Reducing the exposure of the tonsillar fossa does not impact postoperative pain levels in children undergoing tonsillectomy: A double-blind randomized controlled trial

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Marco Aurélio Fornazieri, Edson Satoshi Miyazato, Henrique Massamiti Yamamoto, Paulo de Lima Navarro, Fábio de Rezende Pinna, Richard Louis Voegels
BackgroundIt is not established whether reducing the exposure of the tonsillar fossa would be an effective strategy for postoperative pain relief among the pediatric population submitted to tonsillectomy. We assessed the impact of closing this region using absorbable sutures on pain, on the resumption of normal diet and on the healing process until seven days after surgery.MethodsRandomized, double-blind, controlled trial comparing postoperative pain in 132 children between the ages of 5 and 12 years undergoing tonsillectomy having bilateral closure, unilateral closure or non-closure of the tonsillar fossa.ResultsNo differences in pain levels were reported both at discharge and on postoperative day 7. The day of resumption of normal diet was similar in all patients. Less granuloma and edema of the uvula were noted in patients with non-closure of the tonsillar fossa.ConclusionThese results showed that reducing the exposure of the tonsillar fossa after the removal of the palatine tonsils was not an effective method for postoperative pain relief in children. Moreover, its closure was associated with slower healing.



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Infection of the spheno-occipital synchondrosis: A morbid complication following adenoidectomy

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Amy E. Wagenaar, David M. Mirsky, Nicholas V. Stence, Todd M. Wine, Kenny H. Chan
Two 2-year-old males presented post-operatively following adenoidectomy with persistent fever and neck stiffness. After multiple office visits, both patients were admitted and found to have a widened spheno-occipital synchondrosis and other imaging findings indicative of skull base osteomyelitis. Treatment with antibiotics allowed for recovery with good long-term outcomes. Infection involving the spheno-occiptal synchondrosis is rare and its circuitous presentation of these two children no doubt led to delayed diagnosis.



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Appraisal of comparative single-case experimental designs for instructional interventions with non-reversible target behaviors: Introducing the CSCEDARS (“Cedars”)

Publication date: Available online 28 May 2018
Source:Research in Developmental Disabilities
Author(s): Ralf W. Schlosser, Phillip J. Belfiore, Jeff Sigafoos, Amy M. Briesch, Oliver Wendt
Evidence-based practice as a process requires the appraisal of research as a critical step. In the field of developmental disabilities, single-case experimental designs (SCEDs) figure prominently as a means for evaluating the effectiveness of non-reversible instructional interventions. Comparative SCEDs contrast two or more instructional interventions to document their relative effectiveness and efficiency. As such, these designs have great potential to inform evidence-based decision-making. To harness this potential, however, interventionists and authors of systematic reviews need tools to appraise the evidence generated by these designs. Our literature review revealed that existing tools do not adequately address the specific methodological considerations of comparative SCEDs that aim to compare instructional interventions of non-reversible target behaviors. The purpose of this paper is to introduce the Comparative Single-Case Experimental Design Rating System (CSCEDARS, "cedars") as a tool for appraising the internal validity of comparative SCEDs of two or more non-reversible instructional interventions. Pertinent literature will be reviewed to establish the need for this tool and to underpin the rationales for individual rating items. Initial reliability information will be provided as well. Finally, directions for instrument validation will be proposed.



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The ADHD rating scale-IV preschool version: Factor structure, reliability, validity, and standardisation in a Danish community sample

Publication date: Available online 28 May 2018
Source:Research in Developmental Disabilities
Author(s): Julie Lysdal Alexandre, Anne-Mette Lange, Niels Bilenberg, Anne Mette Gorrissen, Natasja Søbye, Rikke Lambek
BackgroundADHD is a debilitating disorder with symptoms often appearing in early childhood. To facilitate early identification, developmentally appropriate and validated assessment tools for the preschool-age are needed.AimsThe current study aims to examine the psychometric properties of the ADHD Rating Scale (RS)-IV Preschool Version (-P) in a Danish community sample and provide national standardisation data.Methods and proceduresParents (n = 916) and kindergarten teachers (n = 275) of preschool children, aged 3–5 years, completed the ADHD RS-IV-P.Outcomes and resultsConfirmatory factor analysis indicated that a three-factor model (inattention, hyperactivity, and impulsivity) best fit the data regardless of rater. Scales generally showed acceptable internal consistency, test-retest reliability, inter-rater reliability, and criterion validity. Boys received higher ratings on the ADHD RS-IV-P than girls and younger preschool children were rated as more inattentive than older preschool children.Conclusions and implicationsOur findings support the reliability and validity of the ADHD RS-IV-P and a three-factor model of ADHD. However, high factor correlations and similarity in model fit suggest that more research is needed to clarify the organisation of ADHD symptoms in preschool children. Furthermore, the external validity of separate ADHD dimensions at this age should be examined.



