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https://www.readbyqxmd.com/read/30108072/conservative-therapy-for-appendicitis-in-children
#1
Syunsuke Yamanaka, Erik D Skarsgard, Ran D Goldman
Question A 10-year-old girl who was seen in my office last week with acute-onset abdominal pain and fever was referred to an emergency department, was diagnosed with appendicitis, and was treated conservatively with antibiotics, without surgery. Has the paradigm for treating appendicitis changed, and which is the preferred treatment of appendicitis in children: antibiotics or appendectomy? Answer For more than 100 years, surgical management was the principal treatment of acute appendicitis. Potential adverse events associated with appendectomy include bleeding, surgical site infection, and ileus, as well as stress for children and their parents...
August 2018: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/30097276/diagnostic-accuracy-of-laboratory-and-ultrasound-findings-in-patients-with-a-non-visualized-appendix
#2
Laurie Malia, Jesse J Sturm, Sharon R Smith, R Timothy Brown, Brendan Campbell, Henry Chicaiza
Ultrasound (US) and laboratory testing are initial diagnostic tests for acute appendicitis. A diagnostic dilemma develops when the appendix is not visualized on US. OBJECTIVE: To determine if specific US findings and/or laboratory results predict acute appendicitis when the appendix is not visualized. METHODS: A prospective study was conducted on children (birth-18 yrs) presenting to the pediatric emergency department with suspected acute appendicitis who underwent right lower quadrant US...
August 7, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30095595/belly-dancer-syndrome-an-unusual-cause-of-abdominal-pain
#3
Chiara Ossella, Floriana DellʼOmo, Elena Zanetti, Isabella Ferdinanda Pestalozza, Pierluigi Galizia, Salvatore Tripodi
BACKGROUND: Belly dancer syndrome is a rare condition consisting of involuntary, repetitive, often rhythmic contractions of the diaphragm, causing undulating movements of the abdomen that recall those of a belly dancer. It is frequently associated with pain or discomfort in the upper abdomen or lower chest, but clinical symptoms are highly variable often resulting in late diagnosis. Very few pediatric cases have been reported, all of which were secondary to other conditions, and to our knowledge, no idiopathic cases of Belly Dancer Syndrome have been reported in children...
August 8, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/30087069/management-of-children-presenting-with-low-back-pain-to-emergency-department-a-7-year-retrospective-study
#4
Francesco Saverio Biagiarelli, Simone Piga, Antonino Reale, Pasquale Parisi, Marta Luisa Ciofi Degli Atti, Angelo Gabriele Aulisa, Paolo Schingo, Chiara Ossella, Maria Pia Villa, Umberto Raucci
OBJECTIVE: We aimed to describe characteristics, etiology and health care use in children with low back pain (LBP) presenting to pediatric emergency department (ED) and to develop an algorithm to design a diagnostic approach. METHODS: We conducted a 7-year cohort study of children admitted to ED with a primary complaint of LBP. They were classified into diagnostic groups: visceral LBP; traumatic LBP; non-visceral/non-traumatic LBP. To identify high-risk factors (red flags) associated with severe prognosis conditions (SPCs), we analyzed the non-visceral/non-traumatic group comparing the SPC children with those children without SPCs...
July 21, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30086709/efficacy-of-different-doses-of-dexmedetomidine-as-a-rapid-bolus-for-children-a-double-blind-prospective-randomized-study
#5
Fang Chen, Chengyu Wang, Yi Lu, Mengmeng Huang, Zhijian Fu
BACKGROUND: Dexmedetomidine (DEX), a highly sensitive α2 -adrenoceptor agonist that possesses anxiolytic, sedative, and analgesic effects, has been documented as a preventative and treatment for emergence agitation (EA). The therapeutic should be given as a loading dose that is infused during a 10 min period, but if a rapid bolus injection is deemed to be hemodynamically appropriate, it would be a more opportune route of administration. So we studied the efficacy of different doses of DEX as a rapid bolus for children to prevent and treat EA...
August 7, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/30084714/qualitative-analysis-of-palliative-care-for-pediatric-patients-with-cancer-at-bugando-medical-center-an-evaluation-of-barriers-to-providing-end-of-life-care-in-a-resource-limited-setting
#6
B Emily Esmaili, Kearsley A Stewart, Nestory A Masalu, Kristin M Schroeder
Purpose Palliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context. Methods In-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care...
July 2018: Journal of Global Oncology
https://www.readbyqxmd.com/read/30078280/-study-of-the-effects-of-hydromorphone-on-emergence-agitation-of-children-anesthetized-by-sevoflurane
#7
L Y Chu, C X Pan
Objective: To observe the effect of hydromorphone on emergence agitation of children anesthetized by Sevoflurane. Methods: One hundred patients without any analgetic, aged 3 to 7 years, ASA Ⅰ-Ⅱ, undergoing strabismus surgery in Beijing Tongren Hospital from March, 2017 to December, 2017 were selected and they were randomly divided into two groups( n =50), H group and F group by random number table. After standardized tidal volume method induction by 8% sevoflurane and oxygen, suiltable laryngeal mask was inserted, and each patient was left spontaneously breathing anesthetized by 2...
