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a7693520d9910043fd597e183579a6eda2fd2585 |
the incidence of bacterial meningitis in infants and children has decreased since the routine use of conjugated vaccines targeting * haemophilus influenzae * type b, * streptococcus pneumoniae *, and * neisseria meningitidis *. however, this infection continues to be associated with considerable mortality and morbidit... | guidelines | |
a7693520d9910043fd597e183579a6eda2fd2585 |
or partially immunized children, or in individuals who are immune \ - incompetent or immunosuppressed. it is worth noting that disease due to other serogroups ( i. e., non \ - b ) has been increasing in all parts of canada, but particularly in northern populations \ ] \ - \ ]. publicly funded infant immunization progr... | guidelines | |
a7693520d9910043fd597e183579a6eda2fd2585 |
001 \ ) in children \ < 5 years of age, and from 54 % ( 1262 of 2360 \ ) to 43 % ( 1006 of 2353 ; p \ < 0 \. 001 \ ) in children ≥5 years of age. serotypes 19a, 7f, 3, and 22f were the most common serotypes in 2012, with 19a decreasing from 19 % ( 521 of 2727 \ ) to 14 % ( 364 of 2620 ; p \ < 0 \. 001 \ ) \ ]. the inc... | guidelines | |
a7693520d9910043fd597e183579a6eda2fd2585 |
. using current criteria for antimicrobial susceptibility, the save study analysed 6001 invasive isolates of * s pneumoniae - from adults and children in canada \ ]. there was a significant increasing prevalence of penicillin \ - susceptible isolates from 2011 to 2015 \. in 2015, using non \ - meningitis and meningiti... | guidelines | |
a7693520d9910043fd597e183579a6eda2fd2585 |
meningitis in children, it as well as other * h influenzae - serotypes should still be considered in a child who is not fully immunized or unimmunized, or from an area in northern canada with a higher incidence of invasive * h influenzae *. increasingly, hib and other typeable strains of * h influenzae * have shown in... | guidelines | |
a7693520d9910043fd597e183579a6eda2fd2585 |
##r ) testing is often helpful if cultures of blood or csf are negative, and should be pursued with the microbiology laboratory when needed. an lp should always be attempted unless there are contraindications, such as coagulopathy, cutaneous lesions at the proposed puncture site, signs of herniation, or an unstable cl... | guidelines | |
a7693520d9910043fd597e183579a6eda2fd2585 |
##icillin \ - susceptible * s - pneumoniae \ ] \ ]. other factors to consider in the choice of antimicrobials are the child ’ s age and underlying diseases or risk factors such as immunodeficiency. for example, if there is an underlying immunodeficiency, then * listeria * is a possible risk and ampicillin should be ad... | guidelines | |
a7693520d9910043fd597e183579a6eda2fd2585 |
immunization series ), children \ < 4 years old who are incompletely immunized, or immunocompromised children of any age. any index case of hib aged \ < 2 years and not treated with cefotaxime or ceftriaxone should also receive chemoprophylaxis at the end of therapy. public health should be consulted regarding managem... | guidelines | |
a7693520d9910043fd597e183579a6eda2fd2585 |
on likely similar pathogenesis in adult meningitis, empiric steroids can be considered for infants and children with presumptive * s pneumoniae - meningitis. in this setting also, steroids should be discontinued if pneumococcus is not identified within 48 h. the recommended dose of dexamethasone is 0 \. 6 mg / kg / da... | guidelines | |
a7693520d9910043fd597e183579a6eda2fd2585 |
statement, repeat csf culture at 24 h to 48 h is recommended for meningitis caused by gram \ - negative enteric pathogens ( e. g., * e coli * ). cns imaging is recommended when there is failure of sterilization of csf, or if neurological symptoms or other specific complications develop during the course of treatment. ... | guidelines | |
d7f8ba8e30c7f04e0097c52c907186b8b31485f5 |
the prevention of pain in neonates should be the goal of all caregivers because painful exposures have the potential for deleterious consequences. those neonates at greatest risk for neurodevelopmental impairment due to preterm birth ( eg, the smallest and sickest ) are also most likely to be exposed to the greatest n... | guidelines | |
d7f8ba8e30c7f04e0097c52c907186b8b31485f5 |
. 2. newborns should be assessed for pain routinely, and before and after procedures. 3. the chosen pain scales should help guide caregivers in the provision of effective pain relief. reducing pain from bedside care procedures neonates in the nicu often experience painful procedures during routine care, such as needle... | guidelines | |
d7f8ba8e30c7f04e0097c52c907186b8b31485f5 |
