CoNS isolation from blood cultures of paediatric in-patients of the Paediatric Institute HKL. Isolates were identified to species level using Analytical Profile Index Staph identification strips and antimicrobial susceptibility pattern following Kirby-Bauer Disc Diffusion method. The clinical profiles of patients were obtained from their medical records. Results: Eleven CoNS species were identified from 148 isolates. Staphylococcus epidermidis was the most frequent species isolated (67.6%). The majority of the isolates showed resistance to penicillin (85.8%); while 70.3% were methicillin-resistant (MR) CoNS, which demonstrated a significant association with true infection (p=0.021). Predictors for significant CoNS infection included thrombocytopaenia, presence of predisposing factors, nosocomial infection, blood collected from peripheral vein, and CoNS isolated from two consecutive blood cultures. The most common predisposing factors for the isolation of CoNS were the presence of peripheral (54.1%) and central venous catheters (35.1%). Conclusion: CoNS can cause significant bloodstream infections. The isolation of CoNS from blood cultures should be carefully interpreted by considering the predictive factors. Local data regarding predictive factors of patients with culture-positive CoNS, species distribution and antimicrobial susceptibility pattern are useful to determine the significance of blood culture results and care management of patients

Paediatric Mandible Fracture-Various Treatment Modalities – A Report of Case Series

Paediatric mandible fracture is one of the most challenging scenario in maxillofacial trauma to manage. Strategy for management of paediatric mandible fracture must include factors like age, anatomy, stage of dental de-velopment, fracture site and child ability to cooperate with the proposed treatment plan. The main objective be-hind the treatment of these fractures to restore underlying bony architecture to pre-traumatic state as conserva-tively as possible with minimal functional impairment. Therefore, choice of treatment option depends on vari-ous factors. In the present article we have tried to summarise different approaches towards the management of paediatric mandible fracture by presenting different cases of paediatric trauma.

Comparative Study between General Anesthesia and Spinal Anaesthesia in Paediatric Patients

Introduction: Anaesthesia Comprises of analgesia,unconsciousness, relaxation and suppression of reflexes. Thisstate of Anaesthesia can be achieved either by regional orGeneral Anaesthesia (GA). In G.A all the four parameters arefulfilled, where as in regional Anaesthesia the patient need notbe unconscious. Study aimed to prove the supremacy of spinalanaesthesia to general anaesthesia.Material and methods: A Comparative study was done insixty patients divided into two groups as Group ‘S’ receivedspinal anaesthesia with Butivacaine 0.5%, 0.4mg/kg bodyweight. Group ‘G’ (General Anaesthesia) consisting thirtypatients were given G.A relaxant technique with IPPV.Results: ‘S’ group is hemodynamically more stable in theimmediate post operative period when compared with the ‘G’group. Conscious levels: 100% of S group patients showed nosign of altered consciousness. Where as 9 out of 30 patientsi.e 28% G group patients were drowsy in the immediate postoperative period and needed observation for a longer period.No notable complications like nausea, vomiting, or urinaryretention were noticed in both groups.Conclusion: No complications were noted in both groupspatients were drowsy in ‘G’ group, but all are awake andco-operative in ‘S’ group.It can be concluded that the subarachnoid block is proved to be a better choice for the belowthe umbilical level surgeries in pediatric patients as it is havingno complications and will be accepted by surgical team andparents

Resultados visuales y sobrevida de injerto obtenidos en una población pediátrica sometida a queratoplastia / Visual outcomes and graft survival in pediatric patients underwent penetrating keratoplasty

