A review of imaging in the diagnosis and management of complicated paediatric pneumonia.

Paediatric pneumonia and its complications present substantial health and economic challenges. While chest radiographs are commonly used as the initial imaging modality for diagnosing uncomplicated pneumonia, they are less effective for complicated cases. In response, various imaging techniques, such as lung ultrasound, computed tomography (CT), and chest MRI, have been integrated into clinical practice to enhance diagnosis and guide management decisions.

An Australian Single-Center Cohort of Pediatric Empyema: Incidence, Pathogens and Disease Severity, and the Interaction of the COVID-19 Pandemic.

Background: Empyema is the most common complication of pediatric community-acquired pneumonia, posing a significant morbidity to children. Clinicians have observed an increase in empyema rates and acuity in the years following the COVID-19 pandemic.

Methods: This retrospective analysis of children managed for empyema in a tertiary pediatric hospital, aimed to compare the incidence and describe the clinical characteristics prepandemic and postpandemic (2017-2023).

Characteristics and outcomes of respiratory distress among term infants born in a regional setting.

Introduction: Respiratory distress is the leading cause of admission to neonatal units and is a common indication for medical retrieval. Whilst approximately 25% of births in NSW occur in regional centres, there is a paucity of neonatal research in these settings.

Objective: To describe the characteristics and outcomes of term neonates admitted with respiratory distress to two regional special care nurseries (SCNs) and identify variables associated with the need for medical retrieval.

Pediatric empyema: Are ultrasound characteristics at the time of intervention predictive of reintervention?

Background: Parapneumonic effusions and empyema are the most frequent complication of pediatric pneumonia. Interventions include chest drain and fibrinolytics (CDF) or thoracoscopic surgery. CDF is considered less invasive, and more cost-effective though with higher rates of reintervention.

Systematic review of clinical practice guidelines on the management of community acquired pneumonia in children.

Childhood community acquired pneumonia (CAP) is the leading cause of mortality in children under 5 years worldwide. Clinical practice guidelines (CPGs) may be limited by method of development, scope of recommendations and the quality of supporting evidence. This study systematically identified, appraised and compared the recommendations of CPGs for the management of paediatric CAP using the AGREE II tool.

Paediatric pneumonia: deriving a model to identify severe disease.

Background: Community-acquired pneumonia (CAP) is a leading cause of childhood hospitalisation. Limited data exist on factors predicting severe disease with no paediatric-specific predictive tools.

Methods: Retrospective cohort (2011-2016) of hospitalised CAP cases.

Issues affecting young people with asthma through the transition period to adult care.

Asthma is among the most common medical conditions affecting children and young people, with adolescence a recognised period of increased risk, overrepresented in analyses examining recent increasing asthma mortality rates. Asthma may change significantly during this period and management also occurs in the context of patients seeking increased autonomy and self-governance whilst navigating increasing academic and social demands. A number of disease factors can destabilise asthma during adolescence including: increased rates of anaphylaxis, anxiety, depression, obesity, and, in females, an emerging resistance to corticosteroids and the pro-inflammatory effects of oestrogen.

Paediatric pneumonia in high-income countries: Defining and recognising cases at increased risk of severe disease.

World Health Organisation definitions of pneumonia severity are routinely used in research. In high income health care settings with high rates of pneumococcal vaccination and low rates of mortality, malnutrition and HIV infection, these definitions are less applicable. National guidelines from leading thoracic and infectious disease societies describe 'severe pneumonia' according to criteria derived from expert consensus rather than a robust evidence base.

Pro con debates in clinical medicine infection prevention and control in cystic fibrosis: One size fits all? The argument in favour.

This article advocates for a universal approach to infection control measures in cystic fibrosis. The central tenets of infection control include hand hygiene, contact precautions, regular microbiological surveillance and adopting inpatient, outpatient, domestic and social practices to minimise acquisition of common CF pathogens. Infection control measures should be proactive and prospective, assuming all patients harbour aggressive pathogens, and not relying on past culture results.

Bronchopulmonary dysplasia: A review of the pulmonary sequelae in the post-surfactant era.

We describe the respiratory complications of bronchopulmonary dysplasia (BPD) in childhood and adolescence. The pathophysiology of bronchopulmonary dysplasia has evolved in the era of modern neonatal intensive care. In this review, we aim to summarise the contemporary evidence base and describe the common respiratory morbidities related to BPD including; home oxygen therapy, rehospitalisation, asthma and exercise limitation.

