This paper employs archival documents to research how the Gold Coast colonial government worked with European women medical doctors at preventive health to sustain infant and child welfare clinics.After the First Worl...This paper employs archival documents to research how the Gold Coast colonial government worked with European women medical doctors at preventive health to sustain infant and child welfare clinics.After the First World War,the objective of the colonial government and medical officers was to prevent child mortality and child morbidity.European women medical doctors working with the government and in private practice at infant and child welfare clinics cared for African pregnant women,mothers,and children not older than three years old.European women medical doctors at infant and child welfare clinics educated the community.In 1932,the Great Depression peaked and Percy Selwyn-Clarke in the health service needed to increase funds and staff.Selwyn-Clarke established the Gold Coast Local Branch of the British Red Cross Society to work at the infant and child welfare clinics.展开更多
Bland-White-Garland syndrome or ALCAPA is an abnormality of birth of the left coronary artery from the pulmonary artery. It is a diagnostic and therapeutic emergency because it is a curable cause of hypokinetic dilate...Bland-White-Garland syndrome or ALCAPA is an abnormality of birth of the left coronary artery from the pulmonary artery. It is a diagnostic and therapeutic emergency because it is a curable cause of hypokinetic dilated heart disease in infants. We report through this clinical case, the fourth case of infantile ALCAPA diagnosed in Senegal in a 7-month-old infant. The symptomatology began around the age of 2 months, with a grumpy state associated with more marked crying and moaning during feedings and bowel movements. The mother reported hospitalization for a severe lung infection when she was 6 months old. The examination noted an infant in poor general condition, retarded growth and weight, and a 3/6th holosystolic murmur at the apex. Troponinemia was positive at 43.90 ng/L. The electrocardiogram showed Q waves on the lower side, a sub endocardial lesion on the upper side and a ST segment elevation in aVR. Doppler echocardiography showed dilated cardiomyopathy with a mean alteration of systolic function of the left ventricle at 37%, a mean mitral insufficiency and a strong suspicion of a birth anomaly of the left coronary artery. The CT scan confirmed the diagnosis of ALCAPA. Surgicalreimplantation of the left coronary artery at the aortic level was performed at 10 months of life with a favourable outcome at D50 postoperative.展开更多
Objective: Government targets to reduce waiting times are putting enormous pressures on outpatient services. The implementation of an electronic care records service (CRS) at our hospital in 2008 has led to widespread...Objective: Government targets to reduce waiting times are putting enormous pressures on outpatient services. The implementation of an electronic care records service (CRS) at our hospital in 2008 has led to widespread press coverage of ensuing chaos in clinical administration. We wanted to know how this new electronic system impacted on our working patterns in outpatient clinics and – more specifically – on the time actually spent with the patients. Material & methods: This study was performed 4 and 12 months after implementation of CRS to assess its impact on the time distribution in clinic. Senior doctors were monitored with a stop clock during consultations. Timings for pre- and post-consultation administration, and the actual consultation with the patient were recorded. A total of 170 consultations were evaluated in this way. Results: The key findings were that the total time needed to spend on a urological outpatient of 16 minutes remains unchanged from the pre-CRS era, but a majority (57%) of this time is spent in administration on the computer without the patient involved. Conclusion: No more than 15 patients should be seen in a 4 hour outpatient clinic per doctor. This recommendation drawn up by BAUS before CRS remains still valid. Patient administration related to the consultation that has previously been done by administrative aides is now to be done by the doctors on the computer in the same consultation session. Intended to streamline patient pathways, this does reduce the quality interaction-time between doctor and patients significantly.展开更多
