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Biomedical subjects

A M Oudesluys-Murphy

Publications and source records attributed to A M Oudesluys-Murphy.

At least 19 recordsLinked to original sources
PubMed2006

[A child presenting with fever and arthritis due to disseminated gonorrhoea].

A 12-year-old boy with Down's syndrome presented with fever, arthritis and petechiae. Investigations revealed the presence of disseminated gonorrhoea. The patient made a good recovery after antibiotic therapy. A contact investigation was carried out, as well as talks with the family and school, and the case was reported to the Child Abuse Advice and Report Centre. The gonorrhoea was found to be caused by incest. Sexual abuse should be suspected in every child (certainly over the age of 1 year) with a sexually transmitted disease.

Anti-Bacterial Agents↗
PubMed2005

[Aggression towards paediatricians and trainee paediatricians in the Netherlands].

OBJECTIVE: To determine the extent of aggression from the patient or his family to which paediatricians and trainee paediatricians in the Netherlands are exposed. DESIGN: Cross-sectional survey. METHOD: Data were collected using anonymous questionnaires distributed to doctors working in the field ofpaediatrics in the Netherlands during the annual congress of the Paediatric Association of the Netherlands in 2002. RESULTS: A total of 395 usable questionnaires were returned. 78% of the respondents reported that they had, at some time, been confronted with aggression. Verbal aggression was the most common form (75% of the respondents) and was experienced mainly by doctors with little work experience (63% in the preceding year). 20% of the respondents were aware of the existence of training programmes on dealing with aggression in their hospitals, whereas 47% said that they needed such training. CONCLUSION: Aggression in connection with paediatric care was reported by 78% of the respondents, especially verbal aggression directed at doctors with little work experience. Training on how to cope with aggression might be a useful addition to the paediatric curriculum.

Aggression↗
PubMed2004

Procalcitonin as an early marker of infection in neonates and children.

A child or neonate presenting with fever is a common medical problem. To differentiate between those with a severe bacterial infection and those with a localised bacterial or a viral infection can be a challenge. This review provides an overview of neonatal and paediatric studies that assess the use of procalcitonin as an early marker of bacterial infection. Procalcitonin is an excellent marker for severe, invasive bacterial infection in children. However, the use of procalcitonin in the diagnosis of neonatal bacterial infection is complicated, but if correctly used procalcitonin results in a higher specificity than C-reactive protein. In addition, procalcitonin has been shown to correlate with severity of disease (urinary tract infections and sepsis), and can therefore be used as a prognostic marker. Procalcitonin is therefore a useful additional tool for the diagnosis of bacterial disease in neonates and children.

Bacteremia↗
PubMed2003

[Turkish children with recurrent abdominal pain and fever: familial Mediterranean fever].

Four children of Turkish origin, three boys aged 12, 8 and 7 years, and a girl aged 5 years, presented with clinical symptoms of familial Mediterranean fever. They had the characteristic episodes of fever combined with abdominal pain, thoracic pain, general malaise or arthralgia. Familial Mediterranean fever is an autosomal recessive genetic disorder restricted to people originating from the Middle East. The causative gene (MEFV) and many missense mutations have been identified. The clinical syndrome is characterised by self-limiting febrile episodes accompanied by inflammation of the serous membranes, resulting in peritonitis, pleuritis or synovitis. In untreated patients systemic amyloidosis may develop, which manifests as renal insufficiency. The diagnosis is based on the characteristic medical history and is confirmed by DNA analysis. Meanwhile, treatment with colchicine can be started. This is effective in 90% of affected patients. Being aware of the prevalence of familial Mediterranean fever in immigrant populations can improve the quality of life and prevent long-term complications.

Abdominal Pain↗
PubMed2001

Randomised controlled study of clinical efficacy of spacer therapy in asthma with regard to electrostatic charge.

BACKGROUND: Inhalation therapy using a pressured metered dose inhaler (pMDI) and a spacer is frequently used in the treatment of airway disease in children. Several laboratory studies found a clear negative influence of electrostatic charge (ESC) on plastic spacers on the delivery of aerosol. AIMS: To investigate whether ESC on plastic spacers could diminish bronchodilating responses to salbutamol. METHODS: Ninety asthmatic children (aged 4-8 years) were randomised into three groups: metal Nebuchamber, plastic Volumatic, and plastic Aerochamber. The bronchodilating response was measured by the change in peak expiratory flow rate (PEF) after 100 microgram and 400 microgram salbutamol. Within the Volumatic and Aerochamber groups, a crossover comparison was made between electrostatic and non-electrostatic spacers. RESULTS: We found no significant effect of ESC on the bronchodilating response to salbutamol with any of the doses in the Aerochamber and Volumatic groups. For the plastic spacers, the mean difference of the change in PEF after 100 microgram salbutamol between non-electrostatic and electrostatic spacers was only +1.7% (95% CI -1.3% to 4.7%). After 400 microgram salbutamol this was +1.9% (95% CI -1.4% to 5.1%). A comparable efficacy was found for the Nebuchamber, the Aerochamber, and Volumatic with respect to the change in PEF after 100 and 400 microgram salbutamol. CONCLUSION: This study showed no negative influence of ESC on plastic spacers with regard to clinical efficacy of a beta(2) agonist (salbutamol) in children with asthma. The metal Nebuchamber, plastic Aerochamber, and plastic Volumatic were equally effective.