Objetivo: Describir resultados visuales y complicaciones de una serie de casos de pacientes pediátricos a los que se les realizó queratoplastia penetrante en el Hospital de San José, en Bogotá, Colombia. Diseño: Estudio observacional descriptivo, retrospectivo, serie de casos. Método: Se evaluaron 14 ojos de 12 pacientes menores de 16 años a quienes se les realizó queratoplastia penetrante entre los años 1999-2014. Se hizo una revisión de la literatura sobre etiología, manejo quirúrgico, seguimiento y sobrevida de injerto. Resultados: De los 14 ojos estudiados 8 ojos (57,1%) tenían patología congénita con injerto claro en 6 ojos (75%) entre los 3 y 9 meses, 3 ojos (21,4%) tenían etiología traumática, de estos, todos los injertos permanecieron claros en un rango de 3 meses a 11 años y 3 ojos (21,4%) tenían leucomas, queratitis o inminencia de perforación, de estos el injerto permaneció claro entre los 3 y 18 meses. Se encontró una mejoría de visión en 8 de los ojos evaluados (57,1%). Las complicaciones encontradas en estos pacientes fueron: glaucoma en 5 ojos (35.7%), falla de injerto en 6 ojos (42.8%), rechazo endotelial en 7 ojos (50%) y desprendimiento de retina en 1 ojo (7.14%). Conclusión: En el estudio, la mejoría visual fue ligeramente menor a la reportada en la literatura. Las complicaciones presentadas fueron principalmente rechazo endotelial y falla de injerto, lo que difiere de la literatura donde la catarata es la principal complicación.

Purpose: To describe visual results and complications in a case series of paediatric patients who underwent penetrating keratoplasty at Hospital de San José in Bogotá, Colombia. Design: Observational, descriptive and retrospective study, series of cases. Method: 14 eyes of 12 patients under 16 years (2 months - 16 years) who underwent penetrating keratoplasty in Hospital de San Jose from 1999 to 2014 were evaluated. A literature review of etiology, surgical management, monitoring and graft survival of pediatric patients was done. Results: Of the 14 eyes studied, 8 eyes (57.1%) had congenital pathology with clear graft in six eyes between 3 and 9 months, 3 eyes (21.4%) had traumatic aetiology, of these, all graft s remained clear in a range of 3 months to 11 years and 3 eyes (21.4%) had leucoma, keratitis or impending perforation, of these, the graft remained clear between 3 and 18 months. An improvement in vision was found in eight of the evaluated eyes (57.1%). The complications found in these patients were: glaucoma in 5 eyes (35.7%), graft failure in 6 eyes (42.8%), endothelial rejection in 7 eyes (50%) and retinal detachment in 1 eye (7.14%). Conclusion: In our study, the visual improvement was slightly lower than that reported in the literature. The complications presented were mainly endothelial rejection and graft failure, which differs from the literature where cataract is the main complication.

Availability of sugar-free medicine for children: Are we denying their needs?

@#This study aimed to review the availability of sugar-free medicine available in the market using the online Monthly Index of Medical Specialties (MIMS) Malaysia 2016. Data collection was obtained from product information (PI) for prescription medications contained in the MIMS Malaysia 2016. Concise information for each product was collected based on therapeutic class groupings. The therapeutic class obtained from PI was assigned to one of the 11 major therapeutic classes. PI that stated its use in paediatrics was further reviewed for the availability of sugar free ingredient. Each product was then allocated into the poison groups: Group B, Group C and Non-Scheduled Poison. A total of 282 PI items from 336 companies in MIMS Malaysia 2016 that satisfied our eligibility criteria were reviewed. Of the 282 PI items reviewed, most of the products, 169 (59.9%) were sugarbased product, while 87 (30.9%) of them belong to sugar free products. Our study found that most of the medicines reviewed in the MIMS Malaysia 2016 were under Group C (134 of total 282). There is still a high number of sugar-containing medicines despite the promotion of sugar-free medication. Therefore, consumers need to be educated on the use of sugar-free medicines in children to increase the demand and availability in the market.

