Impact of Prehospital Pain Management on Emergency Department Management of Injured Children.

OBJECTIVE: Provision of analgesia for injured children is challenging for Emergency Medical Services (EMS) clinicians. Little is known about the effect of prehospital analgesia on emergency department (ED) care. We aimed to determine the impact of prehospital pain interventions on initial ED pain scale scores, timing and dosing of ED analgesia for injured patients transported by EMS. METHODS: This is a planned, secondary analysis of a prospective multicenter cohort of children with actual or suspected injuries transported to one of 11 PECARN-affiliated EDs from July 2019-April 2020. Using Wilcoxon rank sum for continuous variables and chi-square testing for categorical variables, we compared the change in EMS-to-ED pain scores and timing and dosing of ED-administered opioid analgesia in those who did and those who did not receive prehospital pain interventions. RESULTS: We enrolled 474 children with complete prehospital and ED pain management data. Prehospital interventions were performed on 262/474 (55%) of injured children and a total of 88 patients (19%) received prehospital opioids. Children who received prehospital opioids with or without adjunctive non-pharmacologic pain management experienced a greater reduction in pain severity and were more likely to receive ED opioids in higher doses earlier and throughout their ED care. Non-pharmacologic pain interventions alone did not impact ED care. CONCLUSIONS: We demonstrate that prehospital opioid analgesia is associated with both a significant reduction in pain severity at ED arrival and the administration of higher doses of opioid analgesia earlier and throughout ED care.

[Charcot-Marie-Tooth disease associated with hip dysplasia in an adolescent]. / Dysplasie de hanche de l'adolescent et maladie de Charcot-Marie-Tooth.

Charcot-Marie-Tooth disease (CMT) is classified into hereditary motor and sensory neuropathy and can induce severe neuro-orthopaedics deformities, disabling at an early age. Hip dysplasia is present in 6% of CMT patients affecting preferentially CMT1 patients and can appear from the age of 8 years. The pathophysiological is paradoxical because we are confronted with proximal osteoarthritis deformations but genetics research brings use new trail. The main functional complaint is a hip joint pain during walking. Four orthopaedics abnormalities can be revealed by physical and radiological exam: acetabular dysplasia, femoral dysplasia, high femoral antetorsion and excentric head of femur. The natural evolution, in the absence of treatment, is an early secondary osteoarthritis. The therapeutic management should be as early as possible with preventive measures and joint health. During the symptomatic phase, the only treatment is a surgical correction. A systematic clinical examination of the hip all CMT children and a radiograph of the pelvis at the slightest clinical suspicion is recommended.

A survey of US and Canadian hospitals' paediatric massive transfusion protocol policies.

BACKGROUND: Trauma is the leading cause of death in children >1 year of age, with haemorrhage as the most common cause of medically preventable deaths. While massive transfusion protocols (MTPs) have been investigated and used in adults to reduce death from haemorrhage, there are a paucity of published data on MTP practices and outcomes in children. This study aimed to survey current MTP policies and the frequency of activation at paediatric care centres. STUDY DESIGN AND METHODS: We conducted a survey of MTPs at hospitals in the United States and Canada, including children's general hospitals, children's specialty hospitals and children's units in general hospitals. We collected information on how the MTP is activated, what therapeutics are given, frequency of its use, and how it is audited for compliance. RESULTS: Forty-six survey responses were analysed. Physician discretion was the most common activation criteria (89%). A majority of sites (78%) targeted a 'high' (≥1 : 2) ratio of plasma to red blood cells (RBC). Fifteen percent of sites use antifibrinolytics in their MTPs. Eighty nine percent of sites have type-O RBC units and 48% of sites had thawed plasma units stored in an immediately available location. CONCLUSION: There is a wide variation in MTPs among paediatric hospitals with regard to both activation criteria and products administered. This underscores the need for future prospective studies to determine the most effective resuscitation methods for paediatric populations to improve outcomes and therapeutic safety for massive bleeding.

[A glomus tumor of the toe: a pediatric case report]. / Une tumeur glomique de l'orteil : une observation pédiatrique.

SUMMARY: A glomus tumour of the third toe is quite rare in children. The authors report a clinical observation based on a misdiagnosis due to insufficient investigations, which led to a mistaken referral to a pediatric psychiatrist. Preoperative diagnosis requires a targeted MRI. Complete resection of the tumor results in an immediate resolution of the pain.