are inadequate data on pharmacokinetics at gestational ages under 28 weeks to permit calculation of appropriate dosages. reducing pain from other major procedures analgesia for chest drain insertion should comprise all of the following : 1. general nonpharmacological measures ; 2. slow infiltration of the skin site wi... | guidelines | |
d7f8ba8e30c7f04e0097c52c907186b8b31485f5 |
newborn, american academy of pediatrics ; amanda symington, neonatal nurses # american academy of pediatrics : committee on fetus and newborn, section on surgery and section on anesthesiology and pain management principal authors : keith j barrington md, fetus and newborn committee, canadian paediatric society ; danie... | guidelines | |
a550a29147e89def2fe137a202d90dcc925708ad |
cannabis is the most common illicit drug used worldwide and it is used frequently by canadian teenagers. cannabis use during adolescence can cause functional and structural changes to the developing brain, leading to damage. marijuana use in this age group is strongly linked to : cannabis dependence and other substanc... | guidelines | |
a550a29147e89def2fe137a202d90dcc925708ad |
. regional variations in the frequency of cannabis use exist, with atlantic and western provinces in canada reporting higher use than other regions. indigenous youth are particularly at risk ; nearly two \ - thirds of 15 \ - to 19 \ - year \ - old inuit participants from an earlier study in nunavik, quebec, self \ - r... | guidelines | |
a550a29147e89def2fe137a202d90dcc925708ad |
enters the system, it targets receptors in much higher quantities than endogenous cannabinoids and ‘ floods ’ receptors, with two main results : a system that is no longer working as effectively and toxic changes to the neurons involved. structural changes on mri have also been documented in youth who use cannabis reg... | guidelines | |
a550a29147e89def2fe137a202d90dcc925708ad |
long as 77 days after cessation of cannabis use has been described. furthermore, consuming cannabis \ - infused edibles may inadvertently result in toxicity because absorption can take hours, compared with minutes when smoking. an individual who does not yet feel an effect may over \ - consume, and the unintended cons... | guidelines | |
a550a29147e89def2fe137a202d90dcc925708ad |
cent of young cannabis users also smoke tobacco, indicating a strong link between these two drugs. cannabis use is also linked to tobacco via ‘ mulling ’ : the addition of tobacco to cannabis cigarettes. mixing the two substances aids combustion and constitutes a significant exposure to nicotine. using both tobacco an... | guidelines | |
a550a29147e89def2fe137a202d90dcc925708ad |
. large longitudinal studies have demonstrated that more than 50 % of youth who develop such symptoms will develop a future psychotic disorder. although the absolute risk for developing psychosis is low, the risk for developing a psychotic outcome of any nature is increased by 40 % in individuals who have used cannabi... | guidelines | |
a550a29147e89def2fe137a202d90dcc925708ad |
declined significantly over time though not significantly more than in their non \ - cannabis \ - using twin. one large cohort study had previously found that iq scores declined significantly among heavy cannabis users who were followed prospectively from adolescence to middle age. a dose – response relationship was a... | guidelines | |
a550a29147e89def2fe137a202d90dcc925708ad |
\ - risk illegal activities to access cannabis. cannabis legislation will have a significant impact on the lives and health of children and youth, and safeguards are necessary. based on the physical and mental health risks, and with many legal, financial and public safety issues at stake, policy makers — with support ... | guidelines | |
a550a29147e89def2fe137a202d90dcc925708ad |
. these campaigns should be developed in collaboration with youth leaders and should include messages from young opinion \ - leaders. - invest in the development and implementation of programs for routine roadside detection of cannabinoids and determine suitable consequences for youth who are found to be under the inf... | guidelines | |
83598da82ae18bff796bee54edfa50abfcd24191 |
- current : management of … management of hiv \ - exposed and hiv \ - infected children # principal author ( s ) jl robinson ; canadian paediatric society, paediatr child health 2010 ; 15 ( 6 \ ) : 379 the management of hiv \ - exposed and hiv \ - infected children has been improved by the introduction of new testing ... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
human herpes simplex virus ( hsv ) infection in neonates can result in devastating outcomes, including mortality and significant morbidity. all infants are potentially at risk for neonatal hsv infection. this position statement reviews epidemiology, transmission and risk factors, with a focus on intrapartum infection.... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
