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Mashup Score: 10Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing - 5 day(s) ago
Atopic dermatitis, also known as atopic eczema, is the most common chronic inflammatory skin condition in children. The onset of the disease commonly presents by 5 years of age, with approximately 45% of children developing symptoms within the first 6 months of life. The skin of individuals with atopic eczema is more frequently colonised with Staphylococcus aureus bacteria compared with those without eczema,1 making the skin lesions more readily susceptible to infection. The management of atopic eczema in children is largely conducted in primary care settings. However, handling flare-ups and addressing secondary bacterial infections can pose a significant challenge for healthcare professionals. ### Information about the current guideline The guideline update, NG (190), on secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing was published by the National Institute for Health and Care Excellence in March 2021 box 1.2 It has updated and repla
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Mashup Score: 9Drug-induced liver injury in children - 8 day(s) ago
### Key points An adolescent boy presents to the emergency department after being unwell for 2 days with vomiting and abdominal pain. His clinical examination is normal except for scleral icterus. Blood tests reveal total serum bilirubin of 27 µmol/L, direct bilirubin of 21 µmol/L, alanine aminotransferase (ALT) 261 IU/L, aspartate aminotransferase 210 IU/L, alkaline phosphatase (ALP) 309 IU/L, gamma-glutamyl transferase 117 IU/L (reference range,1 table 1). His full blood count, urea, creatinine and international normalised ratio (INR) are in the normal range. Drug history includes atomoxetine for attention deficit hyperactivity disorder for a year and flucloxacillin 3 weeks back for finger cellulitis. Are drugs the cause of his liver injury and if so which drug? View this table: Table 1 Reference range for blood tests in children (RCPCH)1 Drug-induced liver injury (DILI, box 1)2 is an adverse drug reaction (ADR) to prescription medications, herbal and dietary supplements and xenobiot
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Mashup Score: 5Neonate with a large neck mass - 14 day(s) ago
A male term infant, with polyhydramnios, was delivered by caesarean section. Family history included a sibling with Edward’s syndrome. He required non-invasive respiratory support at birth and was admitted to the neonatal unit. A raised occipital mass was noted (figure 1), measuring 8×6 cm, with central yellow pallor and surrounding margins of purple convoluted friable skin and overlying telangiectasia. There was a strong palpable pulse felt above the mass. Figure 1 Large neck swelling noted on base of occiput. The baby remained haemodynamically stable (admission blood pressure 69/37mmhg) with normal values for both haemoglobin (152 g/L) and platelet count (149×109/L). He was transferred to a tertiary hospital where ultrasound (USS) demonstrated a mass with high intralesional vascular flow (figure 2). MRI demonstrated a large congenital vascular anomaly within the posterior neck soft tissues and identified large feeding and draining vessels. Figure 2 B-mode ultrasound image …
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Mashup Score: 0Of oranges and lemons: you are what you eat - 15 day(s) ago
A young boy presented with increasing lower limb pain and swelling for a month. At the time of his hospitalisation, he was unable to walk. We report the patient’s clinical journey with clinical commentary throughout, highlighting the importance that uncommon diseases may be diagnosed with a high index of suspicion and thorough history taking.
