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Mashup Score: 3
There is a common perception that peanut/tree nut particles can be transmitted through aircraft ventilation systems and pose a significant risk to passengers with food allergies. In fact, food-induced allergic reactions are around 10–100 times less common during flights than ‘on the ground’, perhaps because of the multiple precautions food-allergic passengers take when flying. We review the evidence for strategies to help prevent accidental allergic reactions while travelling on commercial flights (review registered at PROSPERO, ref CRD42022384341). Research studies (including aircraft simulations) show no evidence to support airborne transmission of nut allergens as a likely phenomenon. Announcements requesting ‘nut bans’ are not therefore supported, and may instal a false sense of security. The most effective measure is for passengers to wipe down their seat area (including tray table and seat-back entertainment system). Food proteins are often ‘sticky’ and adhere to these surfaces,
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Mashup Score: 8
Objective To compare the clinical presentations, management and outcomes of avoidant/restrictive food intake disorder (ARFID) across paediatric and child and adolescent (C&A) psychiatric settings. Study design Prospective surveillance study. Methods Data were collected during a 13-month prospective surveillance study of children and adolescents with ARFID in the UK and Republic of Ireland. Paediatricians reported cases via the British Paediatric Surveillance Unit and psychiatrists through the Child and Adolescent Psychiatry Surveillance System. A follow-up questionnaire was sent at 12 months after a case of ARFID was reported. Results 319 cases were included, 189 from paediatricians and 130 from C&A psychiatrists. Patients presenting to paediatricians were younger (9.8 years vs 13.7 years), more often male (62.4% vs 43.1%), and had more chronic symptoms (80.4% vs 67.0%), selective eating (63.7% vs 46.6%) and comorbid autism (67.6% vs 50.0%) than to psychiatrists. Psychiatrists saw pati
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Mashup Score: 0
In April 2024, the final report of the Cass Review, an independent review chaired by Dr Hilary Cass, was published, offering recommendations to improve gender identity services for children and young people in the UK. The core purpose of the Review was to improve care for children and adolescents. Commissioned by National Health Service England, the Review identified a weak evidence base for medical endocrine interventions and recommended that these treatments be provided within a structured research framework. The Review received widespread support from the clinical community. However, in July, the British Medical Association Council, without consulting its own members, unexpectedly passed a motion calling for a public critique of the Review, citing concerns over methodological weaknesses – a position it then softened following public criticism from members, concluding that their review would come instead from a position of neutrality. The original motion was based on two non-peer-rev
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Mashup Score: 29National recommendations for the management of children and young people with IgA vasculitis: a best available evidence, group agreement-based approach - 2 month(s) ago
Objective IgA vasculitis (IgAV) is the most frequently experienced subtype of vasculitis seen in children. Most children fully recover, however, complications including chronic kidney disease are recognised. The aim of this project was to use a best available evidence, group agreement, based approach to develop national recommendations for the initial management of IgAV and its associated complications. Methods A fully representative multiprofessional guideline development group (GDG), consisting of 28 members, was formed and met monthly. Graded recommendations were generated using nationally accredited methods, which included a predefined scope, open consultation, systematic literature review, evidence appraisal, review of national or international guidelines and a period of open consultation. Audit measures and research priorities were incorporated. Results The IgAV GDG met over a 14-month period. A total of 82 papers were relevant for evidence synthesis. For the initial management,
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Mashup Score: 23
A 16-month-old boy presented with autoimmune haemolytic anaemia, thrombocytopenia and rashes. His older brother died at 8 months of age from meningitis. Their parents were non-consanguineous. He had a chest infection at 3 months of age, recurrent eczema from 6 months of age and pallor from 9 months of age. Examination revealed hepatosplenomegaly and generalised eczema plaques. Next-generation sequencing for a primary immunodeficiency identified a novel hemizygous missense variant in the WAS gene, c.219C>G (p.Cys73Trp). WAS protein expression was absent in his lymphocytes …
