INTRODUCTION:

Panton-Valentine leukocidin (PVL) is a toxin associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) worldwide and also occurs in community-associated methicillin-susceptible S aureus (CA-MSSA) strains. The aims of the study were to determine the prevalence of PVL in community-onset S aureus skin and soft-tissue infections (SSTIs) and to analyse the influence of methicillin resistance and PVL presence on the clinical characteristics of these infections.

PATIENTS AND METHODS:

We prospectively enrolled all children with S aureus community-onset SSTIs attending the emergency department of a tertiary hospital between 2007 and 2009.

RESULTS:

A total of 142 S aureus SSTIs were identified, 46 (32%) were PVL positive. The proportion of subjects in each group was: 89 (63%) PVL-MSSA, 33 (23%) PVL+MSSA, 13 (9%) PVL+MRSA and 7 (5%) PVL-MRSA. PVL+infections were more frequently abscesses (63% vs 39%, p<0.01), and more often required incision and drainage (p<0.01) and hospital admission (46% vs 26%, p=0.02). MRSA infections were also more frequently associated with abscesses but in a multivariable analysis only PVL remained independently related (OR 2.33; 95% CI 1.10 to 4.90).

CONCLUSIONS:

Our study found a high prevalence of PVL presence in community-onset S aureus SSTIs in children in Spain. This toxin is associated with more abscess formation, regardless of methicillin resistance.

OBJECTIVE:

To investigate trends in health inequality among children and young people between 1999 and 2009, using outcomes consistent with the current NHS reforms. DESIGN/DATA: Secondary analysis of participants aged 0-24 in the Health Surveys for England (HSE) undertaken in 1999, 2004, 2006 and 2009.

MAIN OUTCOME MEASURES:

Changes in the absolute and relative risks of four health outcomes by deprivation tertiles, based on occupation of the head of household▸ self/parent-reported general health,▸ presence of a long-standing illness (LSI),▸ obesity▸ smoking.

RESULTS:

No indicator showed a reduction in relative or absolute inequality between 1999 and 2009. For children (0-12 years), the relative risk comparing the most and least deprived tertiles increased significantly for poor general health (1999:1.6 (95% CI 1.2 to 2.2); 2009:3.9 (2.4 to 6.2), while the absolute difference in LSI prevalence(%) increased from 1.3 (-2.9 to 5.5) to 7.4 (3.6 to 11.4). Among young people (13-24 years), the absolute difference in LSI prevalence increased from -5.9 (-10.9 to -1.1) to 3.1 (-4.1 to 10.7). Absolute inequality in having tried smoking among children aged 8-15(%) increased significantly in the first half of the decade before decreasing in the second half (1999:3.3 (-1.1 to 7.7); 2004:14.1 (9.6 to 18.8); 2009:4.1 (0.1 to 8.8)). However, the increase in absolute inequality for smoking prevalence among young adults (16-24 years) was maintained throughout the decade (1999:-7.0 (-15.6 to 1.3); 2004:11.6 (3.7 to 20.0); 2009:8.2 (-0.3 to 16.9)).

CONCLUSIONS:

The national programme between 1999 and 2009 was not successful in reducing inequality in four key indicators of health status and future health risk among children and young people. Some inequality measures for general health, LSI prevalence and smoking increased over this time.

OBJECTIVES:

To evaluate clinical outcome and factors affecting outcome in children with snake envenomation.

DESIGN:

Prospective observational study.

SETTING:

Paediatric intensive care unit of a tertiary care teaching hospital in India.

PATIENTS:

We prospectively enrolled children ≤12 years of age admitted to our hospital with a definitive history of snake bite from August 2007 to June 2010.

MEASUREMENTS AND MAIN RESULTS:

Demographic characteristics and clinical course of the enrolled children were recorded in a structured proforma and analysed using appropriate statistical methods. Children were treated as per the WHO guidelines (2005) on the management of snake bite in children. Of 110 children studied, 77 (69%) were male. Most (72; 64.2%) had features predominantly of haematotoxic envenomation while 20 (18%) and 18 (16%) children had features of neurotoxic envenomation and local involvement, respectively. 14 children (13%) died and 13 (12%) had major disabilities. On univariable analysis, the following prehospital and admission variables were found to be significantly associated with poor outcome: age, walking for >1 km after the bite, vomiting, haemoglobin ≤10 g/dl at admission and species of snake (cobra). On multivariable analysis, only younger age (adjusted OR 0.85; 95% CI 0.7 to 0.9), walking for >1 km after the bite (adjusted OR 57; 95% CI 4.2 to 782) and haemoglobin ≤10 g/dl at admission (adjusted OR 6; 95% CI 2 to 18.2) remained significant.