Development of cell lines from the sheep used to construct the CHORI-243 Ovine BAC library.

Two cell lines, designated MARC.OVSM, and MARC.OKF, were initiated from the aorta and kidney, respectively, obtained from the Texel ram used to make the CHORI-243 Ovine BAC library. These cell lines have been submitted to the NIA Aging Cell Repository at the Coriell Cell Respositories, Camden, NJ, USA, and will be made publicly available.

Hirschsprung disease in an infant with a contiguous gene syndrome of chromosome 13.

Hirschsprung disease is a developmental disorder resulting from the arrest of the craniocaudal migration of enteric neurons from the neural crest along gastrointestinal segments of variable length; see Behrman [Nelson textbook of pediatrics, 1992:954-956]. It is a heterogeneous disorder in which familial cases map to at least three loci whose function is necessary for normal neural crest-derived cell development. Homozygous mutations in the endothelin-B receptor gene (EDNRB) on 13q22 have been identified in humans and mice with Hirschsprung disease type 2 (HSCR2). The auditory pigmentary disorder, Waardenburg-Shah syndrome, comprises Waardenburg syndrome and Hirschsprung disease and has also been mapped to the EDNRB locus. Hirschsprung disease, malrotation, isochromia, a profound sensorineural hearing loss, and several other anomalies were found in an infant with an interstitial deletion of 13q, suggesting the existence of a contiguous gene syndrome involving developmental genes necessary for the normal growth of the neural crest derivatives of the eye, inner ear, and colon. We report on an additional patient with a deletion in 13q and Hirschsprung disease. Congenital anomalies associated with deletions of the distal long arm of chromosome 13 are sufficiently consistent to suggest a clinical syndrome.

[Industrial progress concerning latex allergy in surgery]. / Les avancées de l'industrie face à l'allergie au latex en milieu chirurgical.

Latex allergy has been well described in the literature, but it remains a constant worry for high-risk groups. We wish to show that the manufacturing industry has made real progress in response to this iatrogenic pathology. The high-risk groups are defined, in addition to the allergies with which they are associated: foodstuffs, ethylene oxide, airborneallergens. The criteria necessary to have available high-quality sterile surgical gloves are stated: they must be either hypo-allergenic or non-allergenic dependent upon the circumstances of use, they must guarantee protection against the transmission of infection and allow the medical practitioner complete freedom of movement. In the same way urinary catheters for intermittent probing, penile sheaths and condoms are mentioned. Powder must definitely be eliminated from any medical glove, because it can both be a vector for latex particles and can be the cause of granulomas in the abdominal cavity. The European Community standards (CE) and the recommendations of the American Associations of Allergology are explained. Sterilization by gamma irradiation is one sign of real progress, outperforming ethylene oxide which is too allergenic. The composition of the gloves must ensure an effective barrier against both allergens and infections. Pre-lubricated latex-free urinary catheters, penile sheaths and latex-free condoms represent substantial improvements for the population at risk. Since 1995 considerable progress has been made by the manufacturing industry in response to the needs of both allergologists and surgeons.

[Is the asthmatic child able to play sports?]. / L'enfant asthmatique peut-il faire du sport?

Three pathologies can be induced by exercise in asthmatic children: anaphylaxis, urticaria, asthma. Exercise induced anaphylaxis and urticaria are rare conditions. Exercise induced asthma can be prevented by treatment such as cromolyn sodium, nedocromil, beta 2 agonists or a combination of two of these products. Re-adaptation programmes can be set up to raise the point of outbreak of bronchospasm. Despite these possible exercise induced pathologies, regular exercise has many advantage for the asthmatic children (such as improved well being, sociability and cardio-respiratory functions) and must be encouraged. The choice of sport activities must be envisaged with the child, taking into account the various aspects of prevention of exercise induced pathologies.

Regional mapping panels for human chromosomes 1, 2, and 7.

