Applying GRADE for diagnosis revealed methodological challenges: an illustrative example for guideline developers.

Objective: To identify challenges in the application of GRADE for diagnosis when assessing the certainty of evidence in the test-treatment strategy (diagnostic accuracy, test burden, management effectiveness, natural course, linked evidence) in an illustrative example and to propose solutions to these challenges.

Study Design And Setting: A case study in applying GRADE for diagnosis that looked at the added value of IgE for diagnosing allergic rhinitis.

Results: Evaluation of the full test-treatment strategy showed a lack of (high-quality) evidence for all elements.

Applicability of evidence from previous systematic reviews on immunotherapy in current practice of childhood asthma treatment: a GRADE (Grading of Recommendations Assessment, Development and Evaluation) systematic review.

Objective: Because most children with asthma now use inhaled corticosteroids (ICS), the added benefit of immunotherapy in asthmatic children needs to be examined. We re-assessed the effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) in childhood asthma treatment focusing on studies with patient-relevant outcome measures and children using ICS.

Methods: We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to systematically search and appraise the evidence using predefined critical patient-relevant outcomes (asthma symptoms, asthma control and exacerbations).

Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma.

Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.

[Dutch College of General Practitioners' practice guideline 'Asthma in children'].

In children < 6 years characteristic asthma patterns are often lacking and the diagnosis cannot be objectified. For this reason 'episodic expiratory wheezing' is the preferred diagnosis. In children ≥ 6 years asthma is diagnosed on the basis of symptoms; if there is doubt spirometry may be helpful.

Problematic severe asthma in children treated at high altitude: tapering the dose while improving control.

Background: Multidisciplinary treatment at high altitude is a possible treatment option for problematic severe asthma (PSA) in children. This management can result in the tapering of inhaled corticosteroids.

Aim: Our aim was to analyze the effect of multidisciplinary treatment at high altitude, notably the ability to taper corticosteroids.

[A boy with a cough and shoulder pain].

A 15-year-old boy reported to the Accident and Emergency Department with excessive coughing, shortness of breath and pain in the area of his left shoulder blade. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from his sputum. The boy was otherwise healthy, and had no immune deficiency or underlying anatomic abnormality.

The prospective association between behavioural problems and asthma outcome in young asthma patients.

Aim: The aim of this prospective study was to examine the association between behavioural problems and medical and psychological outcomes in clinically treated children and adolescents with asthma.

Methods: Patients (n = 134) were recruited from two high-altitude asthma clinics in Switzerland and one asthma clinic in the Netherlands. Outcome measures were Asthma Control Test (ACT), Paediatric Asthma Quality of Life Questionnaire (PAQLQ(S)), forced expiratory volume in 1 sec (FEV1 ) and fractional concentration of exhaled nitric oxide (FeNO).

Congenital bronchopulmonary foregut malformation initially diagnosed as esophageal atresia type C: challenging diagnosis and treatment.

Communicating bronchopulmonary foregut malformations are extremely rare congenital malformations, characterized by a communicating fistula between an isolated part of the respiratory system and the esophagus or the stomach. In this article, we present a case of esophageal atresia type C, later diagnosed as a rare form of a communicating bronchopulmonary foregut malformation, an esophageal atresia combined with right main bronchus originating from the lower esophagus. Therapeutic resection of the right lung was complicated by postpneumonectomy syndrome.

Gain in lung function after weight reduction in severely obese children.

Aim: The primary objective of this prospective cohort study was to determine the effect of weight loss on pulmonary function values in extremely obese children.

Methods: Obese children participated in a 26-week in-hospital or outpatient multidisciplinary treatment programme. Waist circumference was measured and pulmonary function tests were performed at enrolment and after 6 months.

Behavioral problems in children and adolescents with difficult-to-treat asthma.

Background: The aim of this study was to quantify behavioral problems in clinically treated children and adolescents with asthma and to examine the association of these problems and quality of life with difficult-to-treat asthma.

Methods: Clinical patients with difficult-to-treat asthma (n = 31) and patients with asthma who were not classified as difficult-to-treat asthma (n = 52) completed the Pediatric Asthma Quality of Life Questionnaire [PAQLQ(S)]. Their parents completed the Child Behavior Checklist (CBCL) to assess behavioral problems.

[Mycobacterium haemophilum as the cause of lymphadenitis in the neck in an otherwise healthy boy].

In an 8.5-year-old boy with severe recurring unilateral swelling of the neck, infection with Mycobacterium haemophilum was established. In addition to the more usual causative agents, cervical lymphadenopathy in children can, in rare cases, be caused by M.

[Diagnostic image (69). Foreign body in the proximal esophagus].

In a 15-months-old girl with progressive anorexia and swallowing difficulties X-ray investigation revealed pneumonia and a disc battery in the proximal oesophagus.