Articles: adolescent.
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In adolescence, antidepressants are second-line treatment options after psychological therapy for anxiety and obsessive compulsive disorder. They may be first- or second-line options for severe cases of major depressive disorder. ⋯ Patients must be monitored for rare but serious adverse effects. These include suicide-related behaviours, switching to mania, and serotonin syndrome.
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Eating disorders are associated with adverse health and social outcomes. ⋯ No studies directly assessed the benefits and harms of screening. The SCOFF questionnaire had adequate accuracy for detecting eating disorders among adults. No treatment trials enrolled screen-detected populations; guided self-help, lisdexamfetamine, and topiramate were effective for reducing eating disorder symptom severity among referred populations with binge eating disorder, but pharmacotherapies were also associated with harms.
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This work aimed to review the epidemiology, clinical criteria, and primary and secondary diagnoses of pediatric thunderclap headache and to compare to adult thunderclap headache. ⋯ Thunderclap headache among children aged 6-18 years are rare; this headache presented in 0.08% of the patients admitted to a pediatric emergency department in a tertiary pediatric center. In that recent single-center study, thunderclap was a headache of grade 10 on the pain scale and conferred a benign course. Contrary to adults, in children, most thunderclap headaches are due to either a primary thunderclap headache or another type of primary headache. A number of case reports have attributed pediatric thunderclap to reversible vasoconstriction syndrome and bleeding due to intracranial aneurysm. However, 3-year data from a pediatric emergency department of one center did not find these reasons to be causes of secondary thunderclap headache. This may be due to the rarity of these diagnoses in children compared to adults. Four of the 19 patients with thunderclap headache reported in that single study had secondary thunderclap; the causes were infection in three and malignant hypertension in one. All the patients had a benign course. Although urgent imaging and lumbar puncture are required in the workup of pediatric thunderclap, severe causes are very rare. More research is needed to investigate pediatric thunderclap headache.
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Pit and fissure sealants are plastic materials that are used to seal deep pits and fissures on the occlusal surfaces of teeth, where decay occurs most often in children and adolescents. Deep pits and fissures can retain food debris and bacteria, making them difficult to clean, thereby causing them to be more susceptible to dental caries. The application of a pit and fissure sealant, a non-invasive preventive approach, can prevent dental caries by forming a protective barrier that reduces food entrapment and bacterial growth. Though moderate-certainty evidence shows that sealants are effective in preventing caries in permanent teeth, the effectiveness of applying pit and fissure sealants to primary teeth has yet to be established. ⋯ The certainty of the evidence for the comparisons and outcomes in this review was low or very low, reflecting the fragility and uncertainty of the evidence base. The volume of evidence for this review was limited, which typically included small studies where the number of events was low. The majority of studies in this review were of split-mouth design, an efficient study design for this research question; however, there were often shortcomings in the analysis and reporting of results that made synthesising the evidence difficult. An important omission from the included studies was the reporting of adverse events. Given the importance of prevention for maintaining good oral health, there exists an important evidence gap pertaining to the caries-preventive effect and retention of sealants in the primary dentition, which should be addressed through robust RCTs.
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Paediatric anaesthesia · Feb 2022
ReviewModes of ventilation for pediatric patients under anesthesia: A Pro/Con conversation.
The development of sophisticated modes of ventilation for pediatric patients undergoing anesthesia is ongoing; what remains a challenge for the pediatric anesthesiologist is thoughtful selection of the mode(s) of ventilation for a particular patient in the context of the surgical procedure and the goals of the anesthetic. This article provides some historical accounting of a variety of modes of ventilation, defines the terminology of modern ventilatory modes, and reviews in detail the benefits and pitfalls of the specific modes of ventilation and their applicability to the practice of pediatric anesthesiology. In an attempt to debate the Pros and Cons of different modes of ventilation, and to finally resolve the debate "spontaneous vs. controlled ventilation," we share with you a thoughtful conversation of the continuum of modes of ventilation and their applicability to our pediatric anesthesia population.