Objectives: To evaluate the effect of manual chest compression (MCC) in the variables of oxygenation, hemodynamic and respiratory effeteness in infants suffering from respiratory diseases with atelectasis. Methods: Co...Objectives: To evaluate the effect of manual chest compression (MCC) in the variables of oxygenation, hemodynamic and respiratory effeteness in infants suffering from respiratory diseases with atelectasis. Methods: Controlled clinical trial, in which 38 infants were evaluated,19 ineach study group (group A: atelectasis and group B: control). Data were measured before, immediately after and 10 minutes after the end of the technique’s application. Results: The average age was of 5.05 months. There was an increase of RR in group A immediately after the application of the technique and signs of respiratory distress with a decrease in the oxygen saturation. Conclusion: There was a reduction in SpO2, an increase of RR and a worsening of clinical signs of respiratory distress. Given this, one may consider that there is a controversy about the benefits, mechanism of action, physiological and therapeutic effects of MCC when applied to infants.展开更多
BACKGROUND Neurofibromatosis is an autosomal dominant genetic disorder with various manifestations.Systemic multiple neurofibromatosis is rare in infancy.The disease is difficult to identify in the early stage,and it ...BACKGROUND Neurofibromatosis is an autosomal dominant genetic disorder with various manifestations.Systemic multiple neurofibromatosis is rare in infancy.The disease is difficult to identify in the early stage,and it is prone to misdiagnosis and missed diagnosis.In the presence of lower limb swelling with subcutaneous nodules of unknown cause,café-au-lait spots,and axillary freckles,this disease must be considered.This report presents the clinical manifestations,early detection,diagnosis and treatment,and prognosis of infantile neurofibromatosis type I(NF1).CASE SUMMARY The clinical manifestations,imaging examinations,and gene results of a 3-mo-old male infant with NF1 were analyzed retrospectively.He had“swelling of both legs”at the onset and developed café-au-lait spots,axillary freckles,and multiple neurofibromas later.He had a family history of similar conditions.Gene detection showed a heterozygous mutation of c.4537C>T in the NF1 gene,leading to a nonsense mutation of amino acids(p.R1513x),which originated from the mother of the infant.He was diagnosed with NF1.CONCLUSION Gene diagnosis plays an important role in the early diagnosis of NF1.展开更多
<p> <b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"&...<p> <b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Globally there is a high burden of low serum vitamin D deficiency (VDD) with children being acknowledged at risk due to low vitamin D content in both breastmilk and available foods and inadequate cutaneous synthesis of vitamin D. Even in countries with abundant sunshine, vitamin D deficiency (VDD) remains a problem. There is little characterization of the status of vitamin D among infants in East Africa. This study aimed to determine the prevalence and factors associated with vitamin D deficiency among infants attending the Reproductive and Child Health (RCH) Clinic in Arusha, Tanzania. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A cross-sectional study of 304 infants aged 6 weeks to 12 months was conducted at Arusha Lutheran Medical Centre (ALMC). Infants were enrolled during the warm season between November 2018 and January 2019. A pre-coded questionnaire was used to collect data on sociodemographic characteristics of the infant with consent from their caretakers. Physical examination was done for anthropometric measures and signs of rickets. Blood was drawn for assessment of serum 25-hydroxyvitamin D 25(OH)D, calcium, phosphorus and alkaline phosphate. Vitamin D deficiency was defined as 25(OH)D level below 20 ng/ml (<50 nmol/L) and Vitamin D insufficiency defined as a 25(OH)D level 20 - 30 ng/ml (50 - 75 nmol/L). Statistical </span><span><span style="font-family:Verdana;">analysis was performed using STATA 14 version and factors associated with VDD explored with multivariate analysis. