Browsing by Subject "paediatric"

Now showing 1 - 4 of 4
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    A review of childhood vestibular disorders
    (2010) Rogers, Christine
    Diagnosis of disorders of balance is challenging, as there are broad differentials and patients may present to a variety of healthcare practitioners, ranging from an audiologist to a psychiatrist. In addition, investigations, both at the bedside and laboratory, are often non-contributory, expensive and unpleasant. The adult dizzy patient is regarded with dread by many in the healthcare community: the patient is difficult to diagnose and challenging to treat, and the situation is frequently complicated by the presence of anxiety, panic and depression. When symptoms arise in childhood they cause alarm in the parents and the treating healthcare professional. Diagnosis and management of balance disorders in childhood, is even more demanding when patients are frequently unable to communicate the nature of the complaint. Furthermore, the aetiology and presentation of vestibular disturbance is markedly different between adults and children. Symptoms of vestibular disorders in children may easily be mistaken for behavioural or other medical problems, leading to under-diagnosis and inappropriate investigations and treatment. Detrimental effects of childhood vestibular disorders may include delayed gross motor development, learning and spatial problems, and time off school. This review summarises the most common causes of childhood vestibular disorders and suggests the need for a multidisciplinary approach to assessment.
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    Childhood Asthma
    (South African Academy of Family Physicians, 2011) Levin, M; Weinberg, E
    Asthma is the most common chronic disease of South African children, affecting growth and development and quality of life. Features supporting the diagnosis are a family or personal history of atopy, night cough, exercise-induced cough and/or wheeze and seasonal variation in symptoms. Asthma is on the increase in both developed and developing countries, in both rural and urban communities. The first part of this series aims to give a brief overview of the epidemiology, pathophysiology and diagnosis of childhood asthma.
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    Current practice of air medical services in inter-facility transfers of paediatric patients in the Western Cape Province South Africa
    (Health and Medical Publishing Group, 2014) Howard, I L; Welzel, T B
    Objective. To describe the utilisation and safety of air medical services (AMS), when being used for inter-facility transfers of paediatric patients in the Western Cape Province, South Africa. Methods. A retrospective descriptive analysis was conducted for the time period January 2010 to December 2011. Data were recorded from the Cape Town base of the AMS provider for the Western Cape Provincial Department of Health Emergency Medical Services. Patient demographics, flight and transfer details, interventions performed and adverse events encountered were documented for all patients <13 years of age transferred by either helicopter or fixed-wing aircraft. Results. A total of 485 patients was analysed. More patients were transported by helicopter (n=263, 54%), with neonates making up the largest category for both modes of transfer. Respiratory (29%), neurological (18%), cardiac (14%) and gastrointestinal disorders (14%) made up the majority of non-traumatic reasons for transfer. Overall, transfers by helicopter were quicker (median mission time 03:00; interquartile range 02:32 - 03:25) compared with fixed-wing transfer (05:24; 04:22 - 06:20). The overall incidence of adverse technical events was relatively high (20%). Physiological adverse events ranged between 2% and 16% overall depending on the variable measured. The incidence of cardiac/respiratory arrest and endotracheal tube obstruction/dislocation was low (<2%). Emergency intubation and desaturation >10% from baseline were the most common critical adverse events encountered (6%). Conclusion. Current utilisation of the AMS for paediatric inter-facility transfer is relatively high, at ~25%. Across both the helicopter and fixed-wing platforms, patients with a diverse range of pathologies of equally varying severities were transferred. The adverse events observed were found to be lower than those of trials examining non-specialised paediatric transfer, and were comparable to those seen with transfer by specialised paediatric retrieval teams. The AMS remain a safe and viable alternative to non-specialised paediatric transfer, and may serve as a potential alternative to specialised paediatric transfer in the Western Cape.
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    “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes
    (2019) Swan, Adrian Kenneth; Dunn, Robert N
    Background: The paediatric craniocervical junction has anatomical, physiological and biomechanical properties that make this region unique to that of the adult spine, vulnerable to injury, and contribute to the complexity of management. Traditionally, on-lay fusion with external Halo immobilisation has been used. Instrumented fusion offers intra-operative reduction and immediate stability. Methods: A retrospective review of a single surgeon’s prospectively maintained database was conducted for all cases of paediatric patients that had undergone a fusion involving the occipito-atlanto-axial region. Case notes were reviewed and a radiological analysis was done. Results: Sixteen patients were managed with on-lay fusion and external immobilisation and twentyseven patients were managed with internal fixation using screw-rod constructs. The fusion rates were 80% and 90.5% respectively. Allograft bone grafting was found to be a significant risk factor for non-union. Conclusion: The screws can be safely and predictably placed as confirmed on radiological follow-up with a high fusion rate and an acceptable complication rate. Uninstrumented onlay fusion with Halo immobilization remains an acceptable alternative. Allograft in the form of bone croutons or demineralised bone matrix is a significant risk factor for non-union and posterior iliac crest graft should be used preferentially.