infection ( mother has a new infection with one hsv type in the presence of antibodies to the other type ) ; or - recurrent ( mother has pre \ - existing antibodies to the hsv type that is isolated from the genital tract ). the most common and important category of nhsv acquisition is intrapartum. even for hsv \ - 1, ... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
##ctive antibodies are present. the lowest risk of neonatal transmission occurs with maternal recurrent infection ( at \ < 2 % ) because type \ - specific antibodies are present. \ ] delivery by elective cesarean section markedly reduces but does not eliminate the risk for newborn infection. \ ] \ ] women with recurre... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
infants with disseminated disease did not have skin lesions at any time during their illness, while 32 % with cns disease and 17 % with sem disease did not develop skin lesions. \ ] nhsv infection should be considered in neonates with sepsis syndrome, particularly when this condition is accompanied by liver dysfunctio... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
infectious disease consultant when nhsv is suspected, particularly in settings where testing for nhsv is performed less frequently. expert consultation is important because the utility of testing modalities varies according to sample type, and the laboratory must provide general as well as centre \ - specific advice o... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
using pcr is less well established than csf pcr testing. \ ] \ - \ ] one study that evaluated hsv viral load in serum and csf using a real \ - time pcr assay found that patients with disseminated disease had higher viral loads in their sera, while patients with cns infection had higher viral loads in their csf. \ ] vi... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
into the role of suppressive antiviral therapy in infants with nhsv infections. a recent randomized, double \ - blinded, placebo \ - controlled trial evaluated infants with cns hsv or disseminated hsv with cns involvement, while a second, parallel trial evaluated infants with sem hsv disease. the study demonstrated im... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
test is available. if hsv is detected on a swab or in blood pcr, the infant should be managed as a case of nhsv. note : with respect to the above, some experts recommend performing csf cell count, chemistries and pcr when mucous membrane swabs are taken ( ie, a complete work \ - up ). - first clinical episode of genit... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
symptoms compatible with nhsv disseminated hsv can mimic bacterial sepsis, and clinicians need to consider possible nhsv infection in unwell infants \ < 6 weeks of age. pending laboratory confirmation, consider investigations and treatment of nhsv for the following at \ - risk patients : - infants started on iv antibi... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
at : www. csgnetwork. com / bsacalc. html. data are less convincing for sem or disseminated disease, but suppressive therapy may still be offered. - follow \ - up is necessary to detect and manage adverse effects related to suppressive acv treatment as well as for the neurodevelopmental sequelae of nhsv. complete bloo... | guidelines | |
7a54a6e9c86c0897711f1f4216f57abe55c5404b |
. individuals who have contact with infants should keep their lesions covered. if this is not possible, direct care of neonates should be avoided. - some experts recommend wearing a surgical mask to cover orolabial lesions because these cannot be covered by dressings. - staff with active herpetic whitlow should avoid ... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
ankyloglossia ( ‘ tongue \ - tie ’ ) is a relatively common congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict tongue tip mobility. there is considerable controversy regarding its diagnosis, clinical significance and management, and there is wide variation in practice in this ... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
##y in the context of ankyloglossia and breastfeeding difficulties. the present statement replaces the previous canadian paediatric society document revised in 2011 \. several studies have been published in the interim. there is neither a universally accepted definition of ankyloglossia nor practical objective criteri... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