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Executive function in school-aged children with cerebral palsy: Relationship with speech and language

Publication date: Available online 28 May 2018
Source:Research in Developmental Disabilities
Author(s): Ashley Sakash, Aimee Teo Broman, Paul J. Rathouz, Katherine C. Hustad
Background and AimsAlthough children with cerebral palsy (CP) are at an increased risk for developing speech, language, and executive function (EF) impairments, little is known regarding the relationship among these risk factors. The current study examined how different profiles of speech and language impairment might be associated with impairments in EF skills in school-aged children with CP.Methods and ProceduresForty-seven school-aged children with CP were included. Each child contributed between one and four data points for a total of 87 data points. Children were classified into speech and language profile groups at each data point. EF skills were examined using the Behavior Rating Inventory of Executive Function questionnaire. Outcomes and Results. Compared to a mean of 50 from a normative population of children, mean scores on all measures of EF were significantly elevated for all groups (p<.05). The proportion of children with CP with elevated EF scores was significantly higher for all groups compared to the expected proportion in a normal population of children (p<.05).Conclusions and ImplicationsChildren with CP who do not have impairments in speech or language may be at risk for EF difficulties which may negatively affect social communication, academic performance, and functional independence.



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Chronic Rhinosinusitis in Children: Pathophysiology, Evaluation, and Medical Management

Abstract

Purpose of Review

Pediatric chronic rhinosinusitis (CRS) is a common disorder that carries significant morbidity. The diagnosis requires sinus symptoms that persist despite standard medical therapy greater than 3 months. Viral infections, allergies, and anatomic differences in children lead to chronic obstruction of the osteomeatal complex.

Recent Findings

Chronic rhinosinusitis as a diagnosis is a conglomeration of multiple phenotypes and endotypes. As such, the diagnosis and management are complex. New survey studies provide some consensus on prevalence and management of this disease in children.

Summary

In this review, we highlight the differential diagnosis of pediatric CRS, including non-eosinophilic/infectious variants, eosinophilic variants with and without nasal polyps, allergic fungal sinusitis, aspirin-exacerbated respiratory disease, primary immunodeficiency, and disorders of mucociliary clearance. Further, we detail treatment options that should be considered. Finally, we feature emerging potential treatment options of CRS, including anti-immunoglobulin E, interleukin-5, and interleukin-4 receptor alpha subunit.

https://ift.tt/2kwGbkz

Role of innate immune system in the pathogenesis of ankylosing spondylitis

Publication date: September 2018
Source:Biomedicine & Pharmacotherapy, Volume 105
Author(s): Negar Vanaki, Saeed Aslani, Ahmadreza Jamshidi, Mahdi Mahmoudi
Ankylosing Spondylitis (AS) is a debilitating rheumatic disease that gives young adults a severe form of arthritis with pain and stiffness in the axial skeleton. After the discovery of Human leukocyte antigen B27 (HLA-B27), several hypotheses have been suggested to uncover the exact etiology of AS. The tendency of HLA-B27 to form unusual structures results in recognition and activation of crucial components in innate immune system. Moreover, cellular and soluble arms of the innate response are frequently observed within the affected tissues. Genome-wide analysis has also shown the association of several innate immune-related pathways and cytokines, which act as the effective therapeutic targets in AS. Given the importance of innate immune system, we present a general overview of innate immune components and their involvement in the pathogenesis of AS. In our belief, this kind of explanation can hopefully provide new perspectives for diagnosis and treatment of these patients in the future.



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