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  • ISSN: 2373-9312
    Volume 8, Issue 2
    Review Article
    Brenda Bursch*
    To effectively identify, assess and manage suspected cases of Munchausen by Proxy abuse, clinicians, legal professionals and the public need to incorporate five core principles into their understanding of this life-threatening form of maltreatment. To successfully protect a MBP victim requires a focus on the presence of harmful deception, regardless of underlying health status. It requires appreciation for of the web of individuals who support the ongoing abuse by failing to recognize it and, sometimes, by participating in the false story of illness or impairment. It requires knowledge of the ways in which clinicians can be successfully misled and pressured to provide unneeded assessment and interventions, especially given the limitations of existing diagnostic tools. Finally, it requires understanding that this behavior is compulsive and addictive, likely to require clinical and social assistance for the abuser to refrain from engaging in their harmful behaviors and to become a safe caregiver. Health providers, legal professionals and family members who grasp these principles will be better able to use the available guidelines effectively to identify and protect victims, and to facilitate appropriate treatment of abusers.
    Saccomanni Bernardino*
    Background: Managing ACL tears in the skeletally immature patient is a complicated and at times challenging undertaking. As such, it should be undertaken only by a surgeon with experience treating pediatric and adolescent injuries of this nature.
    Methods: Two basic choices exist: (1) conservative management with or without delayed reconstruction or (2) early reconstruction. While data can be found to support both modes of care, an overwhelming preponderance of the literature supports early operative intervention for complete ACL tears in this population.
    Results and Conclusions: Operative intervention has consistently been shown to increase knee stability and decrease the risk of further damage to the meniscus and articular cartilage with minimal risk of growth disturbance. Conservative or delayed operative care should only be considered in the most compliant patients with uncomplicated injuries. As there is little data supporting one surgical technique as superior, patient age and surgeon familiarity and comfort should guide the choice.
    This paper aims to address the natural course of ACL injuries in the skeletally immature patient, treatment options with associated complications, and current preventative strategies.
    Perspective
    IAN M ROGERS*
    Introduction: The differing experiences of the surgeon, he parent and the baby are discussed in terms of what is presently known about the pathogenesis of pyloric stenosis of infancy (PS).
    Methods: The experiences are culled from personal experience and from the comments made on online pressure and support groups for pyloric stenosis of infancy. These comments are reviewed from the standpoint of the Primary Hyperacidity pathogenesis of cause.
    Conclusion: The present perspectives of the PS surgeon and the difficulties experienced by the PS family fit well which the basic tenets of the Primary Hyperacidity theory. Reference to this theory allows a satisfactory explanation for difficulties in diagnosis and for the variability of presentation.
    Research Article
    Ashish Kumar Simalti* and Pramod Garg
    Introduction: Ability to quantify the severity of the patient and predict the probability of death based on the clinical state of admitted child can help decision making selection of treatments, ethical issues and economic strategies.
    Aim and objectives: To analyze clinical and demographic profile of children admitted in PICU and predictive value of PRISM score.
    Material and methods: It was a prospective, observational, Clinical study. Minimal sample size for the sample to be representative was 240. Consecutive type of non-probability sampling was used during the study. Receiver operator characteristic curve analysis was done for evaluating the efficacy of PRISM Score to predict mortality.
    Results: During the study period we had total 315 admissions with 112 being direct admissions while rests 202 were transfer in from ward. Out of these 315 patients 262 were either transferred out of PICU or discharged to home while 49 children died thus mortality rate was 15%. At cut-off of 10.5, PRISM score at 12 hours and at cut-off of 8.5, PRISM score at 24 hours had good sensitivity and specificity. An inverse correlation was observed between PRISM score at 12 hours and 24 hours with hospital stay i.e. higher PRISM score was correlating with decreased hospital stay.
    Conclusion: There was male predominance and younger rage groups among PICU admissions. PRISM score at presentation may be used as a tool in predicting mortality in critically ill children. Hemato-onclogy and postoperative status were the commonest indications for PICU admissions in our set up.
    Original Research Article
    Waldemar Baldoquin, Misladys Rodriguez, Jose R. García and Felix Dickinson*
    Objective: To describe pneumococcal meningitis main epidemiological features in young children, and discuss potential effect of Cuban Pneumococcal Conjugate Vaccine.
    Methods: Nationwide retrospective observational study (1998-2016), in children <2 years old based on surveillance. It were estimated incidence, mortality and case-fatality rate and pneumococcal meningitis cases comprised in community acquired bacterial meningitis of unknown bacteriological etiology. Prediction of cases (2017-2020) was by time series modelling using generalized linear model methodology.
    Results: 385 cases in children <2 years old, with incidence 7.8/105 population; in infants 9.7/105 population and toddlers 5.9/105 population. Highest overall incidence arose in 2000 (15.1/105 population), decreasing toward 2016. Surveillance reported 106 overall fatalities, causing mortality of 2.1/105 population and 27.5 % case-fatality rate, with similar figures by age groups. Biggest proportion of disease occurred at fourth (13.0 %), second (10.4 %), and sixth (10.0 %), months of birth, with topmost case-fatality rate at ninth (55.5 %), fifth (31.6 %), and tenth (30.0 %), months of birth. Adjusted sum of pneumococcal meningitis cases reached 633, with incidence of 12.8/100 000 population and descending trend. Pneumococcal meningitis prediction in children <2 years old was two cases monthly and annually around 22.
    Conclusions: Pneumococcal meningitis still is the major and most lethal cause of community acquired bacterial meningitis in Cuban children. Introduction of Cuban new heptavalent PCV (serotypes 1, 5, 6B, 14, 18C, 19F, 23F) might decrease considerably Pnm and other clinical features in a near future. Surveillance must follow closely subsequent changes in epidemiological behavior.
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