Clinical and haemodynamic characteristics of preterm infants with early onset sepsis.

AIM: Early onset sepsis (EOS) in preterm infants is associated with high morbidity and mortality. Improved characterisation of the haemodynamic presentation of EOS could lead to more effective and targeted treatments. METHODS: We performed a retrospective observational study of preterm infants ≤32 week' gestation with EOS between 2010 and 2020 and gathered clinical, haemodynamic and echocardiographic data. RESULTS: Of the 2198 admitted infants, 27 infants (median gestational age 28 weeks, median birthweight 1174 g) developed EOS with predominantly gram-negative pathogens and the overall mortality rate was 33.3%. Besides hypotension, clinical signs were non-specific, and over half of infants were normotensive in the first 72 h of life. Those with hypotension received more fluid resuscitation, inotropic support and had a higher mortality compared to the normotensive infants. Cardiac ultrasound was available in 18 infants and commonly revealed higher as expected cardiac output, pulmonary hypertension and diastolic dysfunction. CONCLUSION: Preterm infants with EOS had a high mortality rate, especially when they progressed from sepsis to septic shock. Echocardiography revealed a normal haemodynamic pattern, or one suggestive of vasodilatation and warm shock physiology. Targeting this pathophysiology earlier might improve outcomes.

Review of venom immunotherapy at a regional tertiary paediatric centre.

AIM: Bee stings can result in allergic reactions, including anaphylaxis. Venom immunotherapy (VIT) is a definitive cure for bee venom allergy, but controversy surrounds whether accelerated protocols are safe in children. Our primary aim was to assess the safety profile of ultra-rush bee VIT compared with conventional bee VIT at a regional paediatric tertiary centre. We also sought to evaluate the impact of both approaches on time and resource use. METHODS: Data were collected retrospectively from 14 patients with bee venom allergy who were treated with ultra-rush or conventional bee VIT between 2013 and 2021 at John Hunter Children's Hospital. We compared VIT-associated adverse reactions and use of resources in both these groups. RESULTS: Overall, six patients received ultra-rush bee VIT and eight patients received conventional VIT. The ultra-rush group had a lower rate of systemic reaction (16%) compared with the conventional group (25%). One patient from the conventional group required adrenaline. Ultra-rush patients require fewer injections over a shorter time and fewer hospital visits to complete the protocol. Travel distance for families was significantly reduced. CONCLUSION: At our regional paediatric tertiary centre, ultra-rush bee VIT was a safe treatment option for children with bee venom allergy. It has many advantages over a conventional approach, especially for patients living in regional or remote areas.

Protecting the health of medical students on international electives in low-resource settings.

Background: Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure. Methods: The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material. Results: This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours. Conclusion: This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit items and useful web-based educational resources are provided to help prepare for electives abroad.

Oral administration of diluted nasal desmopressin in managing neonatal central diabetes insipidus.

BACKGROUND: Neonatal central diabetes insipidus (NCDI) remains a therapeutic challenge, as extremely low doses of enteral desmopressin cannot be titrated with current preparations. The aim of this study was to describe the use of orally administered dilute desmopressin in NCDI. METHODS: Nasal desmopressin (100 µg/mL) was diluted in 0.9% saline to 10 µg/mL. Infants were treated with 1-5 µg and doses were titrated to a twice-daily regimen. The feed volume was 150 mL/kg/day and titrated according to weight gain. RESULTS: Five infants aged 6-105 days were included. Stabilizing treatment doses ranged from 2 to 5 µg twice daily in neonates, and 12 µg twice daily in the older infant who was diagnosed at 105 days. CONCLUSIONS: Dilution of nasal desmopressin with saline facilitates safe administration and dose titration in NCDI. We recommend considering this therapeutic approach to NCDI, particularly in small infants or where alternative treatment regimens have been unsuccessful.

Delayed diagnosis of pulmonary tuberculosis in a 13-year-old Malawian boy.