in newborns. \ - the role of a short lingual frenulum as a cause of breastfeeding difficulties has been described in multiple anecdotal reports linking ankyloglossia to poor latch, maternal nipple pain and trauma, suboptimal infant weight gain, infant breast refusal and low maternal milk supply due to poor milk remova... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
with no ankyloglossia. thirty ( 83 % ) of the 36 infants with ankyloglossia were successfully breastfed during the study period, compared with 33 ( 92 % ) of the 36 control infants ( p \ = 0 \. 29 \ ). the duration of breastfeeding was similar in both groups. this study also found no significant difference between ank... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
conservative management ( ie, natural history ). in addition to the studies described, several other prospective cohort studies have shown an association of ankyloglossia with breastfeeding difficulties as well as the benefit of frenotomy in infants with ankyloglossia who present with breastfeeding difficulties. \ - h... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
evidence, frenotomy cannot be recommended for all infants with ankyloglossia. there is no absolute relationship between ankyloglossia and breastfeeding difficulties. if an association between significant tongue \ - tie and major breastfeeding problems is identified and surgical intervention is deemed to be necessary, ... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
14 \. 4. kupietzky a and botzer e. ankyloglossia in the infant and young child : clinical suggestions for diagnosis and management. pediatr dent 2005 ; 27 ( 1 \ ) : 40 \ - 6 \. 5. rowan \ - legg a ; canadian paediatric society, community paediatrics committee. ankyloglossia and breastfeeding. paediatr child health 201... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
p. prevalence, diagnosis, and treatment of ankyloglossia : methodologic review. can fam physician 2007 ; 53 ( 6 \ ) : 1027 \ - 33 \. 14. notestine ge. the importance of the identification of ankyloglossia ( short lingual frenulum ) as a cause of breastfeeding problems. j hum lact 1990 ; 6 ( 3 \ ) : 113 \ - 5 \. 15. be... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
, westcott c. a double \ - blind, randomized, controlled trial of tongue \ - tie division and its immediate effect on breastfeeding. breastfeed med 2012 ; 7 ( 3 \ ) : 189 \ - 93 \. 23. matthews mk. developing an instrument to assess infant breastfeeding behaviour in the early neonatal period. midwifery 1988 ; 4 ( 4 \ ... | guidelines | |
a27dc5c86475d195e344e0b601ece46686a782a3 |
77 ( 5 \ ) : 762 \ - 5 \. 32. dollberg s, marom r, botzer e. lingual frenotomy for breastfeeding difficulties : a prospective follow \ - up study. breastfeed med 2014 ; 9 ( 6 \ ) : 286 \ - 9 \. 33. ovental a, marom r, botzer e, batscha n, dollberg s. using topical benzocaine before lingual frenotomy did not reduce cry... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
while tobacco is sacred in many indigenous cultures, the recreational misuse of commercial tobacco is highly addictive and harmful. tobacco misuse is the leading preventable cause of premature death in the world. smoking rates among canadian indigenous youth are at least three times higher than for their non \ - abori... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
traditions ; the inuit did not begin using tobacco until about one hundred years ago. health professionals working with indigenous communities need to acknowledge and address both the value of traditional tobacco use and the consequences of misusing commercial tobaccos with the families they see in practice. in canada... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
prevalent in indigenous youth than in their non \ - indigenous peers. mental health problems are also a significant risk factor for addictions. young people with higher depression scores are at greater risk for smoking. low self \ - esteem, stress, boredom and low academic achievement all affect the initiation of toba... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
of indoor air quality in nunavut revealed that reduced ventilation and overcrowding were strongly associated with lower respiratory tract infection rates. smokers were present in 94 % of these households and nicotine levels exceeded average levels in one \ - quarter of the dwellings under study. exposure to tobacco sm... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
to tobacco misuse were over $ 4 \. 3 billion annually. the high rates of addiction and poverty in indigenous communities that are exacerbated when smokers divert funds to buy tobacco have far \ - reaching consequences for society as well as for individuals ( lost productivity being just one example ). # what works in ... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
