Neurological complications of rotavirus infection in children: A systematic review and meta-analysis.

AIM: To systematically review the clinical features and outcomes of paediatric patients developing neurological complications associated with a rotavirus infection. METHODS: A systematic literature review and meta-analysis was performed, including articles published from 1984 to 2020. Neurological complications were classified into four groups: encephalitis, cerebellitis, encephalo-cerebellitis and benign convulsions with mild gastroenteritis (CwG). RESULTS: Out of 68 reports that fulfilled the research criteria, 99 cases of CwG, 39 cases of encephalitis, 18 cases of encephalo-cerebellitis and five cases of cerebellitis were collected. Ninety-five patients were from Asia. Median age was 22 (IQR 14-29) months, and the children who developed CwG were significantly younger (19, IQR 12-24 months, p < 0.0001) than the others. Status epilepticus was observed in 23% and 5% of the encephalitis and CwG groups respectively. The most frequently described neuroimaging finding were lesions of the splenium of corpus callosum. Four deaths were reported in the encephalitis group, whereas no fatal events were described in the other groups. Among the surviving children, the encephalo-cerebellitis group showed the most severe long-term outcome. All cases of CwG recovered completely. CONCLUSION: Older age at diagnosis and the development of encephalo-cerebellitis are associated with a higher risk of long-term complications.

Valor nutritivo da Coastcross-1 inoculada com Azospirillum brasilense / Nutritive value of Coastcross-1 inoculated with Azospirillum brasilense

Objetivou-se com este trabalho avaliar a taxa de produção de forragem e o valor nutritivo da Coastcross-1, inoculada com Azospirillum brasilense, fertilizada com diferentes doses de N e submetida ao regime de corte. O delineamento experimental foi o de blocos ao acaso, com três repetições, em esquema fatorial. Os fatores foram o uso da inoculação (não inoculada, inoculada somente no plantio e reinoculada no segundo ano), níveis de N (0, 100 e 200kg/ha/ano de N) e os períodos do ano. Avaliaram-se a taxa de produção e a composição botânica da forragem, a composição morfológica, o teor de proteína bruta, a digestibilidade in situ da matéria orgânica e os nutrientes digestíveis totais da Coastcross-1. A inoculação, quando não associada ao adubo nitrogenado, ocasionou aumento na taxa de produção de forragem, na participação da Coastcross-1 e na produção de nutrientes digestíveis totais. Houve redução nos teores de proteína bruta da Coastcross-1, quando a gramínea adubada com 200kg/ha/ano de N foi inoculada. A inoculação tem efeito positivo na Coastcross-1 não submetida à adubação nitrogenada.(AU)

The objective of this study was to evaluate the forage yield rate and nutritive value of Coastcross-1 inoculated with Azospirillum brasilense and fertilized with different levels of nitrogen subjected to cut. The experimental design was randomized blocks with three replications, in a factorial scheme. The factors were the inoculation (without inoculation, inoculated just in the implantation and reinoculated in the second year), levels of nitrogen (0, 100 and 200kg/ha/year of N) and periods of the year. Forage yield rate and botanical composition; morphological composition, crude protein content, in situ digestibility of organic matter and the total digestible nutrients of Coastcross-1 were evaluated. Inoculation increased the forage yield rate, Coastcross-1 contribution and production of total digestible nutrients, when the pasture was not fertilized with N. There was reduction in Coastcross-1 crude protein content when fertilized with 200kg/ha/yr of N. The inoculation has a positive effect on Coastcross-1 not submitted to nitrogen fertilization.(AU)

Accuracy of tympanic and forehead thermometers in private paediatric practice.

AIM: To compare infrared tympanic and infrared contact forehead thermometer measurements with traditional rectal digital thermometers. METHODS: A total of 254 children (137 girls) aged one to 24 months (median 7 months) consulting a private paediatric practice because of fever were prospectively recruited. Body temperature was measured using the three different devices. RESULTS: The median and interquartile range for rectal, tympanic and forehead thermometers were 37.6 (37.1-38.4)°C, 37.5 (37.0-38.1)°C and 37.5 (37.1-37.9)°C, respectively (p < 0.01). The limits of agreement in the Bland-Altman plots were -0.73 to +1.04°C for the tympanic thermometer and -1.18 to +1.64°C for the forehead thermometer. The specificity of both the tympanic and forehead thermometers for detecting fever above 38°C was good, but sensitivity was low. Forehead measurements were susceptible to the use of a radiant warmer. CONCLUSION: Both the tympanic and forehead devices recorded lower temperatures than the rectal thermometers. The limits of agreement were particularly wide for the forehead thermometer and considerable for the tympanic thermometer. In the absence of valid alternatives, because of the ease to use and little degree of discomfort, tympanic thermometers can still be used with some reservations. Forehead thermometers should not be used in paediatric practice.

Juvenile spring eruption: an outbreak report and systematic review of the literature.

