March 2019 PDF published

Part 2 of Medically Unexplained Symptoms this month.  Also antibiotics in cystitis, too many investigations in community acquired pneumonia, carotenaemia and heart murmurs in unwell children.  Do leave comments below:

February 2019 newsletter

NICE on honey this month.  And antibiotics in URTIs.  Also blueberry muffin syndrome courtesy of our dermatology contributor, medically unexplained symptoms from a great on line resource from MindEd (https://www.minded.org.uk/Component/Details/525083) and information for practitioners and young people and families after a first afebrile seizure.  Please do leave comments below:

January 2019 newsletter

Genetics this month and an explanation of the microarray test.  Managing measles contacts in the “lessons from the front line” section, use of a smartphone app for recording palpitations and the start of a new dermatology series – skin manifestations of systemic disease.  Do leave comments below.

December 2018 PDF

Christmas disease this month, acute psychosis in children, an Emoji guide to the workings of the facial nerve, sleep hygiene and the start of a 2 part series on measles.  Happy New Year and do leave comments below!

November 2018 published

STIs, sexual abuse, eating disorder and haemolytic uraemic syndrome this month.  Do leave comments below:

Haemolytic Uraemic Syndrome (HUS)

With thanks to Dr David Gardiner, one of our current paediatric FY2 doctors at Homerton University Hospital, for updating us on HUS.

News story in 1999

News story from 2018.  Less than 3% of patients die of HUS but 20-30% experience adverse renal outcomes.  Think about it in children with bloody diarrhoea and, often, no fever.

Presentation:

  • Profuse diarrhoea that typically turns bloody after 1-3 days
  • Abdominal pain (crampy)
  • Vomiting
  • Fever (sometimes)
  • Oedema
  • Reduced urine output (abrupt onset) but also polyuria/normal urine output (rarer)
  • Neurological complications: seizure, coma, cranial nerve palsies, confusion, hallucinations
  • Classic triad – anaemia, uraemia and thrombocytopaenia
  • Most common in children under the age of 5

Investigations:

  • B/P – hypertension
  • Blood film: Fragmentation and signs of haemolysis (Coombs test negative)
  • Raised WCC and neutrophils, low platelets, low Hb
  • Raised LDH
  • Clotting screen typically normal (cf DIC)
  • Raised bilirubin, low albumin
  • Urea and creatinine raised
  • Stool for PCR E.Coli

Management:

  • Refer to secondary care urgently
  • Strict input/output fluid monitoring
  • Correction of anaemia
  • Correction of electrolyte imbalances
  • Antihypertensive therapy if required
  • Dialysis
  • Furosemide to induce diuresis
  • Report to PHE – can’t go back to school until 2 negative stool samples

More resources:

Kidney Research website on HUS

https://patient.info/doctor/haemolytic-uraemic-syndrome-pro#ref-8

October 2018 newsletter

This month brings a handout entitled “Towards a healthy lifestyle…” which is a collaboration between dietitians, physiotherapists, psychiatrists and paediatricians at Homerton Hospital.  We have found many families are keen to do something about their child’s weight but don’t know where to start.  Hopefully this friendly article aiming for families to be “healthy enough” is a good place to start.

Also a bit on faltering growth, on-line safety, BRUE and the investigations that do not need to be done.  Tachycardia is (of course) mentioned again.  Do leave comments below.

September 2018 PDF content

September’s newsletter reminds us of the CPD requirements for child safeguarding for all of us, warns us of the dangers of missing Kawasaki Disease, talks about PHE’s #askaboutasthma campaign and describes the differences between fever and sepsis.  Do leave comments below:

Rhinitis Guidelines Updated

Updated rhinitis guideline (2017) from the British Association of Allergy and Clinical Immunology http://www.bsaci.org/Guidelines/rhinitis-2nd-edition-guideline

  • Allergic rhinitis is common and affects 10–15% of children and 26% of adults in the UK
  • Affects quality of life, school and work attendance, and is a risk factor for development of asthma.
  • Diagnosed by history and examination, supported by specific allergy tests.
  • Topical nasal corticosteroids are the treatment of choice for moderate to severe disease
  • Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy
  • Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms
  • Treatment of rhinitis is associated with benefits for asthma
  • Non-allergic rhinitis also is a risk factor for the development of asthma
  • Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous / eosinophilic polyangiitis, sarcoidosis

August 2018 uploaded

August brings more returning travellers, this time with dengue fever.  Also adolescent sleep problems, adverse childhood experiences (ACEs), an update on rhinitis and the neurological effects of rotavirus.  Do leave comments below.