8 Oct, 08 | by Bob Phillips
It’s my own question, this time, and throws up lots of annoying little things.
The problem is straightforward: I’m a paediatric oncologist in my spare time, and was asked about the use of LifeMel honey to prevent infections.
Now, being both an EBMer and a Physician, I said I didn’t know, but didn’t think it could do, but might cause problems. (Remember we’re not supposed to give honey to infants ’cause of botulinism? Same concerns.)
12 Sep, 08 | by Bob Phillips
It’s simple really - Autumn is approaching and most paediatricians are gathering their Virally Protective Hankies to ward off the germs they know they’ll be assaulted by. There’s heavy training in many departments for the new docs — “if it’s bronchiolitis clinically, don’t X-ray them, don’t bleed them, don’t IV them and don’t give them a ‘trial’ of bronchodilators: accept it - there’s nothing you can do and the nurses will get them better with feeds, oxygen and cups of tea”.
But what about the really poorly one, that makes you think “I wish I was next door to PICU” .. surely you’re wanting just to wander down to SCBU and borrow that spare CPAP machine .. that has to work .. doesn’t it ..?
13 Aug, 08 | by Bob Phillips
A 3 year old boy presents to the Emergency Department with a limp. He has been reluctant to weight bear on his right leg during the day and has a temperature of 37.9°C. Hip examination is painful. What clinical or laboratory tests could help discriminate between septic arthritis and transient synovitis?
Of course, you could just ring up orthopaedics and ask them to take him to theatre and wash out the hip - but you may not win many friends that way. How do you decide there is enough ‘clinical suspicion’ to make the call? more…
23 Jul, 08 | by BMJ Group
A blog post of questions that are calling out to be answered.
Ever looked at the Archimedes section and thought “I wonder what I could write about?” or “I wish they’d look at this?” Here’s the space you were looking for.
23 Jul, 08 | by Bob Phillips
Jamie, a 13-year-old girl with cystic fibrosis (CF), has been referred to the Paediatric Diabetes clinic because of an abnormal oral glucose tolerance test (OGTT) in her recent CF Annual Review. It showed impaired glucose tolerance. Continuous glucose monitoring system (CGMS) over three days showed normal fasting and pre-prandial glucose but frequent post-prandial glucose excursions between 11.1 mmol/l and 16.0 mmol/l. In retrospect, although Jamie’s previous OGTT carried out at Annual Review were normal, her lung function had gradually deteriorated over the past three years. This had been attributed to increasing episodes of infective exacerbations. You wondered for how long Jamie has had abnormal glucose metabolism which had gone undetected in her previous OGTT. more…
2 Jul, 08 | by Bob Phillips
A 20 month old presented with 1-day history of temperature, off food and ‘not herself’. Clinical examination showed a slightly irritable child with temperature 38.80C, slightly congested throat and doubtful neck stiffness. An LP shows WCC 2, RCC 0. A diagnosis of viral illness is made, and antibiotics are not commenced.
25 Jun, 08 | by Bob Phillips
What do you do if, accidentally, you scan the abdomen of a neonate and find nephrocalcinosis? Book them in for a transplant in a couple of years? Annual serum electrolytes, blood pressure & isotopic GFR measurement? Pretend you hadn’t seen it?
2 May, 08 | by BMJ Group
A 13 year old boy with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) comes to the clinic with his mother for a review. He was started on atomoxetine 6 weeks prior to this visit for hyperactive/impulsive symptoms and poor concentration. The boy was admitted in the hospital one week ago for changed behaviour, disorientation, irrelevant speech and self-harming behaviour. He was reported as very aggressive and hostile towards other children and adults. In past use of stimulant medication was not considered because of the risk of abuse and drug diversion. Mother correlates this hospitalization due to side effect of atomoxetine. She asks your opinion about increased aggression and hostility related to atomoxetine .
8 Apr, 08 | by Bob Phillips
It’s uncommon for us, as paediatricians, to be asked about how cost-effective our treatments are. Glancing at the media shows health stories about the new wonder drugs in adult cancer, or in Alzheimer’s disease, and how they are being restricted by a heartless and miserly health system. Where do these statements about ‘cost-effectiveness’ come from?
19 Mar, 08 | by Bob Phillips
A 7-year-old boy was referred for medical assessment as part of the process of producing a statement of special educational needs. There had been no medical concerns in the past and there was no family history of note. On examination, the boy was noted to be micro cephalic with head circumference on the 0.4th centile, while his height and weight were on the 50th centile. Neurological examination was normal. Should this boy be referred for an MRI scan of the brain? more…
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