\ - insured health benefits program ( nihb ). the federal health coverage plan for eligible first nations and inuit peoples ( but not metis ) provides drug coverage for all smoking cessation pharmacotherapy agents. however, first nations smokers appear to use nrts less often than other canadian smokers, even when they... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
; they recognized contemporary lifestyles ; they cooperated with existing systems and resources ; they showed a high degree of respect and trust in the individuals and groups involved ; and they created partnerships. elders in indigenous communities represent a culturally relevant but often underused resource. communi... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
##ize the sale or supply of tobacco products to minors ; eliminate unsupervised sales ( e. g., through vending machines, online merchants ) ; require health warnings on tobacco products ; and ban advertisements and sponsorships by tobacco companies. where there are penalties in place for selling or supplying tobacco t... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
. # # for health care providers - understand the distinction between traditional and commercial tobacco use and how such practices apply to some ( not all ) canadian indigenous groups. - ask about and document family smoking and exposure to tobacco smoke at all health appointments. - use the ‘ 5as ’ method to provide ... | guidelines | |
6b069d1e603ff216cef25a03989c818b9bf18d8e |
levy a surcharge on non \ - traditional tobacco to match off \ - reserve prices ). - ensure that tax revenues are used for smoking prevention and cessation education and programming. - ensure access to tobacco cessation and prevention services for all indigenous people. # # for researchers - strengthen data collection... | guidelines | |
e15dd3adaaf8aea55cb10ee728d96a87c61b922c |
the use of silver nitrate as prophylaxis for neonatal ophthalmia was instituted in the late 1800s to prevent the devastating effects of neonatal ocular infection with * neisseria gonorrhoeae *. at that time – during the preantibiotic era – many countries made such prophylaxis mandatory by law. today, neonatal gonococc... | guidelines | |
e15dd3adaaf8aea55cb10ee728d96a87c61b922c |
ranges from 2 % to 40 %. other bacteria such as * staphylococcus - species, * streptococcus - species, * haemophilus - species and other gram \ - negative bacterial species account for 30 % to 50 % of cases. much less commonly, neonatal conjunctivitis is caused by viral infections ( herpes simplex, adenovirus, enterov... | guidelines | |
e15dd3adaaf8aea55cb10ee728d96a87c61b922c |
ophthalmia prophylaxis with these agents. in canada, erythromycin has been the only antibiotic eye ointment available for use in neonates since tetracycline ophthalmic ointment became unavailable. povidone \ - iodine has been considered for prophylaxis, but this agent may not be effective and has been associated with ... | guidelines | |
e15dd3adaaf8aea55cb10ee728d96a87c61b922c |
infections in newborns caused by this organism. close clinical follow \ - up of exposed infants is recommended. the public health agency of canada recommends testing conjunctival and nasopharyngeal secretions of symptomatic infants and treating those who show positive results. a recent meta \ - analysis concluded that... | guidelines | |
e15dd3adaaf8aea55cb10ee728d96a87c61b922c |
circulating strains. povidone \ - iodine or gentamicin ointment should not be used because of high rates of adverse topical effects. to prevent potential cross \ - contamination, single \ - use tubes of erythromycin are used. before administration, each eyelid is wiped gently with sterile cotton to remove foreign matt... | guidelines | |
e15dd3adaaf8aea55cb10ee728d96a87c61b922c |
for women who are not in a stable monogamous relationship. - processes should be in place to ensure communication between physicians and others caring for a woman during pregnancy, and those who will care for her newborn. information regarding maternal sti screening, treatment and risk factors is crucial to the well \... | guidelines | |
e15dd3adaaf8aea55cb10ee728d96a87c61b922c |
##ous calcium. a single dose of cefotaxime \ is an acceptable alternative. ) - if the exposed infant is * unwell - in any way, blood and cerebrospinal fluid cultures should also be performed. infants with established gonococcal disease require additional investigation and therapy in consultation with a specialist in p... | guidelines | |
1f54213dd0122047f9f55b99e63c36a4356385c7 |
hospital \ - acquired acute hyponatremia is increasingly recognized as a cause of morbidity and mortality in children. it has been attributed primarily to the use of hypotonic intravenous ( iv ) fluids to maintain fluid and electrolyte requirements. this practice point outlines current understanding of the problem and... | guidelines | |