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The mean serum 25(OH)D </span></span><span style="font-family:Verdana;">among infants was 34.51 ng/ml (±15.53). Vitamin D deficiency was found in 67/304 (22%) infants and Vitamin D insufficiency in 50 (16.5%) infants. Hypocalcemia was observed in 33 (10.9%) infants and clinical findings of rickets were found in 11 infants (3.6%). Factors independently associated with VDD included age < 6 months (Adjusted Odds Ratio (AOR) 1.56, 95% CI 1.19 - 4.0, p value < 0.026), serum signs of rickets and serum hypocalcemia (p-value < 0.001 and <0.002, respectively). </span><b><span style="font-family:Verdana;">Conclusion and Recommendation: </span></b><span style="font-family:Verdana;">A high prevalence of Vitamin D deficiency (22%) and insufficiency (16.5%) was observed among infants attending RCH Clinic in Arusha, Tanzania. Age < 6 months, a single serum measurement of hypocalcemia and the presence of the clinical sign of rickets were independently associated with VDD. Clinicians should actively assess for VDD and supplement with vitamin D as indicated, especially among infants < 6 months.</span></span> </p>展开更多
BACKGROUND: Delayed vitamin K deficiency is characterized by acute onset, severe illness and high fatality rate. 33%-50% survivors accompany with other various nervous system sequelas. Therefore, diagnosis and treatme...BACKGROUND: Delayed vitamin K deficiency is characterized by acute onset, severe illness and high fatality rate. 33%-50% survivors accompany with other various nervous system sequelas. Therefore, diagnosis and treatment of intracranial hemorrhage in time become a key factor for improving healing rate and reducing fatality rate and incidence of sequela. OBJECTIVE: To investigate the clinical situation, experimental characteristics, CT examination and terminative characteristics of infants with intracranial hemorrhage induced by delayed vitamin K deficiency. DESIGN: Case analysis. SETTING: Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University. PARTICIPANTS: A total of 17 infants with intracranial hemorrhage induced by delayed vitamin K deficiency aged 1-3 months including 11 boys and 6 girls were selected from Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University from January 1994 to December 2005. All infants had drowsiness, rejective milk, spiting milk, gaze of both eyes, tic, coma, full anterior fontanelle, high muscular tension and cerebral hernia, etc. Experimental examination demonstrated that infants had anemia at various degrees; prothrombin time and partial thromboplastin time were prolonged; platelet count was normal. CT examination indicated that screenages of subarachnoid hemorrhage, subdural hematoma, cerebral parenchyma hemorrhage and intraventricular hemorrage were changed. Hemorrhage was stopped by the application of vitamin K. All patients provided informed consent. METHODS: ① Clinical situation and physical sign of infants were observed after hospitalization and scanned with rapid spiral CT scanning system. The thickness and average space of layers were 8-10 mm and the scanning time was 5 s with window width of 30-80 Hu and window position of 28-35 Hu. ② After hospitalization, four items of blood coagulation was measured with Futura meter and biochemical indexes of blood, such as serum calcium, serum alkaline phosphatase, total bilirubin, direct bilirubin and indirect bilirubin, were detected with Roche Modular PPI automatic biochemistry analyzer. ③ After hospitalization, infants were given 5-10 mg vitamin K1 for 3-5 days, and then, they were transfused with 10-15 mL/kg fresh plasma or whole blood for 1-3 times and received other relative therapies. Therapeutic effects were evaluated based on clinical diagnosis and criteria. MAIN OUTCOME MEASURES: ① Clinical situation, physical sign and CT examination; ② results of experimental examination; ③ treatment and termination. RESULTS: A total of 17 infants with intracranial hemorrhage were involved in the final analysis. ① Clinical situation, physical sign and CT examination: All infants had pale facial expression and full or bossing anterior fontanelle. Among them, 13 infants had drowsiness or dysphoria, 12 rejective milk or emesis, 11 tic, 13 injection site hemorrhage, 2 gastrointestinal hemorrhage, 3 cerebral hernia, 11 high muscular tension and 6 cervical rigidity. CT examination demonstrated that most infants (88%, 15/17) had subarachnoid hemorrhage; 10 (59%, 10/17) had subdural hematoma; 8 (47%, 8/17) had cerebral parenchyma hemorrhage; few had intraventricular hemorrhage. In addition, results of CT examination also indicated that 17 infants had intracranial hemorrhage. Hemorrhage sites of 12 infants were equal to or more than 2, which was accounted for 70% (12/17); meanwhile, partial cases accompanied with a large area of focus of cerebral infarction or cerebral hypoxia-ischemia lesion. ② Results of experimental examination: There were 6 infants with elongation