ABSTRACT
We initially suspected primary herpetic gingivostomatitis. But the patient's lab work, persistent fever, and cough led us in a different direction.
Subject(s)
Stomatitis, Herpetic , Stomatitis , Child , Humans , Stomatitis, Herpetic/diagnosis , Stomatitis, Herpetic/drug therapy , Stomatitis/diagnosis , Stomatitis/etiology , Stomatitis/therapyABSTRACT
BACKGROUND: Breastfeeding is best for infants and the World Health Organization recommends exclusive breastfeeding for at least the first 6 months of life. For those who are unable to be breastfed, previous studies demonstrate that feeding high-risk infants with hydrolyzed formulas instead of cow's milk formula (CMF) may decrease the risk of atopic dermatitis (AD). OBJECTIVE: To estimate the economic impact of feeding high-risk, not exclusively breastfed, urban Malaysian infants with partiallyhydrolyzed whey-based formula (PHF-W) instead of CMF for the first 17 weeks of life as an AD risk reduction strategy. METHODS: A cohort Markov model simulated the AD incidence and burden from birth to age 6 years in the target population fed with PHF-W vs. CMF. The model integrated published clinical and epidemiologic data, local cost data, and expert opinion. Modeled outcomes included AD-risk reduction, time spent post AD diagnosis, days without AD flare, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs are expressed in Malaysian Ringgit (MYR; MYR 1,000 = United States dollar [US $]316.50). RESULTS: Feeding a high-risk infant PHF-W vs. CMF resulted in a 14% point reduction in AD risk (95% confidence interval [CI], 3%-23%), a 0.69-year (95% CI, 0.25-1.10) reduction in time spent post-AD diagnosis, additional 38 (95% CI, 2-94) days without AD flare, and an undiscounted gain of 0.041 (95% CI, 0.007-0.103) QALYs. The discounted AD-related 6-year cost estimates when feeding a high-risk infant with PHF-W were MYR 1,758 (US $556) (95% CI, MYR 917-3,033) and with CMF MYR 2,871 (US $909) (95% CI, MYR 1,697-4,278), resulting in a per-child net saving of MYR 1,113 (US $352) (95% CI, MYR 317-1,884) favoring PHF-W. CONCLUSION: Using PHF-W instead of CMF in this population is expected to result in AD-related costs savings.
ABSTRACT
AIM: To determine the results of children who underwent flexible bronchoscopy and bronchoalveolar lavage (BAL) in the Respiratory Medicine Service of Kandang Kerbau Women's and Children's Hospital from 1996 to 2005. METHOD: This was a retrospective study of all patients who underwent flexible bronchoscopy. Patients were traced from the hospital records. RESULTS: Two hundred and eight records were reviewed over a 10-year period. Of these, 63.5% were for male patients. The mean age of the patients was 4.1 years (range: 0.01 to 26 y). Sixty-six percent of the patients were below the age of 5 years. The main indications for bronchoscopy were abnormalities on chest x-ray (56.7%) followed by stridor (23.1%). An abnormality was detected in 77.7% of patients who underwent bronchoscopy. Twenty-three percent (n=45) of the bronchoscopes with BAL were performed on immunocompromised children for identification of microorganisms, of which 20% (n=9) yielded a positive microbiologic result. A positive yield was better if no earlier antimicrobials (26.3%) or only 1 antimicrobial was prescribed (42.8%) as compared with a 10% yield rate on treatment with 2 or more antimicrobials. The most common pathologic microorganisms identified were Candida albicans (18.5%) and Cytomegalovirus (18.5%). Complications from the bronchoscopy occurred in 16.6% of the patients. The main complication was hypoxia, which occurred in 28 children (13.4%). Other complications included cardiac arrhythmias (n=1, 0.5%) and laryngospasm (n=4, 1.9%). There were no fatalities experienced in our center. CONCLUSIONS: Flexible bronchoscopy was well tolerated with no serious adverse events being experienced. It is a useful tool in the investigation of stridor and persistent wheezing in children. For microbiologic identification, the BAL should be performed before initiating antimicrobials for better results.