BACKGROUND: Juvenile spring eruption of the helices of the ears is a distinctive sun-induced condition appearing on the light-exposed skin of the ears, typically in boys and young men in early spring. OBJECTIVES: To determine clinical features and outcome of juvenile spring eruption of the ears. METHODS: We report a new outbreak in 14 Swiss-Italian children. A systematic search of the literature was also performed. RESULTS: Five outbreaks in children involved a total of 203 cases (boys, 72%), and three outbreaks in young adults involved 223 male subjects. A further 54 sporadic cases were found: 41 among children (boys, 97%) and 13 among young adult males. The typical presentation included itching and diffuse erythema of both ears starting in the evening after exposure to bright sunlight during cold weather, followed within 24-48 h by papules or blisters. No other organ system was involved. The subjects recovered spontaneously without sequelae within 1-2 weeks. In New Zealand, among 162 school-aged boys, 20 developed the condition. CONCLUSIONS: A limitation is that the analysis was based upon the scanty available literature. Juvenile spring eruption is a self-limiting and generally easy recognizable variant of polymorphic light eruption. Outbreaks tend to appear on sunny and cold spring days. Paediatricians and general practitioners might rapidly develop the skills necessary to clinically appreciate this condition.

Palatability of crushed ß-blockers, converting enzyme inhibitors and thiazides.

WHAT IS KNOWN AND OBJECTIVES: A problem that often affects antihypertensive drugs is the lack of formulations appropriate for childhood. Parents, therefore, crush tablets and administer the antihypertensive drug mixed with solid food or a palatable drink. Because palatability is a major modulator of adherence to prescribed medication, the palatability of crushed ß-blockers, converting enzyme inhibitors and thiazides was assessed among adult volunteers. METHODS: The palatability of crushed atenolol, bisoprolol, enalapril, lisinopril, ramipril, chlorthalidone and hydrochlorothiazide was evaluated by means of a facial hedonic scale among 20 volunteers. The calcium channel-blockers amlodipine and lercanidipine whose tastes are disliked and liked, respectively, by children were also tested. A concealed random allocation procedure was used. RESULTS: The palatability scores assigned to chlorthalidone, hydrochlorothiazide and lisinopril were superior (P < 0·002) to those assigned to atenolol, bisoprolol, enalapril and ramipril. As with children, the palatability score of lercanidipine was superior to that of amlodipine (P < 0·002). The scores assigned to the various agents were similar in women and in men and were age-independent. WHAT IS NEW AND CONCLUSION: Pulverized atenolol, bisoprolol, enalapril and ramipril are poor tasting. From the perspective of palatability, pulverized chlorthalidone, hydrochlorothiazide and lisinopril are preferable.

Arterial hypertension and proteinuria in pediatric chronic kidney disease.

A variety of chronic kidney diseases tend to progress towards end-stage kidney disease. Progression is largely due to factors unrelated to the initial disease, including arterial hypertension and proteinuria. Intensive treatment of these two factors is potentially able to slow the progression of kidney disease. Blockers of the renin-angiotensin-aldosterone system, either converting enzyme inhibitors or angiotensin II receptor antagonists, reduce both blood pressure and proteinuria and appear superior to a conventional antihypertensive treatment regimen in preventing progression to end-stage kidney disease. The most recent recommendations state that in children with chronic kidney disease without proteinuria the blood pressure goal is the corresponding 75th centile for body length, age and gender; whereas the 50th centile should be aimed in children with chronic kidney disease and pathologically increased proteinuria.

[Examination of urine in the child]. / Urindiagnostik beim Kind.

The examination of urine in children can be very complex, due to the difficulty to obtain clean urine specimens in infants and toddlers. Clean catch is an easy system to obtain urine but patience is needed. Transurethral catheterization or suprapubic aspiration is useful in infants and toddlers with sign of pyelonephritis. Urine bag specimens are not useful in the diagnosis of urinary tract infection because of the high rate of false positive cultures. The 24 hours urine collection is frequently replaced by a spot urine and the ratio of the measured substances with the urine creatinine are calculated. Urine microscopy is needed for the evaluation of pathological results in the dipstick testing: confirm that red urine is due to haematuria by demonstration of red blood cells on urine microscopy, dysmorphic cells and red-cell casts are pathognomonic of glomerular bleeding, white-cell casts signify glomerular inflammation and bacteria are easily seen in unstained urine. A urine culture is pathologic if the colony count exceeds 10(4) in the transurethral catheterization or clean void. In the suprapubic aspiration is any number of colony pathologic. Urate crystals in the urine of infants may cause a pink discoloration to nappies. Urine screenings are not very useful and should be performed only at the age of 5 years or by sexual-active adolescents.

[Childhood hypertension: current medical management]. / Prise en charge pharmacolo- gique de l'hypertension artérietle chronique chez l'enfant: KISS, please.

Pediatricians currently have improved understanding of how to best manage childhood hypertension. The goal of antihypertensive drug therapy in children with secondary hypertension is currently to reduce the blood pressure below the 90th centile. Most authors currently favor therapy with a blocker of the renin-angiotensin system (a converting enzyme inhibitor or an angiotensin II antagonist) or a calcium channel blocker. In patients with kidney disease and diabetes mellitus we generally advise therapy of hypertension with a blocker of the renin-angiotensin system especially in the presence of pathological proteinuria.