of prothrombin time, 5 with partial elongation of prothrombin time, 4 with decrease of serum calcium (1.69-2.25 mmol/L), 3 with increase of serum alkaline phosphatase, 3 with increase of total bilirubin, 3 with increase of direct bilirubin, and 3 with increase of indirect bilirubin. ③ Treatment and termination: After treatment, 12 infants were cured well, 3 improved, 1 given up and 1 died. Later, ten infants received CT re-examination at 3 months after treatment. The results indicated that 3 infants had simple subarachnoid hemorrhage and 4 had subarachnoid hemorrhage accompanying with subdural hematoma. Their focuses were absorbed well and not show as obvious sequela. One infant had subdural hematoma accompanying with subarachnoid hemorrhage, cerebral parenchyma hemorrhage, intraventricular hemorrage and cerebral hypoxia ischemia, and then, after hematom absorption, obvious cerebral malacia focus, hydrocephalus, brain atrophy and inferior accumulating fluid of dura mater were observed; 2 had subdural hematoma accompanying with subarachnoid hemorrhage and cerebral hypoxia ischemia, and then, after bleeding absorption, brain atrophy was changed remarkably; changes of hydrocephalus were observed in one infant. CONCLUSION: ① Symptoms of pale facial expression, full or bossing anterior fontanelle, drowsiness and dysphoria are observed in infants with delayed vitamin K deficiency . ② Experimental indexes demonstrate that prothrombin time and partial prothrombin time are prolonged, and numbers of infants having decrease of serum calcium are in the third place. ③ Poly-intracranial hemorrhage is a notable characteristic of CT examination. Partial infants who have poly-intracranial hemorrhage always accompany with cerebral hypoxia-ischemia lesion or cerebral infarction. Clinical situation and prognosis of infants who have a large area of intracranial hemorrhage and cerebral hypoxia-ischemia changes are poor; however, those of infants who have simple subarachnoid hemorrhage or combination of subarachnoid hemorrhage with subdural hematoma are well. ④ Effect of vitamin K on this kind of disease is well.展开更多
Introduction: Fibromatosis colli is a congenital muscle tumor with an incidence of 0.4%. This lesion is fibrous involving the sternocleidomastoid muscle, discovered after a few weeks of life in a patient who had known...Introduction: Fibromatosis colli is a congenital muscle tumor with an incidence of 0.4%. This lesion is fibrous involving the sternocleidomastoid muscle, discovered after a few weeks of life in a patient who had known or unknown perinatal trauma. Rarely bilateral, it evolves spontaneously favorably in a few weeks or months in the vast majority of cases. Objectives: The purpose of this work is to bring the interest in ultrasound in the management of fibromatosis colli. Material and Methods: This is a descriptive cross-sectional study covering a period of 21 months from December 2019 to December 2021 in the medical imaging department of the medical clinic “Marie Cuire” in Bamako. The variables analyzed were age, sex and ultrasound results. The ultrasound system used was General Electric (GE). Data analysis was performed using Excel software. Results: During the 21-month study period, 1260 infants were seen in our service, including 0.95% for cervical swelling. We had a male predominance with 8 cases out of 12 cases and the age of the patients was mainly between 21 days and 30 days. The diagnosis was made by ultrasound, which revealed within the Sterno-cleido-mastoid muscle (MSCM) a hypo-isoechoic or heterogeneous oblong mass or thickening without any other associated anomaly. Conclusion: Cervical ultrasound is a significant examination in the management of fibromatosis colli for diagnostic confirmation and therapeutic follow-up.展开更多
In the present study, clinical pharmacists monitored the blood concentration of vancomycin in children in the Infant Ward from 2013 to 2014, and the drug dose was adjusted according to its plasma concentration. Moreov...In the present study, clinical pharmacists monitored the blood concentration of vancomycin in children in the Infant Ward from 2013 to 2014, and the drug dose was adjusted according to its plasma concentration. Moreover, we analyzed the plasma concentration of vancomycin in infants in the hospital from 2013 to 2014. Simultaneously, we also discussed the necessity of regular therapeutic drug monitoring of vancomycin in infants, and the important role of clinical pharmacists was further explored. The results showed that it was necessary to routinely monitor the therapeutic drug in infants. Clinical pharmacists performed medication monitoring, which improved the effectiveness of vancomycin and prevented its adverse effects. In addition, it is a new treatment model for the participation of clinical pharmacists in the clinical treatment.展开更多