Childhood tuberculosis (TB) is a significant global health burden. There are more than 1 million new cases of childhood TB annually. Despite this, many national TB control programs largely focus on identification and treatment of smear positive adults. Early case detection is essential if childhood TB is to be controlled and eradicated.Delayed diagnosis of TB is associated with more advanced disease and worse treatment outcomes. Younger children who go undiagnosed for long periods are at risk of developing severe pulmonary and extrapulmonary disease, such as meningitis. Additionally, advanced childhood TB is a common respiratory cause of death in TB-endemic areas. Undoubtedly, delayed diagnosis contributes significantly to TB-related morbidity and mortality.Diagnostic delay may be divided into patient delay, the duration between development of symptoms and presentation to healthcare provider, and healthcare provider delay, the duration between presentation and initiation of appropriate treatment.

Extensive coronary and systemic arterial aneurysm development in severe refractory Kawasaki disease.

We describe the case of an 8-week-old infant with late presentation of severe refractory atypical Kawasaki disease. In addition to developing giant coronary arterial aneurysms and coronary thrombosis, she formed extensive bilateral arterial aneurysms throughout her systemic circulation.

Altitude training for elite endurance athletes: A review for the travel medicine practitioner.

High altitude training is regarded as an integral component of modern athletic preparation, especially for endurance sports such as middle and long distance running. It has rapidly achieved popularity among elite endurance athletes and their coaches. Increased hypoxic stress at altitude facilitates key physiological adaptations within the athlete, which in turn may lead to improvements in sea-level athletic performance. Despite much research in this area to date, the exact mechanisms which underlie such improvements remain to be fully elucidated. This review describes the current understanding of physiological adaptation to high altitude training and its implications for athletic performance. It also discusses the rationale and main effects of different training models currently employed to maximise performance. Athletes who travel to altitude for training purposes are at risk of suffering the detrimental effects of altitude. Altitude illness, weight loss, immune suppression and sleep disturbance may serve to limit athletic performance. This review provides an overview of potential problems which an athlete may experience at altitude, and offers specific training recommendations so that these detrimental effects are minimised.

Towards bioavailability-based soil criteria: past, present and future perspectives.

Bioavailability has been used as a key indicator in chemical risk assessment yet poorly quantified risk factor. Worldwide, the framework used to assess potentially contaminated sites is similar, and the decisions are based on threshold contaminant concentration. The uncertainty in the definition and measurement of bioavailability had limited its application to environment risk assessment and remediation. Last ten years have seen major developments in bioavailability research and acceptance. The use of bioavailability in the decision making process as one of the key variables has led to a gradual shift towards a more sophisticated risk-based approach. Now a days, many decision makers and regulatory organisations 'more readily accept' this concept. Bioavailability should be the underlying basis for risk assessment and setting remediation goals of those contaminated sites that pose risk to environmental and human health. This paper summarises the potential application of contaminant bioavailability and bioaccessibility to the assessment of sites affected by different contaminants, and the potential for this to be the underlying basis for sustainable risk assessment and remediation in Europe, North America and Australia over the coming decade.

Slump test: sensory responses in asymptomatic subjects.

The Slump Test is used as a fast, low-cost diagnostic tool in the evaluation of leg and back pain disorders. The purpose of this study was to identify the normative sensory responses to the Slump Test in asymptomatic subjects. Eighty-four subjects were tested using a standardized procedure by the same examiner to ensure consistency. Prevalence, intensity, location, and nature of responses at each stage of the Slump Test [Slumped Sitting (SS), Knee Extension (KE), Ankle Dorsiflexion (AD), and Cervical Extension (CE)] were recorded. Of the subjects, 97.6% reported a sensory response during the Slump Test. Prevalence of responses increased significantly from 29.8% at SS to 94% at KE and decreased significantly from 97.6% at AD to 65.5% at CE. Median intensity of responses increased significantly from 0/10 at SS, through 4/10 at KE, to 6/10 at AD, and then decreased significantly to 2/10 at CE. At SS, responses were located at the back or neck, but during the subsequent stages, responses were located most commonly in the posterior thigh, knee, and calf. In terms of nature, a number of different descriptors were used, the most common being "stretch," "tight," and "pull." Approximately 80% of subjects reporting a response had complete or partial relief of this response following cervical extension, indicating that the normal response to the Slump Test may be considered a neurogenic response. This normative data may be used as a reference point when using the Slump Test in the examination of leg and back pain disorders.