Administration, Inhalation↗
PubMed2001

Costs of different strategies for neonatal hearing screening: a modelling approach.

OBJECTIVE: To compare the cost effectiveness of various strategies for neonatal hearing screening by estimating the cost per hearing impaired child detected. DESIGN: Cost analyses with a simulation model, including a multivariate sensitivity analysis. Comparisons of the cost per child detected were made for: screening method (automated auditory brainstem response or otoacoustic emissions); number of stages in the screening process (two or three); target disorder (bilateral hearing loss or both unilateral and bilateral loss); location (at home or at a child health clinic). SETTING: The Netherlands TARGET POPULATION: All newborn infants not admitted to neonatal intensive care units. MAIN OUTCOME MEASURE: Costs per child detected with a hearing loss of 40 dB or more in the better ear. RESULTS: Costs of a three stage screening process in child health clinics are 39.0 pounds (95% confidence interval 20.0 to 57.0) per child detected with automated auditory brainstem response compared with 25.0 (14.4 to 35.6) pounds per child detected with otoacoustic emissions. A three stage screening process not only reduces the referral rates, but is also likely to cost less than a two stage process because of the lower cost of diagnostic facilities. The extra cost (over and above a screening programme detecting bilateral losses) of detecting one child with unilateral hearing loss is 1500-4000 pounds. With the currently available information, no preference can be expressed for a screening location. CONCLUSIONS: Three stage screening with otoacoustic emissions is recommended. Whether screening at home is more cost effective than screening at a child health clinic needs further study.

Audiometry, Evoked Response↗
PubMed2000

[Neonatal hearing screening].

Approximately 1 to 2 per thousand live-born infants suffer from a serious perceptive hearing loss. Normal hearing from birth is essential for optimal human development (language and speech, social and emotional development, communicative skills and learning). The earlier the hearing loss is diagnosed the better the prognosis for the infant with a hearing impairment. Suitable methods are now available for neonatal hearing screening: automated measurement of auditory brain stem response and measurement of oto-acoustic emissions. Screening must be viewed as only the first step in a program of diagnosis, treatment and habilitation of these children. The ultimate goal of the implementation of neonatal hearing screening is: identification of bilateral hearing losses before the age of 3 months and start of therapy and counselling before the age of 6 months.

Age Factors↗
PubMed2000

Spontaneous regression of clinical inguinal hernias in preterm female infants.

PURPOSE: This is a prospective study of 8 clinically apparent inguinal hernias in 7 preterm infant girls. METHODS: The diagnosis was made clinically and confirmed by ultrasonography, which also showed the contents of the hernia. RESULTS: One hernia contained an ovary, the other 7 intestinal loops. The hernias with only intestinal loops regressed spontaneously when the girls were between the ages of 2 and 6 months postpartum. This was confirmed by ultrasonography. At follow-up 2 to 6 years later there has been no recurrence. The hernia that contained the ovary did not regress, and hernia repair (confirming the presence of the ovary) was carried out uneventfully. CONCLUSIONS: The authors suggest that preterm infant girls with an inguinal hernia should have ultrasonography performed at presentation. Surgery probably will be required when the hernia contains structures such as an ovary. When the hernia contains only intestinal loops an expectant policy may be advisable. Larger studies are needed to validate these findings.

Female↗
PubMed2000

Inguinal hernias containing the uterus, fallopian tube, and ovary in premature female infants.

Inguinal hernias were diagnosed at 42 and 38 weeks' postconceptional age in 2 premature girls. The hernial sac contained the uterus, one Fallopian tube, and one ovary. The diagnosis was made by physical and sonographic examination and was confirmed during surgical correction. We suggest sonography in the diagnostic workup in (premature) female infants with an inguinal hernia.

Fallopian Tubes↗
PubMed1998

[Impediments to incubator home care in The Netherlands].

OBJECTIVE: To determine whether incubator home care is desirable and feasible. DESIGN: Inventory. SETTING: Four neonatal units representative of the type of care in general hospitals in the Netherlands. METHOD: The relevant data on all infants with a birth weight < or = 2000 g admitted in the last 3 months of 1996 to one of four hospitals were analysed. Conditions for incubator home care were determined (e.g. absence of need for special care, vital function monitoring or nasogastric tube feeding). RESULTS: Forty-nine infants were enrolled. Mean hospital stay was 28.7 days in an incubator plus 19.7 days in a cot. When infants were placed in a cot they usually still needed tube feeding and monitoring of vital functions and sometimes parenteral nutrition, medication or extra oxygen which made home discharge impossible. Therefore a pilot study of actual home care could not be carried out. CONCLUSION: Although early home discharge is very desirable for newborn infants, the number of infants eligible for incubator home care is so small that further attempts to organise it are not useful.

Feasibility Studies↗