生长减缓是帮助早期识别营养问题的重要临床表现,尽早识别和干预婴幼儿生长减缓对改善其近远期健康结局意义重大。之前发表的相关指南和专家共识对生长减缓缺乏统一的定义,影响临床识别、评估与规范管理。2023年3月,Journal of Pediatri...生长减缓是帮助早期识别营养问题的重要临床表现,尽早识别和干预婴幼儿生长减缓对改善其近远期健康结局意义重大。之前发表的相关指南和专家共识对生长减缓缺乏统一的定义,影响临床识别、评估与规范管理。2023年3月,Journal of Pediatric Gastroenterology and Nutrition杂志发表了《生长减缓婴幼儿的追赶生长:指导临床医师的专家建议》,不仅阐述了追赶生长的重要性,还针对如何适当地定义、评估和管理生长减缓制定了切实可行的共识建议,对临床医生具有现实的指导价值。本文结合我国临床现状,对该“建议”进行解读,以期为我国临床医师管理生长减缓婴幼儿提供指导和参考。展开更多
文摘This paper employs archival documents to research how the Gold Coast colonial government worked with European women medical doctors at preventive health to sustain infant and child welfare clinics.After the First World War,the objective of the colonial government and medical officers was to prevent child mortality and child morbidity.European women medical doctors working with the government and in private practice at infant and child welfare clinics cared for African pregnant women,mothers,and children not older than three years old.European women medical doctors at infant and child welfare clinics educated the community.In 1932,the Great Depression peaked and Percy Selwyn-Clarke in the health service needed to increase funds and staff.Selwyn-Clarke established the Gold Coast Local Branch of the British Red Cross Society to work at the infant and child welfare clinics.
文摘Bland-White-Garland syndrome or ALCAPA is an abnormality of birth of the left coronary artery from the pulmonary artery. It is a diagnostic and therapeutic emergency because it is a curable cause of hypokinetic dilated heart disease in infants. We report through this clinical case, the fourth case of infantile ALCAPA diagnosed in Senegal in a 7-month-old infant. The symptomatology began around the age of 2 months, with a grumpy state associated with more marked crying and moaning during feedings and bowel movements. The mother reported hospitalization for a severe lung infection when she was 6 months old. The examination noted an infant in poor general condition, retarded growth and weight, and a 3/6th holosystolic murmur at the apex. Troponinemia was positive at 43.90 ng/L. The electrocardiogram showed Q waves on the lower side, a sub endocardial lesion on the upper side and a ST segment elevation in aVR. Doppler echocardiography showed dilated cardiomyopathy with a mean alteration of systolic function of the left ventricle at 37%, a mean mitral insufficiency and a strong suspicion of a birth anomaly of the left coronary artery. The CT scan confirmed the diagnosis of ALCAPA. Surgicalreimplantation of the left coronary artery at the aortic level was performed at 10 months of life with a favourable outcome at D50 postoperative.
文摘Objective: Government targets to reduce waiting times are putting enormous pressures on outpatient services. The implementation of an electronic care records service (CRS) at our hospital in 2008 has led to widespread press coverage of ensuing chaos in clinical administration. We wanted to know how this new electronic system impacted on our working patterns in outpatient clinics and – more specifically – on the time actually spent with the patients. Material & methods: This study was performed 4 and 12 months after implementation of CRS to assess its impact on the time distribution in clinic. Senior doctors were monitored with a stop clock during consultations. Timings for pre- and post-consultation administration, and the actual consultation with the patient were recorded. A total of 170 consultations were evaluated in this way. Results: The key findings were that the total time needed to spend on a urological outpatient of 16 minutes remains unchanged from the pre-CRS era, but a majority (57%) of this time is spent in administration on the computer without the patient involved. Conclusion: No more than 15 patients should be seen in a 4 hour outpatient clinic per doctor. This recommendation drawn up by BAUS before CRS remains still valid. Patient administration related to the consultation that has previously been done by administrative aides is now to be done by the doctors on the computer in the same consultation session. Intended to streamline patient pathways, this does reduce the quality interaction-time between doctor and patients significantly.