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Mashup Score: 2Drug-induced liver injury in children - 15 day(s) ago
### Key points An adolescent boy presents to the emergency department after being unwell for 2 days with vomiting and abdominal pain. His clinical examination is normal except for scleral icterus. Blood tests reveal total serum bilirubin of 27 µmol/L, direct bilirubin of 21 µmol/L, alanine aminotransferase (ALT) 261 IU/L, aspartate aminotransferase 210 IU/L, alkaline phosphatase (ALP) 309 IU/L, gamma-glutamyl transferase 117 IU/L (reference range,1 table 1). His full blood count, urea, creatinine and international normalised ratio (INR) are in the normal range. Drug history includes atomoxetine for attention deficit hyperactivity disorder for a year and flucloxacillin 3 weeks back for finger cellulitis. Are drugs the cause of his liver injury and if so which drug? View this table: Table 1 Reference range for blood tests in children (RCPCH)1 Drug-induced liver injury (DILI, box 1)2 is an adverse drug reaction (ADR) to prescription medications, herbal and dietary supplements and xenobiot
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Mashup Score: 79Use of corticosteroids for croup in children - 17 day(s) ago
### Key points A 2-year-old child is brought to the emergency department with a barking cough, subcostal recessions and intermittent stridor. Concerned about the symptoms, their parents are asking for the best possible treatment to improve the symptoms and reduce the need for further treatment or admission. In any child presenting with stridor, it is important to consider a wide range of differentials (table 1).1 Croup (also called laryngotracheitis) is a common cause of stridor and upper airway obstruction in children aged 6–36 months.2 Croup usually occurs in the winter months and is most frequently caused by human parainfluenza virus types 1 and 2; less commonly, other respiratory viruses, such as respiratory syncytial virus, can also cause croup.2 Recently, SARS-CoV-2 has emerged as a cause and can often occur in an older demographic of children.3–6 Research involving large cohorts of children with croup has demonstrated that only a small proportion require hospital admission.1 6 T
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Mashup Score: 4Neonate with a large neck mass - 23 day(s) ago
A male term infant, with polyhydramnios, was delivered by caesarean section. Family history included a sibling with Edward’s syndrome. He required non-invasive respiratory support at birth and was admitted to the neonatal unit. A raised occipital mass was noted (figure 1), measuring 8×6 cm, with central yellow pallor and surrounding margins of purple convoluted friable skin and overlying telangiectasia. There was a strong palpable pulse felt above the mass. Figure 1 Large neck swelling noted on base of occiput. The baby remained haemodynamically stable (admission blood pressure 69/37mmhg) with normal values for both haemoglobin (152 g/L) and platelet count (149×109/L). He was transferred to a tertiary hospital where ultrasound (USS) demonstrated a mass with high intralesional vascular flow (figure 2). MRI demonstrated a large congenital vascular anomaly within the posterior neck soft tissues and identified large feeding and draining vessels. Figure 2 B-mode ultrasound image …
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Mashup Score: 2Fifteen-minute consultation: Approach to a child with congenital insensitivity to pain - 24 day(s) ago
The hereditary sensory and autonomic neuropathies (HSANs) are a group of rare genetic disorders characterised by variable phenotypic expression affecting both sensory and autonomic dysfunction. Diagnosing these conditions can be a challenge as the presenting symptoms can be diverse and may overlap. This often leads to a delay in referral and diagnosis. Pain is often used by clinicians as a marker for systemic diseases. The key feature of HSAN conditions is the absence of pain perception and its consequences such as unexplained injuries. When a child presents with an unexplained injury, a diagnosis of non-accidental injuries must be considered, but rarely HSAN could be a possibility. The diagnosis of HSANs in children is both important and rare. This article aims to discuss an approach to the diagnosis and management of HSANs.
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Mashup Score: 8
Mechanically ventilated neonates are prone to unplanned extubation (UE) or accidental extubation causing cardiorespiratory deterioration, hypoxia and need for resuscitation.1 Repeated reintubation may result in airway trauma, subglottic stenosis, prolonged ventilation, prolonged hospital stay and increased risk of infection.2 Studies have shown a variation in the rate of UE in neonatal intensive care unit (NICU) from 1.14 to 5.3 per 100 ventilation days.3 Reasons for the increased incidence of UE in neonates include longer duration of intubation, shorter neonatal tracheal length, less routine use of sedation, procedures such as suctioning, the use of uncuffed endotracheal tubes and the method of fixation due to fragile skin.4 Bedside activities such as weighing, kangaroo care, procedures like line placements, scans/imaging, phlebotomy and transportation of babies are potential risk factors for UE.3 5 UE is not uncommon in the NICU but we noticed multiple UEs in our NICU leading to re-i
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Mashup Score: 66Use of corticosteroids for croup in children - 27 day(s) ago
### Key points A 2-year-old child is brought to the emergency department with a barking cough, subcostal recessions and intermittent stridor. Concerned about the symptoms, their parents are asking for the best possible treatment to improve the symptoms and reduce the need for further treatment or admission. In any child presenting with stridor, it is important to consider a wide range of differentials (table 1).1 Croup (also called laryngotracheitis) is a common cause of stridor and upper airway obstruction in children aged 6–36 months.2 Croup usually occurs in the winter months and is most frequently caused by human parainfluenza virus types 1 and 2; less commonly, other respiratory viruses, such as respiratory syncytial virus, can also cause croup.2 Recently, SARS-CoV-2 has emerged as a cause and can often occur in an older demographic of children.3–6 Research involving large cohorts of children with croup has demonstrated that only a small proportion require hospital admission.1 6 T
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Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing Review of @NICEComms guideline https://t.co/qYZzGKVNnX