Paediatric empyema: worsening disease severity and challenges identifying patients at increased risk of repeat intervention.

Objective: Empyema is the most common complication of pneumonia. Primary interventions include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS). We describe disease trends, clinical outcomes and factors associated with reintervention.

Increasing Rates of Pediatric Empyema and Disease Severity With Predominance of Serotype 3 S. pneumonia: An Australian Single-center, Retrospective Cohort 2011 to 2018.

Background: The impact of universal 13-valent pneumococcal conjugate vaccine immunization on pediatric empyema rates and pathogens in Australia is not known. We aimed to describe empyema epidemiology, clinical characteristics and treatment during an 8-year period.

Methods: A retrospective study between 2011 and 2018 of empyema cases admitted to a large pediatric referral hospital, for management with either pleural drainage and fibrinolytics or surgical intervention.

Assessing the conditions for in vivo electrical virtual biopsies in Barrett's oesophagus.

It has previously been shown that it is possible to differentiate between squamous and columnar epithelia in rat and resected human tissues using an impedance probe to make in vitro measurements. This probe can be passed down an endoscope allowing measurements to be made in patients. However, the probe emerges parallel to the oesophageal wall, with little room to manoeuvre.

Virtual biopsies in Barrett's esophagus using an impedance probe.

Preliminary results of electrical impedance measurements in squamous and columnar epithelia in rat and human tissues are presented. The aim of this work is to show the possibility of differentiating these two types of epithelia in terms of their electrical characteristics. For the measurements, we employed a 1.

Respiratory failure in acute pancreatitis.

There are a number of important pulmonary complications of acute pancreatitis which make a significant contribution to the morbidity and mortality of the condition. The pathophysiology and management guidelines are given for each and approaches towards better treatment in the future are discussed.

Controlled trial of cimetidine in upper gastrointestinal haemorrhage.

One hundred and one patients were studied in a double-blind controlled trial to assess the role of oral cimetidine in preventing the continuation or recurrence of acute upper gastrointestinal haemorrhage from various sources, chiefly peptic ulcer. The dose of cimetidine was 800 mg on entering the study followed by 400 mg six hourly. The source of bleeding was identified endoscopically in 96% of patients, peptic ulcer comprising 70%.

H2-antagonists in the treatment of recurrent ulceration after vagotomy.

Twenty-two patients with recurrent ulceration following vagotomy with and without a drainage procedure have been treated with histamine H2-antagonists and followed for up to 3 years. Four of a group of 6 patients responded to a single therapeutic course. Ten of 16 patients assigned to long term maintenance treatment remain symptom-free.

Double-blind comparison of cimetidine and placebo in the maintenance of healing of chronic duodenal ulceration.

Patients suffering from chronic duodenal ulceration were allocated at random to treatment with either cimetidine (400 mg twice daily) or matching placebo for six months. Before entry to the trial all patients were shown to have healed ulcers on endoscopy. Most of the patients had participated in a one-month trial of cimetidine during which their ulcers healed.

Clinical experience with metiamide.

The new histamine H2-receptor antagonist, metiamide, was shown to inhibit acid and pepsin secretion in gastric secretion studies performed on patients suffering from peptic ulceration. The new drug was administered intravenously in these experiments, but effective plasma levels could also be produced by oral administration. When symptomatic patients were treated with the drug nearly all experienced marked symptomatic relief, and there was some evidence that ulcer healing occurred during treatment.

Treatment of duodenal ulcer with cimetidine.

In a small open trial nineteen patients with active duodenal ulceration shown by fibreoptic endoscopy were treated with a 6-week course of cimetidine 1.6 g daily. Seventeen had healed ulcers on repeat endoscopy at 6 weeks.

Pharmacological evaluation of cimetidine, a new histamine H2-receptor antagonist, in healthy man.

Cimetidine, a new H2-receptor antagonist, was safely administered to eighteen healthy man by the intravenous, intraduodenal or oral route. 2 When gastric secretion was maximally stimulated by either histamine or pentagastrin, the simultaneous administration of cimetidine produced marked inhibition of both acid and pepsin secretion. 3 Cimetidine was well absorbed by mouth and had a blood half-life of 2 hours.