文摘Objectives: To evaluate the effect of manual chest compression (MCC) in the variables of oxygenation, hemodynamic and respiratory effeteness in infants suffering from respiratory diseases with atelectasis. Methods: Controlled clinical trial, in which 38 infants were evaluated,19 ineach study group (group A: atelectasis and group B: control). Data were measured before, immediately after and 10 minutes after the end of the technique’s application. Results: The average age was of 5.05 months. There was an increase of RR in group A immediately after the application of the technique and signs of respiratory distress with a decrease in the oxygen saturation. Conclusion: There was a reduction in SpO2, an increase of RR and a worsening of clinical signs of respiratory distress. Given this, one may consider that there is a controversy about the benefits, mechanism of action, physiological and therapeutic effects of MCC when applied to infants.
文摘BACKGROUND Neurofibromatosis is an autosomal dominant genetic disorder with various manifestations.Systemic multiple neurofibromatosis is rare in infancy.The disease is difficult to identify in the early stage,and it is prone to misdiagnosis and missed diagnosis.In the presence of lower limb swelling with subcutaneous nodules of unknown cause,café-au-lait spots,and axillary freckles,this disease must be considered.This report presents the clinical manifestations,early detection,diagnosis and treatment,and prognosis of infantile neurofibromatosis type I(NF1).CASE SUMMARY The clinical manifestations,imaging examinations,and gene results of a 3-mo-old male infant with NF1 were analyzed retrospectively.He had“swelling of both legs”at the onset and developed café-au-lait spots,axillary freckles,and multiple neurofibromas later.He had a family history of similar conditions.Gene detection showed a heterozygous mutation of c.4537C>T in the NF1 gene,leading to a nonsense mutation of amino acids(p.R1513x),which originated from the mother of the infant.He was diagnosed with NF1.CONCLUSION Gene diagnosis plays an important role in the early diagnosis of NF1.
文摘<p> <b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Globally there is a high burden of low serum vitamin D deficiency (VDD) with children being acknowledged at risk due to low vitamin D content in both breastmilk and available foods and inadequate cutaneous synthesis of vitamin D. Even in countries with abundant sunshine, vitamin D deficiency (VDD) remains a problem. There is little characterization of the status of vitamin D among infants in East Africa. This study aimed to determine the prevalence and factors associated with vitamin D deficiency among infants attending the Reproductive and Child Health (RCH) Clinic in Arusha, Tanzania. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A cross-sectional study of 304 infants aged 6 weeks to 12 months was conducted at Arusha Lutheran Medical Centre (ALMC). Infants were enrolled during the warm season between November 2018 and January 2019. A pre-coded questionnaire was used to collect data on sociodemographic characteristics of the infant with consent from their caretakers. Physical examination was done for anthropometric measures and signs of rickets. Blood was drawn for assessment of serum 25-hydroxyvitamin D 25(OH)D, calcium, phosphorus and alkaline phosphate. Vitamin D deficiency was defined as 25(OH)D level below 20 ng/ml (<50 nmol/L) and Vitamin D insufficiency defined as a 25(OH)D level 20 - 30 ng/ml (50 - 75 nmol/L). Statistical </span><span><span style="font-family:Verdana;">analysis was performed using STATA 14 version and factors associated with VDD explored with multivariate analysis. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The mean serum 25(OH)D </span></span><span style="font-family:Verdana;">among infants was 34.51 ng/ml (±15.53). Vitamin D deficiency was found in 67/304 (22%) infants and Vitamin D insufficiency in 50 (16.5%) infants. Hypocalcemia was observed in 33 (10.9%) infants and clinical findings of rickets were found in 11 infants (3.6%). Factors independently associated with VDD included age < 6 months (Adjusted Odds Ratio (AOR) 1.56, 95% CI 1.19 - 4.0, p value < 0.026), serum signs of rickets and serum hypocalcemia (p-value < 0.001 and <0.002, respectively). </span><b><span style="font-family:Verdana;">Conclusion and Recommendation: </span></b><span style="font-family:Verdana;">A high prevalence of Vitamin D deficiency (22%) and insufficiency (16.5%) was observed among infants attending RCH Clinic in Arusha, Tanzania. Age < 6 months, a single serum measurement of hypocalcemia and the presence of the clinical sign of rickets were independently associated with VDD. Clinicians should actively assess for VDD and supplement with vitamin D as indicated, especially among infants < 6 months.</span></span> </p>