The NIGMS Human Genetic Cell Repository has assembled regional mapping panels for human chromosomes 1, 2, and 7 from human rodent somatic cell hybrids submitted to the collection by researchers from 14 different laboratories. All hybrids were characterized initially by the submitters and verified by the Repository. Each hybrid carries a stable defined human segment as a derivative or deletion chromosome. These panels define 8-10 intervals for each chromosome. The panel for chromosome 2 is a new resource. The panels for chromosomes 1 and 7 complement previously published panels. The Repository distributes these regional mapping panels as cell cultures or as DNA. Information about these panels as well as for panels for chromosomes 3, 4, 5, 6, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 21, 22, 22, and X may be viewed in the NIGMS Repository electronic catalog (http://locus.umdnj.edu/nigms).

Upstaging of non-Hodgkin's lymphoma in a child based on 67Gallium scintigraphy.

PURPOSE: To describe a patient whose non-Hodgkin's lymphoma (NHL) appeared to be localized by standard modalities but who was upstaged after Gallium scintigraphy suggested disseminated disease. PATIENT AND METHODS: A patient with biopsy proven NHL in the maxillary sinus was staged as having localized disease based on computed tomography (CT) scans, bone scintigraphy, and evaluation of bone marrow and spinal fluid. Open biopsy of a bony lesion, standard modalities for lymphoma staging, and Gallium scintigraphy were obtained. RESULTS: Gallium scanning showed bony lesions not previously seen with the standard modalities. Open biopsy of one of these lesions confirmed disseminated disease. CONCLUSIONS: Gallium scanning aids in the early identification of metastases in some patients with NHL and should be included in a standard evaluation of apparently localized disease.

Complete replication of human sperm genome in egg extracts from Xenopus laevis.

To examine the ability of Xenopus egg extracts to support a complete replication cycle of human sperm genome, demembranated human spermatozoa were incubated with the extract from activated Xenopus laevis eggs. Most sperm heads were decondensed within 15 min. The heads became round within 30 min with diameters of 10-30 microns. The process of DNA replication in the pronuclei was monitored by two methods, bromodeoxyuridine incorporation and flow cytometry. The results indicate that DNA replication was initiated approximately 1.5 h after membrane structure formation and that it lasted up to 9 h. The amounts of DNA in most pronuclei were doubled by 4-9 h, depending on which donor toad was the source of the egg extract. Inclusion of the protein synthesis inhibitor, cycloheximide (100 micrograms/ml), had no obvious effect on human sperm DNA replication but appeared to prevent the pronuclei from degradation after a prolonged period (> 6 h) of incubation. After storage in liquid nitrogen for > 1.5 mo, the efficiency of the egg extracts in supporting sperm head decondensation and DNA replication was reduced for human sperm but not for Xenopus sperm. Possible applications of the use of Xenopus egg extract for human sperm activation and DNA replication are discussed.

Idiopathic thrombocytopenic purpura presenting in a high school football player: a case report.

OBJECTIVE: To alert athletic trainers to the signs and symptoms of idiopathic thrombocytopenic purpura and its clinical presentation in order to facilitate immediate intervention. BACKGROUND: Idiopathic thrombocytopenic purpura (ITP), also known as immune thrombocytopenic purpura, is a hemorrhagic disorder that is primarily immunologic in origin but is sometimes triggered by viral infection in children. It has also been associated with heroin and quinine drug use. A reduced platelet count can result in mucosal or deep tissue bleeding, or both, and most importantly, intracranial bleeding. Because football is a collision sport, it is imperative that any player presenting with ITP-type symptoms be removed immediately from all contact and referred to a physician. DIFFERENTIAL DIAGNOSIS: Leukemia, aplastic anemia, drug side effects, vitamin deficiency, kidney failure, infection, multiple contusions. TREATMENT: The traditional first-line treatment consists of corticosteroid medication and time and removal from all physical activities until the blood platelet count is normal and controlled. In quinine-induced ITP, discontinuation of the drug and bedrest are recommended to reduce the risk of major hemorrhage for a 12-to 14-hour period in order to allow the quinine to clear the system and the platelet count to return to normal. UNIQUENESS: ITP's presentation needs to be differentiated from other disorders. Incorrect diagnosis could seriously jeopardize the athlete, who could develop intracranial and internal bleeding. CONCLUSIONS: Recognition of the signs and symptoms associated with ITP is essential to prevent further participation by the athlete. Immediate intervention is needed to determine the severity and to institute appropriate treatment.