Does 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 […]
Does atomoxetine aggravate mood problems?
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, […]
MRI-brain for microcephaly?
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, […]
Leave appendiceal masses alone.
A 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 […]
No dental antibiotic prophylaxis for VP shunts.
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 […]
Irritating hip or rotting femur?
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 […]
Are there effective strategies to reduce the length of stay for “well” near-term babies?
Length 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 […]
Azithromycin for chest infections in severe CP?
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 […]
GnRH analogues to prevent ovarian failure?
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 […]
Is the use of Chest Physiotherapy Beneficial in Children with Community Acquired Pneumonia?
A 7 year old boy is admitted to the General Paediatric ward with a community acquired 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 […]