CONCLUSIONS:

Younger age at presentation, anaemia (haemoglobin ≤10 g/dl) and distance walked after the bite may be independent predictors of mortality and morbidity in children with snake bite. These features in victims of snake bite warrant early referral to and management in tertiary care centres.

Herpes simplex virus (HSV) is a double stranded DNA virus capable of causing primary and recurrent infection. We describe an unusual case of neonatal HSV-2 infection presenting with supraglottitis. Despite a 2 month course of intravenous aciclovir followed by 2 months of oral valaciclovir, the infant subsequently developed HSV-2 encephalitis which responded to further antiviral treatment. The subsequent diagnosis of encephalitis highlights the importance of testing CSF for HSV to establish the presence of CNS infection in neonates and thus the potential benefit of longer term suppressive antiviral therapy.

BACKGROUND:

An earlier randomised controlled trial demonstrated improved treatment engagement in adolescents who received Therapeutic Assessment (TA) versus Assessment As Usual (AAU), following an emergency presentation with self-harm.

OBJECTIVES:

To determine 2-year outcomes for the same adolescents focusing on frequency of Accident and Emergency (A&E) self-harm presentations and treatment engagement.

METHOD:

Patients in the TA groups (n=35) and the AAU group (n=34) were followed up 2 years after the initial assessment. Their primary and secondary care electronic records were analysed.

RESULTS:

There was no significant difference in the frequency of self-harm resulting in A&E presentations between the two groups (OR 0.69, 95% CI 0.23 to 2.13, p=0.53). Treatment engagement remained higher in the TA group than the AAU group.

CONCLUSIONS:

TA is not associated with a lower frequency of A&E self-harm presentations. The effect of TA on engagement is maintained 2 years after the initial assessment. Interventions to reduce self-harm in adolescents are needed.

TRIAL REGISTRATION:

ISRCTN 81605131, http://www.controlled-trials.com/ISRCTN81605131/

To describe the course of obstructive sleep apnoea syndrome (OSAS) in children with syndromic craniosynostosis.Prospective cohort study.Dutch Craniofacial Centre from January 2007 to January 2012.A total of 97 children with syndromic craniosynostosis underwent level III sleep study. Patients generally undergo cranial vault remodelling during their first year of life, but OSAS treatment only on indication.Obstructive apnoea-hypopnoea index, the central apnoea index and haemoglobin oxygenation-desaturation index derived from consecutive sleep studies.The overall prevalence of OSAS in syndromic craniosynostosis was 68% as defined by level III sleep study. Twenty-three patients were treated for OSAS. Longitudinal profiles were computed for 80 untreated patients using 241 sleep studies. A mixed effects model showed higher values for the patients with midface hypoplasia as compared to those without midface hypoplasia (Omnibus likelihood ratio test=7.9). In paired measurements, the obstructive apnoea-hypopnoea index (Z=-3.4) significantly decreased over time, especially in the first years of life (Z=-3.3), but not in patients with midface hypoplasia (Z=-1.5). No patient developed severe OSAS during follow-up if it was not yet diagnosed during the first sleep study.OSAS is highly prevalent in syndromic craniosynostosis. There is some natural improvement, mainly during the first 3 years of life and least in children with Apert or Crouzon/Pfeiffer syndrome. In the absence of other co-morbid risk factors, it is highly unlikely that if severe OSAS is not present early in life it will develop during childhood. Ongoing clinical surveillance is of great importance and continuous monitoring for the development of other co-morbid risk factors for OSAS should be warranted.

OBJECTIVE:

To identify reasons why eligible families are not accessing free 'Healthy Start' vitamin supplementation (providing vitamins A, C and D) in England.

DESIGN:

Qualitative study using in-depth interviews.

SETTING:

13 primary care trusts in England.

PARTICIPANTS:

Purposive sample of 15 Healthy Start coordinators, 50 frontline health and children's professionals and 107 parents.

RESULTS:

Vitamin take-up was low across all research sites, reported as below 10% of eligible beneficiaries for free vitamins. Reasons identified by both parents and professionals included (1) poor accessibility of vitamins, (2) low promotion of the scheme by health professionals, (3) a lack of awareness among eligible families, and (4) low motivation among mothers to take vitamins for themselves during pregnancy or for children under 4 years old.

CONCLUSIONS:

Low uptake rates can be explained by poor accessibility of vitamins and lack of awareness and motivation to take vitamin supplements among eligible families. Universal provision (at least for pregnant women) and better training for health professionals are identified as potential solutions worthy of further research and evaluation.