July 24, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/30077973/patient-reported-experience-measure-in-sickle-cell-disease
#8
Subarna Chakravorty, Amy Tallett, Cara Witwicki, Harriet Hay, Catherine Mkandawire, Avanelle Ogundipe, Patrick Ojeer, Antonia Whitaker, Jessica Thompson, Stephen Sizmur, Ganesh Sathyamoorthy, John O Warner
OBJECTIVES: To develop patient-reported experience measure surveys for patients with sickle cell disease (SCD) to understand their healthcare and lived experience in the UK and for their use in future to inform healthcare service development. DESIGN: Picker methodology was used as follows: (1) qualitative scoping by focus group discussions; (2) questionnaire development through stakeholder consultations; (3) construct validation of questionnaires through cognitive testing; and (4) further assessment of construct validity by a nationwide pilot survey...
August 4, 2018: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/30076160/pain-experience-in-a-us-children-s-hospital-a-point-prevalence-survey-undertaken-after-the-implementation-of-a-system-wide-protocol-to-eliminate-or-decrease-pain-caused-by-needles
#9
Andrea C Postier, Donna Eull, Craig Schulz, Maura Fitzgerald, Barbara Symalla, David Watson, Lexie Goertzen, Stefan J Friedrichsdorf
OBJECTIVES: Pain in hospitalized children remains under-assessed and undertreated. With this study, we aim to describe results from a repeat single-day, hospital-wide survey of children's pain and its treatment after the initiation of a hospital-wide quality improvement initiative used to reduce or eliminate pain caused by needle procedures. METHODS: All patients and parents listed on the inpatient morning census, in emergency department and outpatient surgery registration lists, were invited to participate in a brief single-day point prevalence survey of their experience with pain and its management in the hospital setting...
August 3, 2018: Hospital Pediatrics
https://www.readbyqxmd.com/read/30072186/urachal-remnants-in-patients-presenting-to-the-emergency-department-with-abdominal-pain
#10
Jonathan S Schiffman
BACKGROUND: Rare causes of abdominal pain include abnormalities of the urachus, including patent urachus and urachal cyst with or without infection. However, reviews discussing etiology of abdominal pain, even in children, may completely omit mention of urachal remnants. OBJECTIVES: Determine the incidence of symptomatic urachal remnants in patients presenting to the emergency department (ED), including common presenting findings and method of diagnosis. METHODS: A retrospective chart review was performed of all patients presenting to the ED with abdominal pain who were diagnosed with urachal remnants, including patent urachus or urachal cyst or abscess over a period of 11 years and 7 months in one hospital...
July 30, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30063586/characteristics-of-hbv-associated-hepatocellular-carcinoma-in-children-a-multi-center-study
#11
Douglas B Mogul, Simon C Ling, Karen F Murray, Sara J Schwarzenberg, Erin R Rudzinski, Kathleen B Schwarz
INTRODUCTION: Pediatricians and liver specialists in the United States and Canada continue to encounter hepatitis B virus (HBV) infection in high-risk populations, including unvaccinated children, adopted children, and immigrants. Although hepatocellular carcinoma (HCC) is a known complication of HBV, there exists a paucity of data regarding the clinical presentation of HBV-associated HCC in children in these countries. METHODS: Investigators at four medical centers with large numbers of HBV-positive children queried their pathology and/or oncology databases to identify all cases of HBV-infected children <18 years old presenting with HCC between 1990 and 2015...
July 30, 2018: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/30050617/-ophthalmic-zoster-an-uncommon-dermatosis-in-infants
#12
Bousayna Iraqi, Badr Sououd Benjelloun Dakhamaa
We here report the case of a 9-month infant, born to a mother with a history of varicella in the third trimester of pregnancy but with no history of atopy, admitted to the emergency room with painful, pruritic rash in the right hemiface that had been ongoing for 4 days. During physical examination, the infant appeared to be in pain, with multiple cluster of grouped vesicles on erythematous skin in the right hemiforehead, in the right side of the nose and in the right cheek associated with edema of the upper and lower eyelids, with difficulty opening eyes and purulent conjunctival secretions...
2018: Pan African Medical Journal
https://www.readbyqxmd.com/read/30045357/the-pediatric-disease-spectrum-in-an-emergency-department-at-a-tertiary-care-center-in-beirut-lebanon
#13
Tharwat El Zahran, Mohammad El Warea, Rana Bachir, Eveline Hitti
OBJECTIVE: The aim of this study was to identify the most common diagnoses for pediatric emergency department (ED) visits at a tertiary care center in Lebanon. METHODS: A retrospective chart review of pediatric patients (aged ≤18 years) presenting to the American University of Beirut Medical Center ED during 2010-2011 was completed. The common diagnoses among 5 age groups (<1, 1-4, 5-9, 10-14, and 15-18 years) in 3 categories (all pediatric ED visits, treat and release, admitted visits) were assessed...
