Stool calprotectin in suspected inflammatory bowel disease (IBD)
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Calprotectin is a complex of proteins (60% of the soluble protein of neutrophil cytosol) which contain calcium capable of sequestrating manganese and zinc. It is secreted during inflammation, has antimicrobial properties and has been used as a marker for inflammatory bowel diseases.
From a cohort study examining the use of stool calprotectin as a screening tool for IBD in children, data suggests a normal fecal level (>50mg/g) appears to preclude IBD (an elevated level appears not to enhance one's ability to distinguish organic from nonorganic bowel symptoms).
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A single test to confirm correct placement of a dysfunctional central venous catheter (CVC) in children
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The diagnosis of a dysfunctional CVC, where fluids can be infused but blood cannot be aspirated usually requires a radiographic study with contrast media for diagnosis.
In a cohort study of 22 children from a tertiary care center with an apparent partial dysfunctional CVC, bedside injection of 1ml/kg (max. 20ml) of 4.2% dilute sodium bicarbonate results in a distinct and predictable increase in end-tidal carbon dioxide level in children whose CVC's are intravascular.
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Extremely elevated (<30mg/dl) C-reactive protein (CRP) levels and outcome
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A study group of 435 patients was utilized to examine the clinical significance of an extremely high CRP.
89.4% of children with a high CRP have infectious diseases, frequently pneumonia (47.1%), bacteremia (particularly in oncology patients - 38%) and a low albumin level, with a mortality rate of 17.6%.
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Side effects and complications of proton pump inhibitors (PPIs) - a pediatric perspective
"PPIs are a class of acid suppression medication that block gastric parietal cell acid productivity by irreversibly inhibiting luminal H"/ K" adenylpyrophosphatase (ATPase)". They are being used in increasing amounts in infants and children. While initially thought to be relatively safe, potential safety concerns have arisen, particularly with regard to dysbiosis (microbial imbalance frequently reported in the digestive tract), bacterial functional changes, mucosal secretory alterations, anti-inflammatory effects and other potentially detrimental effects to maintaining health.
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| Complications Associated with PPIs |
A substantive and extensive review of PPIs examines their effects in Infectious Diseases, gastrointestinal infections and diseases, upper and lower respiratory tract infections, spontaneous bacterial peritonitis, rebound acid hypersecretion, calcium absorption, hypomagnesaemia vitamin and mineral absorption plus other effects. This a must read article for all pediatricians (Ed.)
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A qualitative comparative study on medical clowning during invasive procedures in children, examined the skills used by medical clowns, and assessed whether there are any therapeutic benefits to them.
Interviews reveal that clowns use theatrical and clowning tools to enhance patient empowerment, reversal of role, building a "therapeutic alliance" and follow a model of crisis intervention therapy which appears to improve a child's experience during invasive procedures.
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Effects of timing to diagnosis and appendectomy in pediatric appendicitis
A prospective study of pediatric appendicitis in 230 patients (ave. age: 9.3 yrs.) was utilized to to assess appendiceal perforation rate relative to duration of symptomatology, appendectomy timing, hospital length of stay (LOS) and operating room (OR) times.
From diagnosis to appendectomy time, differences between 0-6 hours or longer (to 23 hours) has no significant effect on perforation rate, hospital LOS or OR times. Symptomatology >48 hours increases perforation rate by about 5 fold and LOS's by 56% (Emergency Department LOS before surgery apparently has no effect on perforation rates.)
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Long-term outcomes of four patients with tracheal agenesis (TA) following airway and esophageal reconstruction
TA is a severe congenital disorder with complete or partial absence of the trachea below the larynx, with or without tracheoesophageal fistula (TEF).
A review of four children (assessed at 77-109 months of age) who never required mechanical respiratory support and who had esophageal/alimentary reconstruction at ages 41-55 months, indicates that though all require feeding through a gastrostomy tube, physical and neurological development is close to normal.
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