Atoms
Northern Pakistan: 240727 The view today from Islamabad airport is muddy, hardly a vindication of the decision to fly to the Karakoram heartland but given the seasonal lashing the highway tarmac en route for the K2 hinterland has endured and the inevitable subsequent landslides, might, after all still prove to be the right one. We’ll be joined by several young children, some en route for a few days’ Himalayan air experience with their parents, some travelling back to their bucolic hillside homes. All, quite rightly, curious about everything in their surrounds and innocent to the outside world has to offer. In some way, they, or their as yet unborn siblings, could all be affected at some point in their lives by the themes my selections this month describe so articulately. Toxic shock However good the existing observational data, however meticulously the confounding is addressed, there are...
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Understanding and managing emotional distress on the paediatric ward
We are witnessing a concerning increase of young people in mental health crisis, needing paediatric admissions. Vázquez-Vázquez et al’s1 timely and necessary review of the literature focuses on how services can transform to meet the needs of this troubled population. Thirty-two studies are analysed, highlighting rates of admissions, lack of professional preparedness, and the as-yet limited focus on the lived experience of young people and families. The need for better interagency working is emphasised. What is the problem? Rates of childhood distress have been increasing for some time, with a significant statistical rise in the prevalence of diagnosable anxiety and depression. Children presenting to hospital are in fact the tip of the iceberg; certainly the most visible, but neither the majority, nor even the most complex of ‘CAMHS (Child and Adolescent Mental Health Services)’ patients, many of whom are suffering in relative silence, in the community. ...
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Use of intravenous immunoglobulin in toxic shock syndrome
It is now nearly 50 years since the description of staphylococcal toxic shock syndrome (TSS) in children by James Todd in 1978.1 Streptococcal TSS-like syndrome was first reported in 1987.2 TSS is now known to be caused by toxin-producing strains of Staphylococcus aureus and Groups A, C and G Streptococci, although several other organisms have also been associated with TSS. It has subsequently become clear that this rare syndrome with high morbidity and mortality is due to a superantigen (SAg)-mediated process causing massive lymphocyte activation with uncontrolled cytokine release causing the clinical features which are well described. SAgs produced by these organisms bind to major histocompatability complex (MHC) class II receptors on antigen presenting cells and interact with T cells via the T-cell receptor Vβ chain, inducing MHC-unrestricted T-cell activation and proliferation. The released cytokines, including interferon-, rapidly induce the release of tumour necrosis factor...
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Addressing common questions on food oral immunotherapy: a practical guide for paediatricians
Food allergy has been increasing in prevalence in most westernised countries and poses a significant burden to patients and families; dietary and social limitations as well as psychosocial and economic burden affect daily activities, resulting in decreased quality of life. Food oral immunotherapy (food-OIT) has emerged as an active form of treatment, with multiple benefits such as increasing the threshold of reactivity to the allergenic food, decreasing reaction severity on accidental exposures, expanding dietary choices, reducing anxiety and generally improving quality of life. Risks associated with food immunotherapy mostly consist of allergic reactions during therapy. While the therapy is generally considered both safe and effective, patients and families must be informed of the aforementioned risks, understand them, and be willing to accept and hedge these risks as being worthwhile and outweighed by the anticipated benefits through a process of shared decision-making. Food-OIT is a good example of a preference-sensitive care paradigm, given candidates for this therapy must consider multiple trade-offs for what is considered an optional therapy for food allergy compared with avoidance. Additionally, clinicians who discuss OIT should remain increasingly aware of the growing impact of social media on medical decision-making and be prepared to counter misconceptions by providing clear evidence-based information during in-person encounters, on their website, and through printed information that families can take home and review.
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