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Mashup Score: 7Disseminated cutaneous mastocytosis - 3 month(s) ago
A 13-day-old female baby presented with diffuse red-brown plaques and bullae over the whole body without diarrhoea or seizure. She was born at 39+3 weeks of gestation with a birth weight of 2460 g via spontaneous vaginal delivery. On physical examination, waxy, red-brown macules and indurated plaques were observed (figure 1), with scattered blisters (with arrow) and erosions. A positive Darier’s sign (characterised by histamine release …
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Mashup Score: 3Risky play: our children need more - 3 month(s) ago
Mary is running around her hospital bed, playing with dolls, crayons and toy stethoscopes (or the real thing if she can get her hands on one). She giggles mischievously, tripping and falling as she evades her mother’s playful swipes and our attempts to examine her. Mary is a regular source of joy on the morning ward round and seemingly a picture of health. That is of course, apart from the two large-bore cannulae exuding from her chest, plunged deep into her malfunctioning heart. Assisting with every contraction, she depends on her ‘Berlin Heart’ (a type of ventricular assist device) to deliver the majority of her systolic output. Mary has dilated cardiomyopathy and has been on the ward for several months now, awaiting a heart transplant. No one knows when this will come. All of you reading this article will have interacted with preschool-aged children and will be aware of how active they can and should be. You will also be aware of the challenges of keeping even a healthy child from i
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Mashup Score: 1Associations between maternal body mass index and childhood infections in UK primary care: findings from the Born in Bradford birth cohort study - 3 month(s) ago
Objective To explore associations between maternal body mass index (BMI) in early pregnancy and childhood infections. Design Birth cohort study linked to primary care records. Setting Bradford, UK. Participants Live singleton births within the Born in Bradford cohort study between 2007 and 2011. Exposures Maternal BMI in early pregnancy. Main outcome measures The total number of infections between birth and ~14 years of age with subgroup analysis by infection type and age. Results A total of 9037 mothers and 9540 children were included in the main analysis. 45% of women were of Pakistani ethnicity and 6417 women (56%) were overweight or obese. There was an overall trend for an increasing infection rate with increasing maternal BMI. In adjusted models, only those with obesity grade 2–3 had offspring with significantly higher rates of infection during the first year of life (RR 1.12 (95% CI 1.05 to 1.20)) compared with women of healthy weight. However, by age 5 to <15 years, children bor
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Mashup Score: 2Withdrawing or withholding treatment: Is there a distinction? - 3 month(s) ago
The common law provides helpful principles to follow when contemplating the withdrawal of medical treatment; paediatricians often seek guidance in these circumstances.1 The case of MB2 is particularly relevant; the judge, Holman J, engaged in detail with the facts of infant’s case, and demonstrated how a balancing exercise between risks and benefits of treatment can be formulated, while acknowledging future uncertainties. His approach could provide structure to medical decision-making. M was born in 2004 and was well for the first few weeks of his life. His parents then noticed he was increasingly floppy, and he was admitted to hospital in the seventh week of life. At the time of the hearing, now 18 months, there he remained. M had eventually been intubated and ventilated at 11 months of age, fed via gastrostomy. He had been diagnosed with type 1.1 spinal muscular atrophy (SMA). The court was told by an expert in the field that this was ‘…the most severe of all amongst those (children
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Mashup Score: 24Changes to the UK childhood immunisation schedule - 3 month(s) ago
### SUMMARY The immunisation schedule is designed to optimise protection from serious infectious diseases by providing individual direct protection and, where appropriate, sustained population-level control through herd immunity. Recommendations for each vaccine take into account the age-specific risk for a disease/infection (often early childhood), risk of complications, vaccine efficacy and the vaccine’s potential to reduce transmission.1 Passive protection of neonates and young infants is provided through …
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Review Flying with nut and other food allergies Allergic reactions during commercial air travel 10–100 times less common than when ‘on the ground’ https://t.co/yMd6Ex8Qtq https://t.co/L6EqU9ngqc