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Give Aciclovir for herpetic gingivostomatisis

22 Dec, 08 | by Bob Phillips

ACV moleculeDoes oral aciclovir improve clinical outcome in immunocompetent children with primary herpes simplex gingivostomatitis?

A 3 year old previously well boy presents with a fever of 38.6ºc and several ulcers and erosions extending from his lips, along the tongue and cheek, to the back of the throat. The lesions have all appeared within the last 2 days. He has been crying inconsolably over the past 24 hours and is refusing food and drink. Is the use of oral aciclovir is indicated for primary herpes gingivostomatitis in children?

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Does atomoxetine aggravate mood problems?

2 May, 08 | by BMJ

ATX chemical compoundA 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 .

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MRI-brain for microcephaly?

19 Mar, 08 | by Bob Phillips

Boy with microcephalyA 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…

Leave appendiceal masses alone.

27 Feb, 08 | by Bob Phillips

Acute appendicitisA 5 year old boy was admitted to a rural New Zealand hospital with 10 day history of abdominal pain. The pain was localised to the RIF with guarding and examination revealed a palpable mass in the RIF. He had previously presented with a 1 day history of severe abdominal pain and fever and had been discharged the following day with a diagnosis of gastroenteritis. He was transferred to the tertiary hospital and a diagnosis was made on ultrasound scan of appendiceal mass with abscess. His condition was stable. He was commenced on conservative management and supportive care with intravenous (iv) antibiotics followed by a 2 week course of oral antibiotics. He responded well to conservative management and was scheduled for appendectomy after an interval of 6-8 weeks. You wonder whether it is necessary, now he is well, for him to have an appendectomy.

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No dental antibiotic prophylaxis for VP shunts.

12 Feb, 08 | by Bob Phillips

During a routine clinic follow-up, a patient with an indwelling ventriculo-peritoneal shunt enquires whether prophylactic antibiotics are necessary prior to routine dental hygiene work. He produces a letter from his dentist enquiring the same.

Dr Max Nathan of Morriston Hospital, Swansea, UK has had this happen … has it happened to you? And what did you do?

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Irritating hip or rotting femur?

13 Jan, 08 | by Bob Phillips

Radiograph of Septic HipA 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…

Are there effective strategies to reduce the length of stay for “well” near-term babies?

22 Oct, 07 | by BMJ

Premature babyLength of stay for ‘well’ near term (30-36 week gestation) babies varies between units and between countries, with the UK average being discharge at 36+2 weeks corrected. What strategies are in place in your unit to help these ‘small but well’ babies get out of precious neonatal cots into their own lovingly decorated cribs at home? And more to the Archimedes point – is there any evidence these interventions work?

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Azithromycin for chest infections in severe CP?

22 Oct, 07 | by BMJ

Is the frequency of recurrent chest infections, in children with chronic neurological problems, reduced by prophylactic Azithromycin?
You see Jonny, an 8 yr old boy with severe dystonic CP as a result of his premature birth at 26 wks gestation with another chest infection. He is mainly gastrostomy fed and had a Nissen’s fundoplication 5 yrs ago at the same time his gastrostomy was inserted. He has copious secretions and a poor cough reflex; these are made worse by Nitrazepam he requires for his dystonia. Evidence from previous barium studies and swallow assessments show that he chronically aspirates his secretions. He has no symptoms of upper airway obstruction. He has had increasingly frequent lower respiratory tract infections over the last year, requiring admission and intra-venous antibiotics (a total of four times in 2006). His weight and height have fallen from the 10th to the 3rd percentile. A chest x-ray shows chronic changes suggestive of underlying bronchiectasis. Immune function and Sweat test are normal. He awaits a CT scan. He has daily physiotherapy and regular suction and usually produces copious muco-purulent secretions. He is on maximal anti-reflux medication already. Would prophylactic Azithromycin reduce his risk of further LRTI? Or might it increase growth of multi resistant organisms within his sputum?

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GnRH analogues to prevent ovarian failure?

22 Oct, 07 | by BMJ

Should gonadotropin releasing hormone analogue be administered to prevent premature ovarian failure in young women with systemic lupus erythematosus on cyclophosphamide therapy?
A 15 year old girl with acute renal failure was found to have class IV systemic lupus erythematosus (SLE) nephritis on renal biopsy. A decision was taken to start her on the routine National Institute Health protocol of pulsed methyl-prednisolone and monthly intravenous cyclophosphamide (CYC) (0.5–1.0 g/m2 of body surface area). With her post pubertal status and the possibility of CYC induced gonadal toxicity, the question was raised as to whether she should be put on gonadotropin releasing hormone analogue ( GnRH-a ) therapy for ovarian protection.

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Is the use of Chest Physiotherapy Beneficial in Children with Community Acquired Pneumonia?

11 Jul, 07 | by BMJ

A 7 year old boy is admitted to the General Paediatric ward with a community acquired Pneumonia Radiograph pneumonia affecting the right lower lobe. It is suggested on the ward round that we arrange chest physiotherapy to try and reduce the length of his hospital stay. We wonder if there is evidence to support the use of physiotherapy in this case.

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