Caracterización clínica del dengue y variables predictoras de gravedad en pacientes pediátricos en un hospital de segundo nivel en Chilpancingo, Guerrero, México: serie de casos / Clinical profile of dengue and predictive severity variables among children at a secondary care hospital of Chilpancingo, Guerrero, Mexico: case series

Resumen: Introducción: El dengue sigue en incremento a nivel mundial y actualmente la mayor incidencia de primera infección ocurre en población pediátrica. El dengue grave es potencialmente letal en menores de edad. Este estudio caracteriza el perfil clínico de pacientes pediátricos con dengue atendidos en un hospital de segundo nivel en Chilpancingo, Guerrero, México. Métodos: Serie de casos conformada por 133 pacientes pediátricos hospitalizados con diagnóstico de dengue no grave y dengue grave, de acuerdo a criterios clínicos. Los resultados del análisis univariado de los signos y síntomas clínicos fueron expresados como promedios o porcentajes, y se consideró nivel de significancia estadística de 0.05. Mediante GLMM (Generalised Linear Mixed Models) se estimó la predicción de dengue grave con la presencia de signos y síntomas clínicos. Resultados: El 58% (77/133) de los pacientes fue clasificado como dengue grave. Hubo diferencias significativas entre los grupos de dengue en los signos y síntomas siguientes: fiebre, dolor abdominal, epistaxis y cuenta plaquetaria. El dengue grave se presentó en mayor proporción en los pacientes mayores de cuatro años de edad (p<0.05). El GLMM identificó un conjunto de cuatro signos y síntomas clínicos (fiebre ≥39 °C, mialgias, artralgias y dolor abdominal) como predictores de la gravedad del dengue. Conclusiones: Los resultados de este estudio exploratorio sugieren cambios en la frecuencia de síntomas y signos clínicos del dengue en la población pediátrica. Pacientes pediátricos con diagnóstico presuntivo de dengue que presenten fiebre ≥39 °C, mialgias, artralgias y dolor abdominal deben considerarse como potenciales casos de dengue grave.

Abstract: Background: Dengue continues to increase globally. Currently, the highest incidence of first infection occurs in paediatric population, where severe dengue fever is potentially lethal. This study characterizes the clinical profile of paediatric patients with dengue fever in the South of Mexico. Methods: We undertook a series case study of 133 paediatric inpatients who presented clinical diagnosis of non-severe dengue and severe dengue fever. We described univariate analysis as means or percentages, using 0.05 as significance level. We estimated the prediction of severe dengue considering clinical signs and symptoms only using GLMM (Generalised Linear Mixed Models). Results: 58% (77/133) patients had severe dengue. There were significant differences among the dengue groups, in the following signs and symptoms: Fever, abdominal pain, epistaxis and platelet count. Children older than four years old had a higher proportion of severe dengue (p<0.05). GLMM identified a group of four clinical signs and symptoms (fever ≥39 °C, myalgia, arthralgia and abdominal pain) as predictors of severe dengue. Conclusions: The results of this exploratory study suggest changes in the frequency of clinical signs and symptoms among paediatric inpatients. Paediatric patients with a presumptive diagnosis of dengue, showing fever of ≥39° C, myalgia, arthralgia and abdominal pain should be considered as potential cases of severe dengue.

Characteristics of Th17 cells in peripheral blood in paediatric patients with chronic hepatitis B / 中国综合临床

Objective To study the characteristics of Th17 cells frequency and the relationship with clinical characters in paediatric patients with chronic hepatitis B.Methods Forty-five paediatric patients with chronic hepatitis B within 16-year old from December 2010 to February 2014 in Maternal and Child Health-Care Hospital were enrolled in present study,and 11 age-matched healthy children were enrolled as control group.Hepatitis B virus markers(HBV-M),HBV-DNA loads and alanine amino shift enzyme(ALT) levels in serum were detected in the two groups.The frequencies of Thl7 cells in peripheral blood were measured by flow cytometry.Tumor grade was classed in Children with liver tissue.Results Compared with the control group ((1.61 ± 0.56) ％),the Th17 cells frequencies in peripheral blood ((3.03 ± 1.08) ％) were significantly increased in chronic hepatitis B paediatric patients(t=-0.52,P＜0.01).There was no correlations between Th17 cells frequencies with HBV DNA quantity(lg(HBV-DNA)6.49±3.25) and ALT level((40.5±11.3) U/L) (P ＞0.05).The patients with higher HAI scores (G2-G3) had a greater proportion of Th17 cells ((5.95 ±2.05)％) than those with lower HAI scores(G0-G1) ((1.31±0.19)％),and the difference was significant(t =-1.51,P＜0.01).Conclusion Th17 cells frequencies in peripheral blood were associated closely with liver injury in paediatric patients with CHB.