文摘BACKGROUND: Delayed vitamin K deficiency is characterized by acute onset, severe illness and high fatality rate. 33%-50% survivors accompany with other various nervous system sequelas. Therefore, diagnosis and treatment of intracranial hemorrhage in time become a key factor for improving healing rate and reducing fatality rate and incidence of sequela. OBJECTIVE: To investigate the clinical situation, experimental characteristics, CT examination and terminative characteristics of infants with intracranial hemorrhage induced by delayed vitamin K deficiency. DESIGN: Case analysis. SETTING: Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University. PARTICIPANTS: A total of 17 infants with intracranial hemorrhage induced by delayed vitamin K deficiency aged 1-3 months including 11 boys and 6 girls were selected from Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University from January 1994 to December 2005. All infants had drowsiness, rejective milk, spiting milk, gaze of both eyes, tic, coma, full anterior fontanelle, high muscular tension and cerebral hernia, etc. Experimental examination demonstrated that infants had anemia at various degrees; prothrombin time and partial thromboplastin time were prolonged; platelet count was normal. CT examination indicated that screenages of subarachnoid hemorrhage, subdural hematoma, cerebral parenchyma hemorrhage and intraventricular hemorrage were changed. Hemorrhage was stopped by the application of vitamin K. All patients provided informed consent. METHODS: ① Clinical situation and physical sign of infants were observed after hospitalization and scanned with rapid spiral CT scanning system. The thickness and average space of layers were 8-10 mm and the scanning time was 5 s with window width of 30-80 Hu and window position of 28-35 Hu. ② After hospitalization, four items of blood coagulation was measured with Futura meter and biochemical indexes of blood, such as serum calcium, serum alkaline phosphatase, total bilirubin, direct bilirubin and indirect bilirubin, were detected with Roche Modular PPI automatic biochemistry analyzer. ③ After hospitalization, infants were given 5-10 mg vitamin K1 for 3-5 days, and then, they were transfused with 10-15 mL/kg fresh plasma or whole blood for 1-3 times and received other relative therapies. Therapeutic effects were evaluated based on clinical diagnosis and criteria. MAIN OUTCOME MEASURES: ① Clinical situation, physical sign and CT examination; ② results of experimental examination; ③ treatment and termination. RESULTS: A total of 17 infants with intracranial hemorrhage were involved in the final analysis. ① Clinical situation, physical sign and CT examination: All infants had pale facial expression and full or bossing anterior fontanelle. Among them, 13 infants had drowsiness or dysphoria, 12 rejective milk or emesis, 11 tic, 13 injection site hemorrhage, 2 gastrointestinal hemorrhage, 3 cerebral hernia, 11 high muscular tension and 6 cervical rigidity. CT examination demonstrated that most infants (88%, 15/17) had subarachnoid hemorrhage; 10 (59%, 10/17) had subdural hematoma; 8 (47%, 8/17) had cerebral parenchyma hemorrhage; few had intraventricular hemorrhage. In addition, results of CT examination also indicated that 17 infants had intracranial hemorrhage. Hemorrhage sites of 12 infants were equal to or more than 2, which was accounted for 70% (12/17); meanwhile, partial cases accompanied with a large area of focus of cerebral infarction or cerebral hypoxia-ischemia lesion. ② Results of experimental examination: There were 6 infants with elongation of prothrombin time, 5 with partial elongation of prothrombin time, 4 with decrease of serum calcium (1.69-2.25 mmol/L), 3 with increase of serum alkaline phosphatase, 3 with increase of total bilirubin, 3 with increase of direct bilirubin, and 3 with increase of indirect bilirubin. ③ Treatment and termination: After treatment, 12 infants were cured well, 3 improved, 1 given up and 1 died. Later, ten infants received CT re-examination at 3 months after treatment. The results indicated that 3 infants had simple subarachnoid hemorrhage and 4 had subarachnoid hemorrhage accompanying with subdural hematoma. Their focuses were absorbed well and not show as obvious sequela. One infant had subdural hematoma accompanying with subarachnoid hemorrhage, cerebral parenchyma hemorrhage, intraventricular hemorrage and cerebral hypoxia ischemia, and then, after hematom absorption, obvious cerebral malacia focus, hydrocephalus, brain atrophy and inferior accumulating fluid of dura mater were observed; 2 had subdural hematoma accompanying with subarachnoid hemorrhage and cerebral hypoxia ischemia, and then, after bleeding absorption, brain atrophy was changed remarkably; changes of hydrocephalus were observed in one infant. CONCLUSION: ① Symptoms of pale facial expression, full or bossing anterior fontanelle, drowsiness and dysphoria are observed in infants with delayed vitamin K deficiency . ② Experimental indexes demonstrate that prothrombin time and partial prothrombin time are prolonged, and numbers of infants having decrease of serum calcium are in the third place. ③ Poly-intracranial hemorrhage is a notable characteristic of CT examination. Partial infants who have poly-intracranial hemorrhage always accompany with cerebral hypoxia-ischemia lesion or cerebral infarction. Clinical situation and prognosis of infants who have a large area of intracranial hemorrhage and cerebral hypoxia-ischemia changes are poor; however, those of infants who have simple subarachnoid hemorrhage or combination of subarachnoid hemorrhage with subdural hematoma are well. ④ Effect of vitamin K on this kind of disease is well.