1f54213dd0122047f9f55b99e63c36a4356385c7 |
for these sequelae compared with adults. the routine practice of providing hypotonic maintenance iv solutions, usually containing 20 mmol / l to 30 mmol / l of na, is based on holliday and segar ’ s seminal paper published in 1957 \ ] and translates to the use of 0 \. 2 % nacl / dextrose 5 %. these recommendations wer... | guidelines | |
1f54213dd0122047f9f55b99e63c36a4356385c7 |
##mic metabolic acidosis has been recognized in the context of rapid isotonic saline infusion delivered perioperatively \ ] but has not been reported in the trials of iv saline used for maintenance requirements in children to date. initial prospective trials comparing the tonicity of iv fluids were primarily focused o... | guidelines | |
1f54213dd0122047f9f55b99e63c36a4356385c7 |
of hyponatremia in the hypotonic group compared with none in the group receiving isotonic fluids. the third trial studied a combined medical and surgical paediatric population, and was conducted in mexico. \ ] one hundred and fifty \ - one children were randomized to one of two hypotonic solutions ( 0 \. 3 % saline or... | guidelines | |
1f54213dd0122047f9f55b99e63c36a4356385c7 |
, urea, creatinine ) should be measured when starting iv fluid therapy in hospitalized children. 2. children receiving maintenance iv fluids should have their serum electrolytes checked regularly, with patients who may be at high risk of impaired renal water excretion checked daily if not more frequently. 3. all child... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
an increase in * clostridium difficile - infection incidence has been observed among hospitalized children in the united states. the present statement, targeted at clinicians caring for infants and children in community and institutional settings, summarizes the relevant information relating to the role of * c diffici... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
to three days. \ ] \ - \ ] a history of therapy with antibiotics or antineoplastic agents is present in most adult patients with cdi. \ ] in the united states, an increase in cdi incidence has been observed among hospitalized children. \ ] \ ] duration of hospital stay, older age \ ] and exposure to multiple antibioti... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
risk factors for cdi \ ] \ - \ ] are likely to receive acid \ - suppressing medications. in one paediatric report, h2 receptor antagonists were actually associated with decreased colonization by * c difficile *. \ ] a previously uncommon strain of * c difficile - ( north american pulse \ - field type \ - 1 \ ] ; curre... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
- molecular \ - weight proteins capable of binding to specific receptors on intestinal mucosal cells. toxin a can disrupt neuronal function and cause the aberrant release of calcium. \ ] \ ] \ ] toxin b exerts its effect on leukocytes by altering the chemotaxis of neutrophils, the activation of macrophages and mast ce... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
##ypotension, shock, peritonitis, ileus or megacolon. in this regard, * c difficile - is a well \ - established cause of pseudomembranous colitis. characteristic features include progressively severe diarrhea, abdominal pain, fever, leukocytosis, systemic toxicity, and stool containing blood, mucous and leukocytes. th... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
initial screening, followed by the toxin eia or ( preferably ) a cell cytotoxin assay as the confirmatory test for gdh \ - positive stool specimens. polymerase chain reaction testing is rapid, sensitive and specific, and appears promising in addressing toxin testing concerns. \ ] \ ] significant variations exist in te... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
infants and young children versus adults limit this approach. the high frequency of * c difficile - and its toxins in the gi tract of healthy infants and children confounds the diagnosis of * c difficile - disease in a child with mild \ - to \ - moderate watery ( nonbloody ) diarrhea with toxin present in the stool. i... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
drug resistance and, typically, the initial regimen will result in prompt improvement with the first recurrence. the risk of a second recurrence does not appear to be related to the choice of drug ( vancomycin or metronidazole ) used to treat a first recurrence. repeated courses of treatment may be needed in some pati... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