Detection of dengue virus 4 from central India.

Background & objectives: Dengue is an important arboviral disease. All four dengue virus serotypes are reported to be circulating in India. It is also known that different serotypes, genotypes and clades of genotype determine outbreak severity. Dengue affected children are known to have serious disease outcome. We carried out this study to give reliable diagnosis of dengue infection in children and to detect circulating serotype in central India. Methods: Samples collected from paediatric patients suspected to have dengue fever were subjected to IgM and IgG ELISA to determine dengue virus infection. Samples collected within 0-5 days of onset of illness and positive by IgM ELISA were tested by nested reverse transcription polymerase chain reaction (nRT-PCR). The PCR products were sequenced and analyzed. Results: Of the 89 samples tested, 18 and 7 were positive for dengue IgM and IgG, respectively. Dengue activity was observed in both Jabalpur city and adjoining rural settings. One sample found positive by nRT-PCR was further sequenced to confirm dengue virus 4 as aetiological agent. Interpretation & conclusions: Our findings demonstrated dengue virus infection in children and adolescent in central India. Because of continuous changing epidemiology, it is important to monitor dengue virus activity at both serological and molecular level in this part of the country for better patient care and management.

A conservative approach to pediatric mandibular fracture management: Outcome and advantages.

Pediatric mandibular fractures are rare and their treatment remains controversial. Management is extremely complicated in mixed dentition as it is inherently dynamic and unstable. Treatment options include soft diet, intermaxillary fixation with eyelet wires, arch bars, circummandibular wiring, or stents. Alternative options include open reduction and internal fixation through either an intraoral or extraoral approach. This case report describes and evaluates the conservative technique of acrylic splint in the treatment of pediatric mandible fracture in a 12-year-old female child. The patient with isolated mandibular fracture was treated with acrylic splint and interdental wiring followed by evaluation of clinical and radiographic healing as well as the somatosensory status. Patient demonstrated clinical union to her pre-injury occlusion by three to four weeks. Panoramic finding supported the finding of clinical examination throughout the study. High osteogenic potential of the pediatric mandible allowed conservative management to be successful in this case.

Accelerated stability and antimicrobial sensitivity studies of amoxicillin dry suspensions marketed in Bangladesh.

Since its introduction, amoxicillin dry suspension has been the mainstay for the antibacterial therapy for paediatric patients. But use of substandard preparation of antibiotic is one of the most important causes of microbial resistance. The present study has been carried out to evaluate the quality and stability status of 10 marketed amoxicillin dry suspensions of Bangladesh. All the brands were analyzed for their potency using chemical and microbiological methods described in the United States Pharmacopoeia and British Pharmacopoeia. Potency determination was done at three controlled temperatures - refrigerated, room and elevated (40C) showed that two samples were over potent but one sample was substandard out of the 10 samples. The initial potencies of the two samples were within USP range when freshly reconstituted but after 7 days, at room temperature, potencies deteriorated and came down to 90%. In refrigerated condition, all the samples remained in good condition and at 40C, a considerable loss of potencies in all the samples were observed. Results of microbiological assay also support the results of chemical assay. The study emphasizes the necessity of routine inspection, monitoring and evaluation of quality of formulations containing amoxicillin dry syrup.

Application of Vancomycin in Paediatric Patients:Evaluation on Rationality of Drug Use / 中国药房

OBJECTIVE:To investigate the application of vancomycin in pediatric patients.METHODS:By reviewing medical histories of 368 pediatric patients who had been treated with vancomycin from 2005 to 2006,the use of vancomycin was investigated in respect of children' general condition,microbiological examination,dosage regimen,adverse drug reactions to evaluate the rationality of drug use.RESULTS:ADR occurred in 17 cases(4.6%).The use of vancomycin was rational or basically rational in 240 cases(65.2%).CONCLUSION:It is necessary to tighten more strict control on the use of vancomycin in pediatric patients.