文摘Introduction: Fibromatosis colli is a congenital muscle tumor with an incidence of 0.4%. This lesion is fibrous involving the sternocleidomastoid muscle, discovered after a few weeks of life in a patient who had known or unknown perinatal trauma. Rarely bilateral, it evolves spontaneously favorably in a few weeks or months in the vast majority of cases. Objectives: The purpose of this work is to bring the interest in ultrasound in the management of fibromatosis colli. Material and Methods: This is a descriptive cross-sectional study covering a period of 21 months from December 2019 to December 2021 in the medical imaging department of the medical clinic “Marie Cuire” in Bamako. The variables analyzed were age, sex and ultrasound results. The ultrasound system used was General Electric (GE). Data analysis was performed using Excel software. Results: During the 21-month study period, 1260 infants were seen in our service, including 0.95% for cervical swelling. We had a male predominance with 8 cases out of 12 cases and the age of the patients was mainly between 21 days and 30 days. The diagnosis was made by ultrasound, which revealed within the Sterno-cleido-mastoid muscle (MSCM) a hypo-isoechoic or heterogeneous oblong mass or thickening without any other associated anomaly. Conclusion: Cervical ultrasound is a significant examination in the management of fibromatosis colli for diagnostic confirmation and therapeutic follow-up.
基金Shanghai Outstanding Young University Teachers Research and Special Funds(Grant No.ZZjdyx13089)Science and Technology Commission of Shanghai Municipality Grants(Grant No.12DZ1930404)
文摘In the present study, clinical pharmacists monitored the blood concentration of vancomycin in children in the Infant Ward from 2013 to 2014, and the drug dose was adjusted according to its plasma concentration. Moreover, we analyzed the plasma concentration of vancomycin in infants in the hospital from 2013 to 2014. Simultaneously, we also discussed the necessity of regular therapeutic drug monitoring of vancomycin in infants, and the important role of clinical pharmacists was further explored. The results showed that it was necessary to routinely monitor the therapeutic drug in infants. Clinical pharmacists performed medication monitoring, which improved the effectiveness of vancomycin and prevented its adverse effects. In addition, it is a new treatment model for the participation of clinical pharmacists in the clinical treatment.
文摘生长减缓是帮助早期识别营养问题的重要临床表现,尽早识别和干预婴幼儿生长减缓对改善其近远期健康结局意义重大。之前发表的相关指南和专家共识对生长减缓缺乏统一的定义,影响临床识别、评估与规范管理。2023年3月,Journal of Pediatric Gastroenterology and Nutrition杂志发表了《生长减缓婴幼儿的追赶生长:指导临床医师的专家建议》,不仅阐述了追赶生长的重要性,还针对如何适当地定义、评估和管理生长减缓制定了切实可行的共识建议,对临床医生具有现实的指导价值。本文结合我国临床现状,对该“建议”进行解读,以期为我国临床医师管理生长减缓婴幼儿提供指导和参考。