##i - has been associated with fungemia in immunocompromised patients and in patients with central venous lines. \ ] other agents used to treat cdi include teicoplanin, which is likely to be as effective as vancomycin, \ ] bacitracin and fusidic acid. the latter two agents were shown to be associated with lower effica... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
##fficile * \ - associated diarrhea should only be diagnosed if toxin is detected in the stool. culture of the bacteria is not sufficient evidence to support the diagnosis in symptomatic patients. - the testing of stool samples from asymptomatic patients or from patients whose symptoms have resolved is not recommended... | guidelines | |
3ac241b5cbe8fbda76808419bc8fb8845784b6ef |
- the regimens used to treat patients with first episodes of c difficile \ - associated colitis can be repeated for the first recurrence or one can use oral vancomycin. * second or later recurrences * - second or later recurrences should typically be treated with vancomycin, using a tapered and / or pulsed regimen. an... | guidelines | |
81dcea4c989936bddea0a6466a7ba42335c18f59 |
croup is one of the most common causes of upper airway obstruction in young children. it is characterized by sudden onset of barky cough, hoarse voice, inspiratory stridor and respiratory distress caused by upper airway inflammation secondary to a viral infection. published guidelines for the diagnosis and treatment o... | guidelines | |
81dcea4c989936bddea0a6466a7ba42335c18f59 |
##glottic region becomes narrowed, causing upper airway obstruction and the symptoms typically associated with croup. # clinical presentation classical croup symptoms have a rapid onset and include barky cough, inspiratory stridor, hoarseness and respiratory distress. nonspecific symptoms of an upper respiratory illne... | guidelines | |
81dcea4c989936bddea0a6466a7ba42335c18f59 |
- and should be considered for treating all children presenting with croup and symptoms ranging from mild to severe. improvement generally begins within 2 to 3 hours after a single oral dose of dexamethasone and persists for 24 to 48 hours. one recent cochrane review analyzed results from 38 randomized controlled tria... | guidelines | |
81dcea4c989936bddea0a6466a7ba42335c18f59 |
with a single dose of corticosteroids for treatment of croup. nebulized epinephrine is recommended for moderate to severe croup. reports of administering epinephrine in children with severe croup have demonstrated a lower number of cases requiring intubation or tracheotomy. when compared with a placebo, nebulized epin... | guidelines | |
ce257cc15132c7300718598840c5524d9eb1b8f4 |
head lice ( * pediculus humanus capitis * ) infestations are not a primary health hazard or a vector for disease, but they are a societal problem with substantial costs. diagnosis of head lice infestation requires the detection of a living louse. although pyrethrins and permethrin remain first \ - line treatments in c... | guidelines | |
ce257cc15132c7300718598840c5524d9eb1b8f4 |
require the higher temperatures found near the scalp to hatch \. an infestation with lice is called pediculosis and usually involves less than 10 live lice \. itching occurs if the individual with lice becomes sensitized to antigenic components in the saliva injected as the louse feeds \ \. on the first infestation, s... | guidelines | |
ce257cc15132c7300718598840c5524d9eb1b8f4 |
actively infested \. for children with less than five nits close to the scalp, only 7 % became actively infested. therefore, having nits close to the scalp does not necessarily indicate that a live infestation is underway or will occur. well \ - established treatment options for a proven head lice infestation include ... | guidelines | |
ce257cc15132c7300718598840c5524d9eb1b8f4 |
canada, which could explain treatment failure rates. however, because these products are effective in more cases than these data imply, the precise relationship between r allele and treatment failure remains unclear. rule out the following much more common possibilities before considering resistance \ \ : - misdiagnos... | guidelines | |
ce257cc15132c7300718598840c5524d9eb1b8f4 |
use in canada. benzyl alcohol is highly effective against live lice but is not ovicidal. a second treatment 9 days after the first treatment is required for a full treatment course. benzyl alcohol lotion is approved for use in individuals 6 months to 60 years of age, and skin irritation is the only common side effect ... | guidelines | |
ce257cc15132c7300718598840c5524d9eb1b8f4 |
. 5 % malathion lotion, 7 days apart \. wet combing resulted in a cure ( no detection of live lice after 2 weeks ) in 38 % of cases, while the malathion treatment cured 78 % of cases \. another study combining wet combing with topical 1 % permethrin treatment did not improve on results obtained with permethrin treatme... | guidelines | |