July 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/30045355/analgesic-efficacy-of-intranasal-ketamine-versus-intranasal-fentanyl-for-moderate-to-severe-pain-in-children-a-prospective-randomized-double-blind-study
#14
Kellie Quinn, Sabina Kriss, Jefferson Drapkin, Antonios Likourezos, Illya Pushkar, Jason Brady, Matthew Yasavolian, Salil S Chitnis, Sergey Motov, Christian Fromm
PURPOSE: This study aimed to compare analgesic efficacy of intranasal (IN) ketamine to IN fentanyl for moderate to severe pain in children in a pediatric emergency department. METHODS: A prospective, randomized, double-blinded, noninferiority study evaluating children aged 3 to 17 years in a pediatric emergency department with acute moderate to severe pain was conducted. Patients received either 1 mg/kg of IN ketamine or 1.5 μg/kg of IN fentanyl and were evaluated after 10, 20, 30, and 60 minutes...
July 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/30045349/emergency-provider-use-of-plain-radiographs-in-the-evaluation-of-pediatric-constipation
#15
Ryan Kearney, Todd Edwards, Miranda Bradford, Eileen Klein
BACKGROUND: More than half of children evaluated as outpatients for abdominal pain are diagnosed with constipation. X-ray use in this scenario is variable: less than 5% in clinic settings, greater than 70% in emergency departments. X-rays increase misdiagnosis rate, remain costly, and involve radiation exposure. OBJECTIVES: The aim of this study was to assess the use of plain radiographs by pediatric emergency medicine (PEM) providers in the diagnostic evaluation and management of pediatric constipation...
July 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/30043448/ear-drops-for-the-removal-of-ear-wax
#16
REVIEW
Ksenia Aaron, Tess E Cooper, Laura Warner, Martin J Burton
BACKGROUND: Ear wax (cerumen) is a normal bodily secretion that can become a problem when it obstructs the ear canal. Symptoms attributed to wax (such as deafness and pain) are among the commonest reasons for patients to present to primary care with ear trouble.Wax is part of the ear's self-cleaning mechanism and is usually naturally expelled from the ear canal without causing problems. When this mechanism fails, wax is retained in the canal and may become impacted; interventions to encourage its removal may then be needed...
July 25, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/30043434/administering-analgesia-sublingually-is-a-suitable-option-for-children-with-acute-abdominal-pain-in-the-emergency-department
#17
Giorgio Cozzi, Chiara Zanchi, Antonio Chiaretti, Vincenzo Tipo, Marta Cernich, Carolina D'Anna, Claudia Fantacci, Ester Conversano, Davide Zanon, Luca Ronfani, Egidio Barbi
AIM: Acute abdominal pain is a frequent complaint in children attending emergency departments. The aim of this study was to investigate the pain score reductions when children with acute abdominal pain received medication sublingually. METHODS: We carried out a multicentre randomised controlled trial in three children's hospitals in Italy between March 2015 and June 2017. Children from four to 18 years of age with acute abdominal pain were recruited if their self-reported pain was at least six on a scale from 0-10...
July 24, 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/30038534/a-qualitative-study-of-the-language-of-satisfaction-in-children-with-pain
#18
Tara McGrath, Samina Ali, Nadia Dow, Sarah Aziz, Molly Pilarski, Amy L Drendel
Background: Measures of satisfaction are essential to understanding patient experience, in general, and particularly with pain management. Objectives: (A) To identify the words children commonly use to communicate satisfaction, in general, and for pain management and (B) to determine if this vocabulary matches their caregivers. Methods: A study of child-caregiver pairs seen at a paediatric emergency department (PED) from July to November 2014 was conducted...
July 2018: Paediatrics & Child Health
https://www.readbyqxmd.com/read/30032889/mother-s-recorded-voice-on-emergence-can-decrease-postoperative-emergence-delirium-from-general-anaesthesia-in-paediatric-patients-a-prospective-randomised-controlled-trial
#19
S Byun, S Song, J H Kim, T Ryu, M Y Jeong, E Kim
BACKGROUND: Emergence delirium is a behavioural disturbance after general anaesthesia in children that can distress patients, parents, and primary caregivers. We hypothesised that listening to the mother's recorded voice can reduce ED compared with listening to a stranger's recorded voice. METHODS: This prospective, double-blind, randomised study was conducted in 2- to 8-yr-old patients who had undergone general anaesthesia. Sixty-six patients were randomly assigned to listen to either the mother's voice (Group M, n=33) or a stranger's voice (Group S, n=33)...
August 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/30024506/pleomorphic-rhabdomyosarcoma-of-the-liver-with-a-hepatic-cyst-in-an-adult-case-report-and-literature-review
#20
REVIEW
Jingyang Yin, Zuojin Liu, Kang Yang
RATIONALE: Rhabdomyosarcoma (RMS), a malignant tumor with striated muscle differentiation, is the most common type of soft-tissue sarcoma in children and adolescents, but rarely occurs in adults, and especially in human livers. Moreover, this disease has a very poor prognosis. Here we report a case of primary RMS of the liver in a 66-year-old woman. This case is rare with respect to the location and clinical course of the tumor. The tumor had enlarged rapidly, ruptured, and eventually caused the patient's death after a long history of a stable abdominal mass that indicated a hepatic cyst...
July 2018: Medicine (Baltimore)
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