Brain metabolism and severe pediatric traumatic brain injury.

Age-dependent changes in brain metabolism may influence the response to and tolerance of secondary insults, potentially affecting outcomes. More complete characterization of brain metabolism across the clinical trajectory of severe pediatric TBI is needed to improve our ability to measure and better mitigate the impact of secondary insults. Better management of secondary insults will impact clinical care and the probability of success of future neuroprotective clinical trials. Improved bedside monitoring and imaging technologies will be required to achieve these goals. Effective and sustained integration of brain metabolism information into the pediatric critical care setting will be equally challenging and important.

Atypical Hemolytic Uremic Syndrome and Chronic Ulcerative Colitis Treated with Eculizumab.

BACKGROUND: Hemolytic-uremic syndrome (HUS) presents with hemolytic anemia, thrombocytopenia, and thrombotic microangiopathy of the kidney and usually results from Shiga-toxin induced activation of the alternative complement pathway. Gastroenteritis is a common feature of the Shiga-toxin producing Escherichia coli HUS, referred to as STEC-HUS. An inherited or acquired complement dysregulation may lead to HUS referred to as non-STEC or atypical (a)HUS. Although gastroenteritis is not a common presentation of aHUS, some patients develop ischemic colitis and may be misdiagnosed as acute appendicitis or acute ulcerative colitis (UC). CASE DIAGNOSIS ­TREATMENT: We present a patient with low circulating complement (C) 3 levels who developed aHUS in the course of chronic active UC. Resolution of renal and gastrointestinal manifestations in response to treatment with eculizumab, a humanized monoclonal antibody against terminal C5 protein suggests the role of alternative complement in the pathogenesis of both, aHUS and UC. CONCLUSION: This case illustrates that dysregulation of the alternative complement pathway may manifest in other organs besides the kidney and that the circulating C3 levels do not correlate with the disease activity or the clinical response to eculizumab.

Learning sets ... the way forward?

Community nursery nurses (CNNs) have increasingly important roles within clinical service delivery. Maintaining and enhancing their learning has not been extensively developed within the NHS. We report on a cost-effective, structured programme that focused on one aspect of their learning: managing childhood behaviour. Childhood behaviour problems place substantial demands on the health service. CNNs are increasingly recognised as being potentially in the front line for managing these issues. CNNs have excellent training within play skills but often have more limited training in managing childhood behaviour problems. Learning sets were developed and evaluated as effective in delivering training to CNNs on childhood behaviour. Our programme allowed CNNs to shape learning over a six-month period. It aimed to value existing skills and promote a learner-centred approach. This teaching method encouraged generic skills in exploring evidence-based approaches to clinical care. Learners valued collaboration and identified new clinical strategies that included standardisation of advice given.