ce257cc15132c7300718598840c5524d9eb1b8f4 |
risk nor a sign of lack of cleanliness. the role of environmental decontamination data on whether disinfecting personal, school or household items decreases the likelihood of reinfestation are lacking \ \. because lice live close to the scalp, nits are unlikely to hatch at room temperature \ \ and environmental cleani... | guidelines | |
ce257cc15132c7300718598840c5524d9eb1b8f4 |
reinfestation. - topical insecticides can be toxic. take care to avoid unnecessary exposure and, when indicated, minimize skin contact beyond the scalp. - excluding children with nits or live lice from school or child care has no rational medical basis and is not recommended. - for children ≥2 months of age, permethri... | guidelines | |
cee156fe753224ab2397d2c72906efeb3765dec7 |
- current : dieting in adolescence dieting in adolescence # principal author ( s ) sm findlay ; canadian paediatric society, paediatr child health 2004 ; 9 ( 7 \ ) : 487 \ - 91 concern with weight and shape is extremely common during the adolescent years. in addition to being exposed to the very real health risks of o... | guidelines | |
cee156fe753224ab2397d2c72906efeb3765dec7 |
diet pill use as unhealthy or extreme dieting \ -. in many studies, chronic dieting ( more than 10 diets in a year ), fad dieting, fasting and skipping meals are also classified as unhealthy strategies. many authors refer to the use of these behaviours to achieve weight loss as disordered eating if the behaviours are ... | guidelines | |
cee156fe753224ab2397d2c72906efeb3765dec7 |
sectional american study, 36 % of normal weight girls were dieting, compared with 50 % of overweight girls and 55 % of obese girls. distortion of body image is common among adolescents who frequently ‘ feel fat ’ even at a normal weight. it is clear that the perception of being overweight is a factor in a teenager ’ s... | guidelines | |
cee156fe753224ab2397d2c72906efeb3765dec7 |
demonstrated that teenagers who engage in other risk activities, including substance use, unprotected sex and illegal activity, are also more likely to engage in health \ - compromising weight loss strategies. a prospective study also found that adolescent girls who are concerned about their weight or who are dieting ... | guidelines | |
cee156fe753224ab2397d2c72906efeb3765dec7 |
even binge eat. while it is not known if these effects are also true for children and youth, these symptoms could have serious implications on the immature adolescent who is undergoing rapid social and psychological development. many lifestyle habits are established during the adolescent years and alterations in the e... | guidelines | |
cee156fe753224ab2397d2c72906efeb3765dec7 |
and even binge eating. finally, there is mounting concern that dieting in preadolescents and adolescents may have the paradoxical effect of resulting in excess weight gain over time. in a recent large \ - scale study involving over 15, 000 children ( nine to 14 years old ) followed over a three \ - year period, it was... | guidelines | |
cee156fe753224ab2397d2c72906efeb3765dec7 |
and comparing it with bmi percentile curves is the most reliable way to assess whether a teen is in a healthy weight range. - clinicians should be aware that many weight loss attempts in teenagers are not required or justified on the basis of improved health and may reflect other issues in the adolescent ’ s life, suc... | guidelines | |
20ea0a749f6da381ab113d995afc404ce8bfcc47 |
pulse oximetry screening is safe, noninvasive, easy to perform and proven to enhance detection of critical congenital heart disease in newborns. however, this test has yet to be adopted as routine practice in canada. the present practice point highlights essential details and recommendations for screening, which resea... | guidelines | |
20ea0a749f6da381ab113d995afc404ce8bfcc47 |
##tric surveillance program ( cpsp ) showed that 36 % of responders had been involved in a late \ - presenting cchd case, of which 52 % of the responders recalled the case requiring resuscitation. current screening with prenatal ultrasound is limited by low sensitivity. in alberta, from 2007 to 2010, only 50 % of newb... | guidelines | |
20ea0a749f6da381ab113d995afc404ce8bfcc47 |
easy to perform and widely available. in one systematic review of 229, 421 neonates, pos was shown to have a high specificity ( at 99 \. 9 % ) and a moderately high sensitivity ( at 76 \. 5 % ). studies from the usa and uk also report that pos is cost \ - neutral to cost \ - effective for detecting cchd –. abnormal, p... | guidelines |
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